ABSTRACT
AIM: The aim of this study was to analyse risk factors and complications associated with low ankle-brachial index (ABI) in a type 2 diabetic population with proliferative retinopathy. METHODS: This study included 181 subjects. ABI was measured with a Doppler device. Subjects with ABI <0.9 were diagnosed with peripheral vascular disease (PVD). The exclusion criterion was medial arterial calcification. RESULTS: The mean (± SD) age and diabetes (DM) duration were 65±9.7 years and 18.6±9.1 years, respectively. ABI <0.9 was associated with increasing age (P<0.001), DM duration (P=0.02), higher total (P=0.02) and LDL cholesterol (P=0.035), higher ESR (P=0.04), uric acid (P=0.004) vibration perception thresholds (VPT), and lower eGFR (P<0.001). BMI (P<0.001), waist index (P=0.01), FPG (P=0.013), HbA1c (P=0.005) and ALT (P<0.001) were significantly lower in patients with PVD. Multivariate analysis revealed age (P=0.04), high total cholesterol (P=0.038), low BMI (P=0.017), low VPT (P=0 031) and declining eGFR (p=0.006) to be independent predictors of PVD. CONCLUSION: Increasing age, total cholesterol levels, and VPT, together with declining renal function and lower BMI are independent predictors of PVD in a type 2 diabetic population with advanced microvascular disease. Knowledge of risk factors will help target preventive measures and treatment to subjects most susceptible to PVD.
Subject(s)
Ankle Brachial Index , Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy/etiology , Peripheral Vascular Diseases/etiology , Age Factors , Aged , Biomarkers/blood , Chi-Square Distribution , Cholesterol/blood , Cross-Sectional Studies , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/physiopathology , Diabetic Retinopathy/blood , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/physiopathology , Female , Humans , Male , Malta , Middle Aged , Multivariate Analysis , Peripheral Vascular Diseases/blood , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/physiopathology , Predictive Value of Tests , Risk Assessment , Risk Factors , Sensory Thresholds , VibrationABSTRACT
AIM: The aim of this paper was to analyze the relation between glomerular filtration rate (GFR) and albumin excretion rate (AER) in subjects with type 2 diabetes. METHODS: Three hundred thirteen type 2 diabetic patients attending Diabetes Centre, Malta, were studied between 2008 and 2009. GFR was estimated using the Modified Diet Renal Disease (MDRD) formula while two spot measurements of urinary AER were used to determine albuminuria. RESULTS: Forty-nine patients were hyperfiltrating, of whom 69% were normoalbuminuric, 24% microalbuminuric, and 6% macroalbuminuric; 229 subjects had normal eGFR; of these 67% were normoalbuminuric, 27% microalbuminuric and 6% macroalbuminuric; 35 subjects had eGFR<60mL/min/1.73 m2, of whom 43% were normoalbuminuric, 37% microalbuminuric and 20% macroalbuminuric. No association was found between eGFR and AER in subjects with hyperfiltration (P=0.39); however eGFR was strongly correlated with AER in subjects with eGFR <60ml/min/1.73 m2 (r= -0.376; P=0.026). In multinomial logistic regression analysis, eGFR was significantly associated with albuminuria in non-hyperfiltrating, but not in hyperfiltrating, subjects. CONCLUSION: Our data suggests that hyperfiltration and albuminuria occur independently of each other in the early stages of DN, but the decline in eGFR and albuminuria follow a parallel course in later stages of DN suggesting that they may share common pathophysiological mechanisms or they may be causally linked.
