Pulse Pressure and Prediction of Incident Foot Ulcers in Type 2 Diabetes

OBJECTIVE — To assess the relevance of pulse pressure as a predictor of foot ulcers in type 2 diabetic subjects. RESEARCH DESIGN ANDMETHODS — A cohort study was performed on a consec-utive series of 1,945 type 2 diabetic outpatients without a foot ulcer at baseline. Incident foot ulcers were identified through the regional hospital discharge system, which contains ICD codes of current diagnoses. RESULTS — During a follow-up of mean SD 4.2 2.2 years, 86 ulcers were observed. After adjusting for confounders, the highest quartiles of pulse pressure had a 2.39-fold (95 % CI 1.14–5.02) risk of foot ulcers. When ischemic ulcers were considered separately, the highest pulse pressure quartile was associated with an increased age- and sex-adjusted risk (2.08 [95% CI 1.02–4.24]), whereas no increase of risk was observed for neuropathic ulcers. CONCLUSIONS — Elevated pulse pressure represents an independent predictor of foot ulcers in diabetic patients; this parameter should be considered for the stratification of risk of ischemic or neuroischemic ulcers. Diabetes Care 32:897–899, 2009 Pulse pressure is a recognized riskfactor for cardiovascular disease innondiabetic (1 – 4) and diabetic (5,6) subjects. In particular, elevated pulse pressure is associated with in-creased risk of arteriopathy of the lower limbs, even after adjusting for mean blood pressure (7). This study aimed to assess the relevance of pulse pressure as a pre-dictor of foot ulcers in type 2 diabetic sub-jects, which has not been specifically investigated so far. RESEARCH DESIGN AND METHODS — A cohort study was performed on a consecutive series of 1,945 type 2 diabetic outpatients referre