Multiple Risk Factors Play Role in Odds of Developing Peripheral Artery Disease in Patients with Type 2 Diabetes

Patrick Campbell

A systematic review and meta-analysis presented at AACE 2021 sheds light on risk factors associated with increased odds of developing peripheral artery disease among patients with type 2 diabetes.

An analysis of data from nearly a dozen studies is providing insight into the relationship between various risk factors and risk of peripheral artery disease (PAD) in patients with type 2 diabetes.

Presented by Martha Rosana, MD, of the Department of Internal Medicine at the University of Indonesia, at the American Academy of Clinical Endocrinology’s 30th Annual Meeting (AACE 2021), results of the study detail the impact of increased age, increased duration of diabetes, and disease history can have on risk of PAD in patients with type 2 diabetes.

Led by Rosana and colleagues from the University of Indonesia, the current study was designed to provide clinicians and researchers with a comprehensive review of risk factors associated with incidence of PAD in patients with type 2 diabetes. With this in mind, investigators designed their study as a systematic review and meta-analysis of studies detailing incidence of PAD in populations with type 2 diabetes from major databases and other sources.

Risk factors of interest for the investigators’ analyses included age, sex, duration of diabetes, hypertension status, history of coronary artery disease (CAD) or stroke, obesity, HbA1c levels, eGFR, dyslipidemia, smoking status, and fibrinogen level.

For the purpose of analysis, investigators designed their study using the PRISMA standard and data obtained from the PubMed, MEDLINE, ProQuest, and EMBASE database. Their specific search sought to identify cohort or case-control studies reporting risk factors of PAD incidence among patient populations with type 2 diabetes mellitus.

From their search of databases, investigators identified 14,129 articles for possible inclusion in the systematic review and meta-analysis and 39 articles from other sources. After exclusion of duplicates and screening, 51 full-text articles were assessed for eligibility. Of these, 10 were included in the qualitative synthesis and 9 were included in the meta-analysis.

Among the articles assessed but that were ultimately excluded, the most common reason for exclusion was a different diagnosis criterion for PAD (n=13) followed by a different outcome measure (n=11), patient population did not have type 2 diabetes mellitus (n=5), and used the same subject as another study (n=5). All 10 studies included in the qualitative synthesis had a low risk of bias according to the Newcastle-Ottawa Scale and included a total population of 73,834 patients with type 2 diabetes.

Upon analysis, investigators found being 70 years of age or older (OR, 3.44; 95% CI, 2.11-5.62), having diabetes for 5 years or more (OR, 1.81; 95% CI, 1.24-2.64), a history of CAD (OR, 1.55; 95% CI, 1.30-1.83), hypertension (OR, 1.43; 95% CI, 1.10-1.86), and elevated LDL-C (2.51; 95% CI, 1.38-4.58) were associated with an increase in odds of developing PAD. Investigators noted all evidence had a grade of moderate certainty.

This study, “Risk Factors of Peripheral Arterial Disease in Type 2 Diabetes Mellitus Patients: A Systematic Review and Meta-analysis,” was presented at AACE 2021.