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Toe brachial index in middle aged patients with diabetes mellitus type 2: Not just a peripheral issue
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
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2013 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 100, no 2, 195-202 p.Article in journal (Refereed) Published
Abstract [en]

Aim

To explore risk factors for peripheral arterial disease (PAD) as well as the association between toe blood pressure and subclinical and clinical central vascular disease in patients with type 2 diabetes.

Method

Toe brachial index (TBI) was cross-sectionally analyzed in 742 middle-aged (54–66 years) patients with type 2 diabetes as well as non-diabetic controls and related to other vascular measures (e.g. carotid intima media thickness (IMT), presence of carotid plaque, central arterial stiffness and left ventricular mass index) and previous cardiovascular events.

Results

A TBI ≤ 0.7 was seen in 22% of the patients but only one patient had severe TBI reduction (TBI ≤ 0.3). The corresponding figures in the controls were 13% and 0%, respectively. Mean TBI was significantly lower in patients with type 2 diabetes than in controls (0.81 ± 0.14 vs. 0.87 ± 0.15, p < 0.001). In patients with diabetes, a lower TBI was associated with increased central arterial stiffness (p < 0.001), IMT (p < 0.001) and carotid plaque (p < 0.001) as well as with decreasing glomerular filtration rate (p < 0.001). Lower TBI was found in patients with previous macrovascular ischemic events. Furthermore, TBI was negatively correlated with age (p < 0.001), diabetes duration (p < 0.001) and HbA1c (p = 0.01).

Conclusion

PAD, assessed with TBI, is common in a Swedish middle-aged diabetes type 2 cohort, affecting about one-fifth. As ankle pressure may be confounded by falsely high values in patients with diabetes due to media calcification we conclude that information about TBI may improve the risk evaluation regarding arteriosclerotic disease in both small and large vessels in type 2 diabetes.

Place, publisher, year, edition, pages
Elsevier , 2013. Vol. 100, no 2, 195-202 p.
Keyword [en]
Diabetes mellitus, Toe pressure, Toe brachial index, Cardiovascular
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-95976DOI: 10.1016/j.diabres.2013.03.004ISI: 000320590900015OAI: oai:DiVA.org:liu-95976DiVA: diva2:641635
Note

Funding Agencies|Medical Research Council of Southeast Sweden||King Gustav V and Queen Victorias foundation||Center for Medical Image Science and Visualization (CMIV)||Linkoping University||County Council of Ostergotland||GE Healthcare||Swedish Heart-Lung Foundation||Swedish Research Council|12661|Diabetes Research Center||

Available from: 2013-08-19 Created: 2013-08-12 Last updated: 2017-12-06

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Spångeus, AnnaWijkman, MagnusLindström, TorbjörnEngvall, JanÖstgren, Carl JohanNyström, Fredrik H.Länne, Toste

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Spångeus, AnnaWijkman, MagnusLindström, TorbjörnEngvall, JanÖstgren, Carl JohanNyström, Fredrik H.Länne, Toste
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Internal MedicineFaculty of Health SciencesDepartment of EndocrinologyDivision of Cardiovascular MedicineDepartment of Clinical Physiology in LinköpingDivision of Community MedicinePrimary Health Care in FinspångDepartment of Thoracic and Vascular Surgery
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