High prevalence of lower extremity peripheral artery disease in type 2 diabetes patients with proliferative diabetic retinopathy

Yi-Wen Chen; Ying-Ying Wang; Dong Zhao; Cai-Guo Yu; Zhong Xin; Xi Cao; Jing Shi; Guang-Ran Yang; Ming-Xia Yuan; Jin-Kui Yang

doi:10.1371/journal.pone.0122022

High prevalence of lower extremity peripheral artery disease in type 2 diabetes patients with proliferative diabetic retinopathy

PLoS One. 2015 Mar 30;10(3):e0122022. doi: 10.1371/journal.pone.0122022. eCollection 2015.

Authors

Yi-Wen Chen¹, Ying-Ying Wang², Dong Zhao³, Cai-Guo Yu⁴, Zhong Xin², Xi Cao², Jing Shi², Guang-Ran Yang², Ming-Xia Yuan², Jin-Kui Yang²

Affiliations

¹ Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
² Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Diabetes Research and Care, Beijing, China.
³ Department of Endocrinology, Beijing Tongzhou District Luhe Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Diabetes Research and Care, Beijing, China.
⁴ Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Endocrinology, Beijing Tongzhou District Luhe Hospital, Capital Medical University, Beijing, China.

Abstract

Little is known about the relationship between lower extremity peripheral arterial disease (PAD) and proliferative diabetic retinopathy (PDR) in type 2 diabetes (T2D). Here, we explored the relationship between sight-threatening PDR and PAD. We screened for diabetic retinopathy (DR) and PAD in hospitalized patients with T2D. Patients with a diabetic duration of more than 10 years, HbA1c ≥7.5%, eGFR ≥60 mL/min/1.73 m2 and with PDR or with no diabetic retinopathy (NDR) were eligible for this cross-sectional study. Severities of DR were graded by digital retinal photographs according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. We assessed PAD by measuring Ankle Brachial Index (ABI), Toe Brachial Index (TBI) and Doppler ultrasound. Statistical analyses were performed using SPSS 17.0 software. Of the 1544 patients, 169 patients with extreme eye (57 PDR and 112 NDR) phenotypes met the inclusion criteria. Patients with PDR had a significantly higher proportion of low ABI (≤0.99) and high ABI (≥1.3) than patients with NDR (28.1% and 15.8% vs. 14.3% and 6.2% respectively, P<0.05). PDR patients also had lower TBI than NDR patients (0.56±0.09 vs. 0.61±0.08, P<0.01). The proportion of patients with abnormal duplex ultrasound was higher in PDR than in NDR (21.1% vs. 9.8%, P<0.001). This showed that PDR associated with PAD could be defined in multiple ways: abnormal ABI (≤0.9) (OR = 3.61, 95% CI: 1.15-11.26), abnormal TBI (OR = 2.84, 95% CI: 1.19-6.64), abnormal duplex (OR = 3.28, 95% CI: 1.00-10.71), and critical limb ischemia (OR = 5.52, 95% CI: 2.14-14.26). Moreover, PDR was a stronger independent correlation factor for PAD than a diabetic duration of 10 years. In conclusion, PAD is more common in PDR than in NDR. It implies that PDR and PAD are mostly concomitant in T2D. We should focus on screening PAD in patients with PDR in clinical practice.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Ankle Brachial Index
Cross-Sectional Studies
Diabetes Mellitus, Type 2 / complications*
Diabetic Retinopathy / diagnosis*
Female
Humans
Lower Extremity / blood supply*
Male
Middle Aged
Peripheral Arterial Disease / diagnosis
Peripheral Arterial Disease / epidemiology*
Prevalence
Ultrasonography, Doppler

Grants and funding

This work was supported by the National Natural Science Foundation of China (81070644) and the Beijing Municipal Science and Technology Project (D12110000412001) to YJK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.