Diabetes duration and advanced diabetes-related complications in lower-extremity versus coronary revascularization
Mitsuyoshi Takahara, Yoshimitsu Soga, Osamu IidaAbstract
Context
Diabetes-related burden, including longer diabetes duration and advanced complications, substantially influences management strategies and healthcare utilization among patients with diabetes. It remains unclear whether the diabetes-related burden is comparable between patients with lower extremity artery disease (LEAD) and those with coronary artery disease (CAD), which are commonly grouped as manifestations of cardiovascular disease.
Objective
This study aimed to compare diabetes-related burden between patients with diabetes undergoing revascularization for LEAD and those undergoing revascularization for CAD.
Methods
This cross-sectional study analyzed 5,808 patients with diabetes undergoing revascularization for LEAD or CAD, who were registered in a prospective multicenter study. Diabetes duration, glycated hemoglobin levels, and the presence of advanced diabetes-related complications were assessed at the time of index revascularization and compared cross-sectionally between the LEAD and CAD groups.
Results
The LEAD group exhibited a longer diabetes duration and a higher prevalence of advanced complications, whereas glycated hemoglobin levels at revascularization did not significantly differ between the groups. The prevalence of advanced complications remained higher in the LEAD group after adjustment for diabetes duration. The adjusted prevalence ratios of LEAD relative to CAD were 1.57 (95% confidence interval, 1.41–1.75, P < 0.001) for proliferative retinopathy, 2.39 (1.82–3.13, P < 0.001) for loss of protective sensation, and 2.12 (1.82–3.13, P <0.001) for dialysis-dependent renal failure, respectively.
Conclusions
Patients undergoing revascularization for LEAD exhibited a longer diabetes duration than those undergoing revascularization for CAD. They also had a higher prevalence of advanced diabetes-related complications, even after adjustment for diabetes duration.