Prognostic impact of the ankle–brachial index on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

Abstract

A low ABI is associated with excess risk of adverse cardiovascular outcomes, mortality and peripheral neuropathy development or worsening, and improves cardiovascular risk stratification. The ABI should therefore be routinely evaluated in individuals with type 2 diabetes.

Levels of ankle–brachial index and the risk of diabetes mellitus complications

“…As for the microvascular complications, Lee et al found a twofold risk of retinopathy in persons with altered ABI, defined as ABI values of <0.9 or ≥1.3,48 similar to the risk of neuropathy reported by Cardoso et al , and both being slightly higher than our results 15. Cardoso et al did not find a relation of low ABI with retinopathy or renal outcomes,15 whereas in our study, low ABI was significantly associated with all the microvascular outcomes.…”

“…Previous studies in patients with diabetes obtained higher estimates for mortality and cardiovascular events than our study. For all-cause mortality, HRs of 2.01–2.10 were observed in participants with low15 26 and high ABIs26; for MCEs, an HR of 2.5 was estimated 15. However, lower risk figures have also been reported in these patients (with diabetes).…”

“…Additional to the analysis of an array of ABI categories, the study population—with diabetes, no symptoms of PAD, and no previous cardiovascular disease—was another highlight in our report. Only two previous longitudinal analysis evaluated persons with asymptomatic PAD, like in our study, but they included persons at higher risk, for example, with previous coronary artery disease,15 or with cerebrovascular disease15 16; furthermore, they did not specify subcategories within low ABI nor did they examine the effect of high ABI levels. The association of ABI with mortality and with macrovascular and microvascular complications of diabetes has not been previously analyzed in persons with diabetes, asymptomatic for PAD, and in primary prevention.…”

“…Additionally, some studies have examined the risk of both high and low ABI values, but the association of the degree of arterial impairment (obstruction or pathological constriction) with complications has been hardly addressed,14 especially regarding microvascular complications. Even more, previous reports in persons with asymptomatic PAD included patients with previous cardiovascular events,15 16 but primary prevention is of particular importance in persons with diabetes, because the occurrence of a first cardiovascular event is associated with increased morbidity and mortality in these persons, compared with the population without diabetes 10. Accordingly, we sought to evaluate the association of categorized ABI with mortality, cardiovascular outcomes, and microvascular complications in patients with diabetes in primary cardiovascular prevention.…”

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis

“…There were several methods for DPN diagnosis, we classified in four groups: a) >2 clinical signs, including nine studies [48,49,54,56,58,64,71,72,75]; b) >2 clinical signs and symptoms, including 14 studies [50, 52, 53, 57, 59-61, 63, 65, 66, 68-70]; c) >2 clinical signs + nerve conduction test (NCT), including one study [55]; and d) only NCT or sudomotor disfunction test, including four studies [51,62,67,74]…”