Intensive Treatment of Diabetes Is Associated With a Reduced Rate of Peripheral Arterial Calcification in The Diabetes Control and Complications Trial

Peripheral arterial disease (PAD) is a significant contributor to the morbidity and mortality of>2 million Americans (1). In addition to its own specific disease risks, PAD has been shown to be a predictor of cardiovascular mortality and coronary artery disease, as well as a general marker for the atherosclerotic disease process (2,3). PAD complications, especially in the lower limb, are significantly greater in individuals with diabetes compared with those without diabetes, and the risk imparted by diabetes is similar or greater in magnitude to that seen for ischemic heart disease and stroke (4,5). The aortofemoral arteries are prime sites for PAD; hence, determination of claudication and measurement of blood flow in the lower extremities are the most common assessments (6). A relatively low ankle systolic blood pressure (ankle-to-brachial ratio index [ABI]) has been found to be an indicator of atherosclerosis/occlusion in this region (5). Conversely, in diabetes, a high-pressure ABI due to medial wall arterial calcification and non-compressible vessels may also be associated with adverse outcomes, including diabetic kidney disease (7). Sex differences have been reported in ABI measurements in type 1 diabetes, with women having a greater frequency of low ABI and men having a higher frequency of high ABI (7). Here, we extend these analyses by examining the effect of previous intensive diabetes management o