Peripheral arterial disease in diabetic and nondiabetic patients - A comparison of severity and outcome

OBJECTIVE - The ann of this study was to quantify the distribution of perip heral arterial disease in the diabetic and nondiabetic population attending for angiography and to compare severity and outcome between both groups of patients. RESEARCH DESIGN AND METHODS - Randomly selected lower-extremity angiograms were examined according to the Bollinger system. Patient demographics and m edical history were recorded and case notes were examined to determine whic h patients later underwent a revascularization procedure or amputation and which patients had died. RESULTS - A total of 136 arteriograms obtained between 1992 and 1996 were a nalyzed. The age (mean SD) of the patients was 64.7 +/- 10.8 years. Diabeti c patients (43%) and nondiabetic patients were of similar age (63.9 +/- 10. 4 vs. 65.3 +/- 11.1 years, P = 0.43), with a similar history of smoking (81 .0 vs. 76.9%, P = 0.26), ischemic heart disease (41.4 vs. 37.2%, P = 0.54), and hypercholesterolemia (24.4 vs. 30.8%, P = 0.48). However, there were a greater proportion of hypertensive patients in the diabetic group (63.8 vs . 39.7%, P = 0.006). Diabetic patients had greater severity of arterial dis ease in the profunda femoris and all arterial segments below the knee (P = 0.02). A greater number of amputations occurred in the diabetic group: diab etic patients were five times more likely to have an amputation (41.4 vs. 1 1.5%, odds ratio [OR] 5.4, P < 0.0001). Mortality was higher in the diabeti c group (51.7 vs. 25.6%, (DR 3.1, P = 0.002), and diabetic patients who die d were younger at presentation than. nondiabetic patients (64.7 +/- 11.4 vs . 71.1 +/- 8.7 years, P = 0.04). CONCLUSIONS - In patients with peripheral arterial disease, diabetic patien ts have worse arterial disease and a poorer outcome than nondiabetic patien ts.