Factores de riesgo de complicaciones vasculares en extremidades inferiores en los pacientes con diabetes / Risk factors of vascular complications in lower limbs in diabetic patients

Fundamento y Objetivo: Evaluar en el paciente con diabetes los factores de riesgo que se asocian a la aparición de complicaciones vasculares en extremidades inferiores. Pacientes y método: Estudio longitudinal retrospectivo en el que se evalúan 270 pacientes con diabetes seguidos en el Hospital la Paz desde 2000 hasta 2008. Medimos el índice tobillo-brazo (ITB), índice dedo-brazo (IDB) y presión arterial (PA) del primer dedo. Definimos evento vascular en extremidades inferiores. Comparamos distintas variables clínicas y epidemiológicas entre los pacientes con y sin evento vascular. Con un modelo de regresión de Cox se valora qué variables presentan asociación independiente con la aparición de evento. Resultados: Los valores medios de ITB, IDB y PA del primer dedo son significativamente menores en los pacientes con evento (ITB medio [DE] de 0,92 [0,30] frente a 0,78 [0,46], p=0,007; IDB medio de 0,86 [4,40] frente a 0,42 [0,22], p=0,001; PA media de 72,08 [30,62] frente a 56,25 [29,51], p=0,014). Resulta significativa la asociación de evento vascular con alteraciones biomecánicas (p=0,022), úlceras activas (p=0,000), antiguas (p=0,000) e insensibilidad (p=0,023). En la regresión de Cox demostraron tener valor independiente el IDB (hazard ratio [HR] 0,05; intervalo de confianza del 95% [IC 95%] 0,00-0,52; p=0,013), alteraciones biomecánicas (HR 4,92; IC 95% 1,13-18,75; p=0,019), úlceras activas (HR 3,26; IC 95% 1,37-7,79; p=0,008) y previas (HR 5,55; IC 95%1,85-16,59; p=0,002). Conclusión: Los factores que nos sirven para predecir de forma independiente la aparición de eventos vasculares en extremidades inferiores en el futuro son el IDB, la existencia de alteraciones biomecánicas en los pies y el haber presentado úlceras. Son independientes de la edad, tipo de diabetes o existencia de otras complicaciones micro o macrovasculares de la misma (AU)

Background and Objetive: To evaluate the risk factors of complications in lower limbs in diabetic patients. Patients and methods: We evaluated 270 patients with diabetes followed in Hospital la Paz from 2000 to 2008.We measured the ankle-brachial index (ABI), toe-brachial index (TBII), and toe blood pressure (BP). We defined vascular complications in lower limbs. We compared some epidemiological and clinical variables between patients with and without a vascular event. We analyzed which variables have an independent association with the later appearance of a vascular event with Cox regression model. Results: The mean value of ITB, IDB and toe blood pressure were significantly lower in patients who had a vascular event compared to those who had not presented it (ITB mean 0.92±0.30 vs 0.78±0.46, P=.007; IDB mean 0.86±4.40 vs 0.42±0.22, P=.001; PA mean 72.08±30.62 vs 56.25±29.51, P=.014).The association of vascular event and biomechanical abnormalities (P=.022), active and old ulcers (P=.000), and insensivity (P=.023) were significantly. In the Cox regression model the toe brachial index (HR 0.05; IC:0.00-0.52; P=.013), the active (HR 3.26; IC:1.37-7.79; P=.008) and old ulcers (HR 5.55; IC:1.85-16.59; P=.002). and the biomechanical abnormalities (HR 4.92; IC:1.13-18.75; P=.019) had an independent value.Conclusions: Toe brachial index, biomechanical abnormalities and ulcers have an independent value to predict the later appearance of vascular events. In addition, they are independent of the age, type of diabetes and others diabetic complications (AU)

[Risk factors of vascular complications in lower limbs in diabetic patients]. / Factores de riesgo de complicaciones vasculares en extremidades inferiores en los pacientes con diabetes.

BACKGROUND AND OBJECTIVE: To evaluate the risk factors of complications in lower limbs in diabetic patients. PATIENTS AND METHODS: We evaluated 270 patients with diabetes followed in Hospital la Paz from 2000 to 2008.We measured the ankle-brachial index (ABI), toe-brachial index (TBII), and toe blood pressure (BP). We defined vascular complications in lower limbs. We compared some epidemiological and clinical variables between patients with and without a vascular event. We analyzed which variables have an independent association with the later appearance of a vascular event with Cox regression model. RESULTS: The mean value of ITB, IDB and toe blood pressure were significantly lower in patients who had a vascular event compared to those who had not presented it (ITB mean 0.92±0.30 vs 0.78±0.46, P=.007; IDB mean 0.86±4.40 vs 0.42±0.22, P=.001; PA mean 72.08±30.62 vs 56.25±29.51, P=.014).The association of vascular event and biomechanical abnormalities (P=.022), active and old ulcers (P=.000), and insensivity (P=.023) were significantly. In the Cox regression model the toe brachial index (HR 0.05; IC:0.00-0.52; P=.013), the active (HR 3.26; IC:1.37-7.79; P=.008) and old ulcers (HR 5.55; IC:1.85-16.59; P=.002). and the biomechanical abnormalities (HR 4.92; IC:1.13-18.75; P=.019) had an independent value. CONCLUSIONS: Toe brachial index, biomechanical abnormalities and ulcers have an independent value to predict the later appearance of vascular events. In addition, they are independent of the age, type of diabetes and others diabetic complications.

[Peripheral arterial disease in diabetic patients: utility of the toe-brachial index]. / Arteriopatía periférica en el paciente diabético: utilidad del índice dedo-brazo.

BACKGROUND AND OBJECTIVE: To evaluate the influence of peripheral neuropathy, autonomic neuropathy and arterial wall calcification on the concordance of ankle-brachial index (ABI) and toe-brachial index (TBI) in diabetic patients. PATIENTS AND METHOD: We evaluated in 221 diabetic patients (73.8% type 2; 66.6% male) the presence of: peripheral arterial disease, peripheral neuropathy, autonomic neuropathy and arterial wall calcification. RESULTS: The mean (standard deviation) difference between ABI and TBI in our population was 0.33 (0.25). Patients with arterial wall calcification had a higher mean difference between ABI and TBI than patients without arterial wall calcification -0.87 (0.39) vs 0.30 (0.21) (p < 0.005)-. Mean difference between ABI and TBI was similar for patients with and without autonomic neuropathy -0.36 (0.26) vs 0.30 (0.24) (p = 0.057)- and for patients with and without peripheral neuropathy -0.34 (0.28) vs 0.31 (0.21) (p = 0.423)-. Among all patients there was a significant linear association (r = 0.506; p < 0.001) between ABI and TBI. For patients with arterial wall calcification there was no correlation between both indices (r = -0.070; p = 0,857). CONCLUSIONS: Our findings indicate that in diabetic patients, TBI is the method of choice to evaluate lower limb perfusion in the presence of overt arterial wall calcification.

Arteriopatía periférica en el paciente diabético: utilidad del índice dedo-brazo / Peripheral arterial disease in diabetic patients: utility of the toe-brachial index

Fundamento y objetivo: Evaluar la influencia de la neuropatía periférica, neuropatía autonómica y calcificaciones arteriales en la concordancia del índice tobillo-brazo (ITB) e índice dedo-brazo (IDB) en pacientes con diabetes. Pacientes y método: Evaluamos en 221 pacientes diabéticos (el 73,8% con diabetes mellitus tipo 2 y un 66,6% varones) la existencia de arteriopatía periférica, neuropatía periférica, neuropatía autonómica y calcificaciones arteriales. Resultados: La diferencia media (desviación estándar) entre el ITB y el IDB en nuestra población fue de 0,33 (0,25). Esta diferencia fue significativamente mayor en los pacientes con calcificaciones arteriales, con una media de 0,87 (0,39), frente a 0,30 (0,21) (p < 0,005). Sin embargo, fue similar en los pacientes con y sin neuropatía autonómica ­0,36 (0,26) frente a 0,30 (0,24) (p = 0,057)­ y en los pacientes con y sin neuropatía periférica ­0,34 (0,28) frente a 0,31 (0,21) (p = 0,423)­. En la población estudiada se obtuvo una relación lineal significativa (r = 0,506; p < 0,001) entre el ITB y el IDB, que desapareció en presencia de calcificaciones arteriales (r = ­0,070; p = 0,857). Conclusiones: Los resultados indican que en los pacientes diabéticos el IDB es el método de elección para evaluar la existencia de arteriopatía periférica en presencia de calcificaciones arteriales

Background and objective: To evaluate the influence of peripheral neuropathy, autonomic neuropathy and arterial wall calcification on the concordance of ankle-brachial index (ABI) and toe-brachial index (TBI) in diabetic patients. Patients and method: We evaluated in 221 diabetic patients (73.8% type 2; 66.6% male) the presence of: peripheral arterial disease, peripheral neuropathy, autonomic neuropathy and arterial wall calcification. Results: The mean (standard deviation) difference between ABI and TBI in our population was 0.33 (0.25). Patients with arterial wall calcification had a higher mean difference between ABI and TBI than patients without arterial wall calcification ­0.87 (0.39) vs 0.30 (0.21) (p < 0.005)­. Mean difference between ABI and TBI was similar for patients with and without autonomic neuropathy ­0.36 (0.26) vs 0.30 (0.24) (p = 0.057)­ and for patients with and without peripheral neuropathy ­0.34 (0.28) vs 0.31 (0.21) (p = 0.423)­. Among all patients there was a significant linear association (r = 0.506; p < 0.001) between ABI and TBI. For patients with arterial wall calcification there was no correlation between both indices (r = ­0.070; p = 0,857). Conclusions: Our findings indicate that in diabetic patients, TBI is the method of choice to evaluate lower limb perfusion in the presence of overt arterial wall calcification