Diabetes mellitus and intermittent claudication: a cross-sectional study of 920 claudicants

Francisco S Lozano, José R González-Porras, José R March, José M Lobos, Eduardo Carrasco, Eduardo Ros, Francisco S Lozano, José R González-Porras, José R March, José M Lobos, Eduardo Carrasco, Eduardo Ros

Abstract

Introduction: Diabetes mellitus (DM) and intermittent claudication (IC) are frequently associated health conditions. Our hypothesis is that the nature, severity and quality of life (QoL) of patients with IC and DM are worse than those of claudicant patients without diabetes.

Material and methods: An observational, cross-sectional and multicentre study of 920 patients with IC, divided into two groups: diabetic (n = 477) and non-diabetic (n = 443). For each group, we examined clinical and biological characteristics (including levels of glucose and lipids), the ankle-brachial index (ABI), responses to the Walking Impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire.

Results: Compared with claudicant patients without diabetes, claudicants with diabetes were older (p < 0.001), more likely to be female (p = 0.006), with a higher BMI (p < 0.001), more likely to have a sedentary lifestyle (p < 0.001) and to be a non-smoker (p < 0.001). Claudicant patients with diabetes also had significantly more cardiovascular risk factors (p < 0.001), more frequent ischaemic cardiopathy (p = 0.023) and chronic renal failure (p = 0.002), and fewer prior ictus events (p = 0.003). No significant differences between groups were found with respect to blood pressure, levels of cholesterol or triglycerides. The mean ABI of diabetic-IC patients was slightly lower than IC patients without diabetes (p = 0.016). All WIQ subdomains scores were significantly lower (p < 0.001), indicating poorer walking ability, in claudicant and diabetic patients with compared with those without diabetes. The mean E5-QD global scores and the mean EQ-5D visual analogue scale in the whole series were 0.58 (SD = 0.21) and 55.04 (SD = 21.30), respectively. Both E5-QD scores were significantly lower, indicating poorer QoL, in claudicant patients with diabetes than claudicant patients without diabetes (p < 0.001).

Conclusion: Patients with IC and DM had more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and QoL than claudicant patients without diabetes.

Figures

Figure 1
Figure 1
Study design. CQ = Clinical Questionnaire; ABI = Ankle-Brachial Index; WIQ = Walking Impairment Questionnaire; EQ-5D = European Quality of Life-5 Dimensions; DM = Diabetes Mellitus.
Figure 2
Figure 2
QoL measured by EQ-5D in several chronic diseases. DM = Diabetes Mellitus (Janssen et al. 2001); COPD = Chronic Obstructive Pulmonary Disease (Rutten-van Mölken et al. 2006); CHF = Chronic Heart Failure (de Rivas et al. 2008); IC = Intermittent Claudication (present study).

References

    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II working group. Inter-society consensus for the management of peripheral arterial disease (TASC II) J Vasc Surg. 2007;45(Suppl S):S5–S67.
    1. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working. Group. TransAtlantic Inter-Society Consensus (TASC) J Vasc Surg. 2000;31:S1–S296.
    1. Blanes J, Cairols MA, Marrugat J. Prevalence of peripheral artery disease and its associated risk in Spain: the ESTIME study. Int Angiol. 2009;28:20–25.
    1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053. doi: 10.2337/diacare.27.5.1047.
    1. Jude EB, Eleftheriadou I, Tentolouris N. Peripheral arterial disease in diabetes–a review. Diabet Med. 2010;27:4–14. doi: 10.1111/j.1464-5491.2009.02866.x.
    1. Murabito JM, Evans JC, D'Agostino RB Sr, Wilson PW, Kannel WB. Temporal trends in the incidence of intermittent claudication from 1950 to 1999. Am J Epidemiol. 2005;162:430–437. doi: 10.1093/aje/kwi217.
    1. Dolan NC, Liu K, Criqui MH, Greenland P, Guralnik JM, Chan C. et al.Peripheral artery disease, diabetes, and reduced lower extremity functioning. Diabetes Care. 2002;25:113–120. doi: 10.2337/diacare.25.1.113.
    1. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C. et al.American heart association council on peripheral vascular disease; council on epidemiology and prevention; council on clinical cardiology; council on cardiovascular nursing; council on cardiovascular radiology and intervention, and council on cardiovascular surgery and anesthesia. Measurement and interpretation of the ankle-brachial index: a scientific statement from American heart association. Circulation. 2012;126:2890–2909. doi: 10.1161/CIR.0b013e318276fbcb.
    1. Regensteiner JG, Steiner JF, Panzer RJ, Hiatt WR. Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. J Vasc Med Biol. 1990;2:142–152.
    1. Collins TC, Suarez-Almazor M, Petersen NJ, O'Malley KJ. A Spanish translation of the walking impairment questionnaire was validated for patients with peripheral arterial disease. J Clin Epidemiol. 2004;57:1305–1315. doi: 10.1016/j.jclinepi.2004.03.005.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Bosch JL, Hunik MG. Comparison of the Health Utilities Index Marck 3 (HU13) and EuroQol EQ-5D in patients treated for intermittent claudication. Qual Life Res. 2000;9:591–601. doi: 10.1023/A:1008929129537.
    1. Badia X, Roset M, Montserrat S, Herdman M, Segura A. The Spanish version of EuroQol: a description and its applications. European quality of life scale. Med Clin. 1999;112(Suppl 1):79–85.
    1. Setacci C, de Donato G, Setacci F, Chisci E. Diabetic patients: epidemiology and global impact. J Cardiovasc Surg. 2009;50:263–273.
    1. Jensen SA, Vatten LJ, Myhre HO. The association between diabetes mellitus and the prevalence of intermittent claudication: the HUNT study. Vasc Med. 2008;13:239–244.
    1. Faglia E. Characteristics of peripheral arterial disease and its relevance to the diabetic population. Int J Low Extrem Wounds. 2011;10:152–166. doi: 10.1177/1534734611417352.
    1. Gregg EW, Beckles GL, Williamson DF, Leveille SG, Langlois JA, Engelgau MM. et al.Diabetes and physical disability among older U.S. adults. Diabetes Care. 2000;23:1272–1277. doi: 10.2337/diacare.23.9.1272.
    1. Breek JC, Hamming JF, De Vries J, Van Berge Henegouwen DP, Van Heck GL. The impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life in patients with intermittent claudication. J Vasc Surg. 2002;36:94–99. doi: 10.1067/mva.2002.124369.
    1. Oka RK, Sanders MG. The impact of type 2 diabetes and peripheral arterial disease on quality of life. J Vasc Nurs. 2005;23:61–66. doi: 10.1016/j.jvn.2005.03.032.
    1. Mahé G, Ouedraogo N, Leftheriotis G, Vielle B, Picquet J, Abraham P. Exercise treadmill testing in patients with claudication, with and without diabetes. Diabet Med. 2011;28:356–362.
    1. Müller-Bühl U, Engeser P, Klimm HD, Wiesemann A. Quality of life and objective disease criteria in patients with intermittent claudication in general practice. Fam Pract. 2003;20:36–40. doi: 10.1093/fampra/20.1.36.
    1. Izquierdo-Porrera AM, Gardner AW, Bradham DD, Montgomery PS, Sorkin JD, Powell CC. et al.Relationship between objective measures of peripheral arterial disease severity to self-reported quality of life in older adults with intermittent claudication. J Vasc Surg. 2005;41:625–630. doi: 10.1016/j.jvs.2005.01.012.
    1. Cunningham MA, Swanson V, O'Carroll RE, Holdsworth RJ. Randomized clinical trial of a brief psychological intervention to increase walking in patients with intermittent claudication. Br J Surg. 2012;99:49–56. doi: 10.1002/bjs.7714.
    1. Jain A, Liu K, Ferrucci L, Criqui MH, Tian L, Guralnik JM. et al.The walking impairment questionnaire stair-climbing score predicts mortality in men and women with peripheral arterial disease. J Vasc Surg. 2012;55:1662–1673. doi: 10.1016/j.jvs.2011.12.010.
    1. Khammash MR, Obeidat KA, El-Qarqas EA. Screening of hospitalised diabetic patients for lower limb ischaemia: is it necessary? Singapore Med J. 2008;49:110–113.
    1. Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg. 2011;41:110–116. doi: 10.1016/j.ejvs.2010.09.020.
    1. Aboyans V, Lacroix P, Tran MH, Salamagne C, Galinat S, Archambeaud F. et al.The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease. J Vasc Surg. 2011;53:984–991. doi: 10.1016/j.jvs.2010.10.054.
    1. Spronk S, White JV, Bosch JL, Hunink MG. Impact of claudication and its treatment on quality of life. Semin Vasc Surg. 2007;20:3–9. doi: 10.1053/j.semvascsurg.2007.02.003.
    1. Dumville JC, Lee AJ, Smith FB, Fowkes FG. The health-related quality of life of people with peripheral arterial disease in the community: the Edinburgh Artery Study. Br J Gen Pract. 2004;54:826–831.
    1. Hart HE, Redekop WK, Berg M, Bilo HJ, Meyboom-de JB. Factors that predicted change in health-related quality of life were identified in a cohort of diabetes mellitus type 1 patients. J Clin Epidemiol. 2005;58:1158–1164. doi: 10.1016/j.jclinepi.2005.02.021.
    1. Janssen MF, Lubetkin EI, Sekhobo JP, Pickard AS. The use of the EQ-5D preference-based health status measure in adults with Type 2 diabetes mellitus. Diabet Med. 2011;28:395–413. doi: 10.1111/j.1464-5491.2010.03136.x.
    1. O'Reilly DJ, Xie F, Pullenayegum E, Gerstein HC, Greb J, Blackhouse GK. et al.Estimation of the impact of diabetes-related complications on health utilities for patients with type 2 diabetes in Ontario, Canada. Qual Life Res. 2011;20:939–943. doi: 10.1007/s11136-010-9828-9.
    1. Amer MS, Alsadany MA, Tolba MF, Omar OH. Quality of life in elderly diabetic patients with peripheral arterial disease. Geriatr Gerontol Int. 2013;13:443–450. doi: 10.1111/j.1447-0594.2012.00928.x.
    1. Gardner AW, Montgomery PS. The effect of metabolic syndrome components on exercise performance in patients with intermittent claudication. J Vasc Surg. 2008;47:1251–1258. doi: 10.1016/j.jvs.2008.01.048.
    1. Grandy S, Fox KM. Change in health status (EQ-5D) over 5 years among individuals with and without type 2 diabetes mellitus in the SHIELD longitudinal study. Health Qual Life Outcomes. 2012;10:99. doi: 10.1186/1477-7525-10-99.
    1. Cassar K, Bachoo P, Brittenden J. The effect of peripheral percutaneous transluminal angioplasty on quality of life in patients with intermittent claudication. Eur J Vasc Endovasc Surg. 2003;26:130–136. doi: 10.1053/ejvs.2002.1929.
    1. Spronk S, Bosch JL, Veen HF, Den Hoed PT, Hunink MGM. Intermittent claudication: functional capacity and quality of life after exercise training or percutaneous transluminal angioplasty – systematic review. Radiology. 2005;235:833–842. doi: 10.1148/radiol.2353040457.
    1. McDermott MM, Ferrucci L, Guralnik JM, Dyer AR, Liu K, Pearce WH. et al.The ankle-brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease. Vasc Med. 2010;15:251–257. doi: 10.1177/1358863X10365181.
    1. Regensteiner JG, Hiatt WR, Coll JR, Criqui MH, Treat-Jacobson D, McDermott MM. et al.The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program. Vasc Med. 2008;13:15–24. doi: 10.1177/1358863X07084911.
    1. de Rivas B, Permanyer-Miralda G, Brotons C, Aznar J, Sobreviela E. Health-related quality of life in unselected outpatients with heart failure across Spain in two different health care levels. Magnitude and determinants of impairment: the INCA study. Qual Life Res. 2008;17:1229–1238. doi: 10.1007/s11136-008-9397-3.
    1. Rutten-van Mölken MP, Oostenbrink JB, Tashkin DP, Burkhart D, Monz BU. Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest. 2006;130:1117–1128. doi: 10.1378/chest.130.4.1117.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться