Relationship between clinical course and measures of atherosclerosis in diabetic foot / 대한내과학회지

ABSTRACT

BACKGROUND: Although various factors may influence the outcome of diabetic foot ulcers in diabetic subjects, the severity of peripheral vascular disease (PVD) is the main independent risk factor for amputation. The carotid intima-medial thickness (IMT), ankle brachial pressure index (ABPI) and pulse wave velocity (PWV) have been used as noninvasive markers of PVD. The present study aims to examine the association of carotid IMT, ABPI and PWV with the risk of lower extremity amputation in diabetic foot patients. METHODS: Total 114 diabetic patients (39 diabetic foot patients and 75 patients who didn't have diabetic foot) were participated for the study. Twenty four of diabetic foot patients underwent lower extremity amputation. Informations about past history, social habit and courses of diabetic foot were collected from the patients by means of a structured interview. We measured carotid IMT, ABPI and PWV. RESULTS: The following characteristics were significantly related to the development of diabetic foot ulcers male, smoker, alcohol drinker, longer diabetes duration, presence of diabetic chronic complications, lower ABPI (0.8 mm), increased PWV. Patients with amputation had lower HDL cholesterol, higher incidence of osteomyelitis and older age, compared with patients without amputation. We observed a significant association between mean carotid IMT and the rate of amputation in diabetic foot patients [odd ratio, 11.42 (95% confidence interval, 1.03~127.19)]. CONCLUSIONS: This study suggests that measurement of carotid IMT as noninvasive index of atherosclerosis may be a useful indirect method in identifying diabetic foot patients who may have lower extremity amputation.