第二型糖尿病患之周邊動脈疾病之研究

Abstract

Aim: The main purpose of this study is to explore the natural history of peripheral arterialdisease (PAD) in type 2 diabetes, including prevalence, incidence, mortality, risk factors and potential regression. Study design and methods: A clinic for screening diabetic complications has been set up since July 1996. Till Dec 2002, 3,632 type 2 diabetic patients were referred for a baseline screening. Among them, there were 1,577 subjects were followed with a baseline ABI>0.9 and were analyzed for incidence of PAD. Among the patients for incidence study, there were 344 cases over 60 years old with adiponectin data. The effect of adiponectin level on PAD incidence was further analyzed. Age, sex, duration of diabetes, hemoglobin A1c, systolic/diastolic blood pressure, triglyceride, total cholesterol, smoking, exercise, body mass index, college education were also obtained and analyzed with Students t-test, Chi-square (or Fisher’s exact test), and correlations. Logistic regression, Cox regression.and Monte Carlo Markov Chain method were used for the analyses of the risk factors of prevalence and incidence, and progression and/or regression for the natural history of PAD among type 2 diabetes. P below 0.05 was considered statistic significance. Results: The prevalence of PAD was 5.95 % in a group of type 2 diabetes with a mean duration of 9.02 ± 8.00 years. The incidence was estimated at 1.14 % per year during 4.24 ± 2.08 years of follow-up. ABI > 1.4 or ABI < 0.9 were ndependent risk factors for all-cause and cardiovascular mortality in subjects with type 2 diabetes. Old age, smoking, poor glycemic or blood pressure control, dyslipidemia were significant risk factors for PAD prevalence, incidence, and mortality (for ABI between 0.9 and 1.4). Hypoadiponectinemia (<3.75 μg/ml) was associated with new PAD onset for those aged over 60. Incident cases, mild PAD (ABI 0.7~0.9 vs. < 0.7), and better blood pressure control, higher education level, and higher BMI were salutary factors for regression of PAD. Conclusion: Ankle-brachial index (ABI) is still a good, if not the best, screening tool for peripheral arterial disease in type 2 diabetic patients. Abnormal ABI, either below 0.9 or above 1.4, is associated with a significantly higher all-cause or cardiovascular mortality in patients with type 2 diabetes. Age is the strongest factor for abnormal ABI and mortality. Among the modifiable risk factors, glycemic, lipid and blood pressure control are important to prevent new PAD. Moreover, once a low ABI is detected, aggressive treatment should be instituted because one third or more patients might have a chance to return normal ABI before they progress to a severer degree of PAD with ABI<0.7.