Modeling of Risk Factors for Peripheral Artery Disease in Patients with Type 2 Diabetes

The aim of the study was to determine the value of clinical, metabolic and inflammatory factors in assessing the risk of peripheral artery disease (PAD) in patients with type 2 diabetes (T2D). In 194 patients with T2D, in-depth screening/monitoring of complications and assessment of metabolic parameters were performed. Low limb arteries were assessed by duplex ultrasound. Glucose variability parameters were derived from continuous glucose monitoring. Serum inflammatory mediators (IL-6, IL-8, IL-18, TNF-α, sCD40L) were measured by multi-bead assay. Results: 50 patients showed no atherosclerosis, in 63 patients an increased intima-media thickness (IMT) and/or atherosclerotic plaque(s) were revealed, 81 patients had stenosis and/or occlusion. Using ROC-analysis, the values of cut-off points were obtained for the following risk factors for IMT/plaques: age >65 years (OR=3.54, p=0.001), IL- 6 ≥54.8 ng/ml (OR=2.3, p=0.005). Risk factors for stenosis/occlusion were diabetes duration ≥ 15 years (OR=3.4, p<0.001), estimated glomerular filtration rate (eGFR) ≤67 ml/min/1.73m2 (OR=3.32, p<0.001), mean amplitude of glycemic fluctuations (MAGE) ≥3.4 mmol/L (OR=2.19, p=0.045), IL-6 ≥59.7 pg/ml (OR=2.16, p=0,04), ankle-brachial index ≤0.98 (OR=10, p<0.001). Acute cerebrovascular accident increased the risk of IMT /plaques (OR=3.9, p=0.05), stenosis/occlusions (OR=5.7, p=0.04). In the logistic regression model age (OR=1.14, p=0.00008) and MAGE (OR =1.37, p=0.01) were risk factors for IMT/plaques; the risk of stenosis/occlusion was associated with diabetes duration (OR=1.1, p=0.00009), eGFR (OR=1.12, p=0.02), HbA1c (OR=1.21, p=0.03) and male sex (OR=1.75, p=0.004). Conclusion: The identified risk factors should be taken into account in PAD prevention and screening in T2D patients.