Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions

Hap, Katarzyna; Biernat, Karolina; Konieczny, Grzegorz

doi:10.1155/2021/5122494

Cited by 13 publications

(8 citation statements)

References 97 publications

(145 reference statements)

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“…DPN and PAD are closely related among these complications, and DPN may usually precede PAD. However, arterial stenosis aggravates DPN ( 30 ). Thus, the relationship appears bidirectional.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict the risk of peripheral artery disease in patients with type 2 diabetes mellitus

Liang

Song²,

Sun³

et al. 2022

Front. Endocrinol.

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ObjectiveTo develop and validate a nomogram for predicting the risk of peripheral artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM) and assess its clinical application value.MethodsClinical data were retrospectively collected from 474 patients with T2DM at the Air Force Medical Center between January 2019 and April 2022. The patients were divided into training and validation sets using the random number table method in a ratio of 7:3. Multivariate logistic regression analysis was performed to identify the independent risk factors for PAD in patients with T2DM. A nomogram prediction model was developed based on the independent risk factors. The predictive efficacy of the prediction model was evaluated using the consistency index (C-index), area under the curve (AUC), receiver operating characteristic (ROC) curve, Hosmer-Lemeshow (HL) test, and calibration curve analysis. Additionally, decision curve analysis (DCA) was performed to evaluate the prediction model’s performance during clinical application.ResultsAge, disease duration, blood urea nitrogen (BUN), and hemoglobin (P<0.05) were observed as independent risk factors for PAD in patients with T2DM. The C-index and the AUC were 0.765 (95% CI: 0.711-0.819) and 0.716 (95% CI: 0.619-0.813) for the training and validation sets, respectively, indicating that the model had good discriminatory power. The calibration curves showed good agreement between the predicted and actual probabilities for both the training and validation sets. In addition, the P-values of the HL test for the training and validation sets were 0.205 and 0.414, respectively, indicating that the model was well-calibrated. Finally, the DCA curve indicated that the model had good clinical utility.ConclusionA simple nomogram based on three independent factors–duration of diabetes, BUN, and hemoglobin levels–may help clinicians predict the risk of developing PAD in patients with T2DM.

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“…DPN and PAD are closely related among these complications, and DPN may usually precede PAD. However, arterial stenosis aggravates DPN ( 30 ). Thus, the relationship appears bidirectional.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict the risk of peripheral artery disease in patients with type 2 diabetes mellitus

Liang

Song²,

Sun³

et al. 2022

Front. Endocrinol.

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“…Likewise, the model could be extended by simulation of different types of intervention therapy, next to the considered PTA, PTA/S, and bypass. In addition to the chosen and commonly used treatments evaluated in this work, other methods could be used in various stages of the disease, to maintain the functional status of the limb, such as pulsatile pneumatic compression therapy, the systemic hyperbaric oxygen therapy, lower limb offloading, or other physiotherapy interventions [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Discrete Event Simulation Model for Cost-Effectiveness Evaluation of Screening for Asymptomatic Patients with Lower Extremity Arterial Disease

Kamenský

Rogalewicz

Gajdoš

et al. 2022

IJERPH

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Lower limb ischemic disease (LEAD) affects a significant portion of the population, with most patients being asymptomatic. Patient screening is necessary because LEAD patients have an increased risk of occurrence of other cardiovascular events and manifestations of disease, in terms of leg symptoms such as intermittent claudication, critical limb ischemia, or amputation. The aim of this work was to evaluate the cost-effectiveness of screening using ABI diagnostics in asymptomatic patients and its impact on limb symptoms associated with LEAD. A discrete event simulation model was created to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as QALYs. A cost-effectiveness analysis was performed to compare ABI screening examination and the situation without such screening. A probabilistic sensitivity analysis and scenario analysis were carried out to evaluate the robustness of the results. In the basic setting, the screening intervention was a more expensive intervention, at a cost of CZK 174,010, compared to CZK 70,177 for the strategy without screening. The benefits of screening were estimated at 14.73 QALYs, with 14.46 QALYs without screening. The final ICER value of CZK 389,738 per QALY is below the willingness to pay threshold. Likewise, the results of the probabilistic sensitivity analysis and of the scenario analysis were below the threshold of willingness to pay, thus confirming the robustness of the results. In conclusion, ABI screening appears to be a cost-effective strategy for asymptomatic patients aged 50 years when compared to the no-screening option.

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“…Preventive measures on all levels of healthcare are essential to reduce the number of T2D-caused amputations. 62 63 Rather than solely managing amputations as the last consequence, rehabilitation professionals should get increasingly involved in provision of comprehensive care.…”

Section: Discussionmentioning

confidence: 99%

Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries

et al. 2021

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ObjectivesLimb amputation incidence is particularly high in fragile contexts due to conflict, accidents and poorly managed diabetes. The study aim was to analyse (1) demographic and amputation characteristics of persons with any type of acquired amputation (PwA) and (2) time between amputation and first access to rehabilitation in five conflict and postconflict countries.DesignA retrospective, observational study analysing differences in demographic and clinical factors and time to access rehabilitation between users with traumatic and non-traumatic amputations.SettingFive countries with the highest numbers of PwA in the global International Committee of the Red Cross database (Afghanistan, Cambodia, Iraq, Myanmar, Sudan). Cleaned and merged data from 2009 to 2018 were aggregated by sex; age at amputation and registration; cause, combination and anatomical level of amputation(s); living environment.ParticipantsAll PwA newly attending rehabilitation.ResultsData for 28 446 individuals were included (4329 (15.2%) female). Most were traumatic amputations (73.4%, 208 90); of these, 48.6% (138 01) were conflict related. Average age at traumatic amputation for men and women was 26.9 and 24.1 years, respectively; for non-traumatic amputation it was 49.1 years and 45.9 years, respectively. Sex differences in age were statistically significant for traumatic and non-traumatic causes (p<0.001, p=0.003). Delay between amputation and rehabilitation was on average 8.2 years for those with traumatic amputation, significantly higher than an average 3 years for those with non-traumatic amputation (p<0.001).ConclusionsYoung age for traumatic and non-traumatic amputations indicates the devastating impact of war and fragile health systems on a society. Long delays between amputation and rehabilitation reveal the mismatch of needs and resources. For rehabilitation service providers in fragile settings, it is an enormous task to manage the diversity of PwA of various causes, age, sex and additional conditions. Improved collaboration between primary healthcare, surgical and rehabilitation services, a prioritisation of rehabilitation and increased resource provision are recommended to ensure adequate access to comprehensive rehabilitation care for PwA.

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Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions

Cited by 13 publications

References 97 publications

Development and validation of a nomogram to predict the risk of peripheral artery disease in patients with type 2 diabetes mellitus

Development and validation of a nomogram to predict the risk of peripheral artery disease in patients with type 2 diabetes mellitus

Discrete Event Simulation Model for Cost-Effectiveness Evaluation of Screening for Asymptomatic Patients with Lower Extremity Arterial Disease

Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries

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