Detection of peripheral arterial disease in patients with diabetes mellitus type 2 in regards to established cardiovascular disease

Uvod: Šećerna bolest (engl. diabetes mellitus, DM), kronična je bolest metabolizma obilježena poremećenim vrijednostima glukoze u krvi te brojnim komplikacijama. Periferna arterijska bolest (PAB) makrovaskularna je komplikacija, čiji se probir sve više radi brzim, neinvazivnim mjerenjem pedobrahijalnog indeksa (engl. ankle- brachial index, ABI) s dodatnim ciljem modifikacije kardiovaskularnog rizika. Ciljevi: Primarni cilj istraživanja bio je odrediti prevalenciju bolesnika sa PAB u odabranom uzorku ispitanika, pomoću ABI. Sekundarni cilj je bio odrediti na koje podskupine bolesnika s DM treba usmjeriti probir, s koncentracijom na bolesnike koji su preboljeli veliki kardiovaskularni nepovoljni događaj (engl. major adverse cardiac event, MACE). Ispitanici i postupci: U presječno istraživanje uključeno je 100 ispitanika sa DM tip 2, iz Centra za dijabetes, endokrinologiju i kardiometabolizam Specijalne bolnice za medicinsku rehabilitaciju bolesti pluća, srca i reumatizma TTO, kojima je učinjen probir na PAB određivanjem ABI i brzina pulsnog vala (engl. pulse wave velocity, PWV) te su rezultati uspoređeni s antropometrijskim i laboratorijskim parametrima, u korelaciji s komorbiditetima i/ili komplikacijama bolesti. Rezultati: U našem je uzorku prevalencija PAB iznosila 8%. Osobe s MACE-om u anamnezi imaju niži ABI te više vrijednosti bubrežne disfunkcije u odnosu na ispitanike koji nisu preboljeli MACE. Viša karotido- femoralna i brahio- pedalna PWV koreliraju sa starijom dobi ispitanika i duljim trajanjem DM tip 2. Zaključak: Prekasno prepoznavanje PAB u osoba s DM, a posebice u onih s preboljelim MACE-om, može se spriječiti sustavnim probirom svih oboljelih osoba, s obzirom da je određivanje ABI i PWV neinvazivan i praktičan alat koji to omogućuje u svakodnevnoj kliničkoj praksi.Introduction: Diabetes mellitus (DM) is a chronic metabolic disease characterised with abnormal blood glucose levels and numerous complications. Peripheral arterial disease (PAD) is its macrovascular complication, for which screening can be done with fast, noninvasive measurement of the ankle- brachial index (ABI) with an added goal of cardiovascular risk modification. Aims: The primary aim of this research was to determine the prevalence of patients with PAD in the chosen sample of participants, with the help of ABI. The secondary aim was to determine on which subgroups of patients with DM, the screening for PAD should be directed, with specific attention towards patients who had a major adverse cardiovascular event (MACE) in their anamnesis. Participants and procedures: In this cross- sectional research, 100 patients of the Center for diabetes, endocrinology, and cardio metabolism of the Special hospital for medical rehabilitation of the diseases of the lung, heart, and rheumatism Thalassotherapy Opatija, with DM type 2, were included. They have been screened for PAD through the measurement of ABI and pulse wave velocities (PWV) and the results were then compared with antropometric and laboratory parameters, in correlation with comorbidities and/or complications of the disease. Results: In our sample the prevalence of PAD was 8%. Patients with MACE in their anamnesis had lower ABI values and higher values of kidney disfunction than the patients who hadn't had MACE. Higher carotid- femoral and brachial- ankle PWV correlated with older age and longer duration of DM type 2 in participants. Conclusion: Late diagnosis of PAD in patients with DM, especially ones who suffered a MACE, can be prevented with systemic screening of all patients, since determining ABI and PWV is a noninvasive and practical tool which enables that in daily clinical practice