Endocrine Abstracts (2008) 16 P241

Iliofemoral arterial occlusion in type 2 diabetics shortens life duration to the greatest extent: 10 years follow up study

Dragan Tesic1, Svetolik Avramov2 & Pavle Pantelinac1

1Clinic of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad, Serbia; 2Clinic of Vascular Surgery, Novi Sad, Serbia.

Background and aim: We have sought to determine factors associated with age at death in patients with type 2 diabetes (T2DM) investigated for peripheral arterial disease (PAOD).

Materials and methods: There were n=167 T2DM, 140 with PAOD(G1-4) and n=27 Controls; patients were monitored from Jan-1997 till Dec-2006. CW-Doppler examination and segmental pressures showed: 35pts with crural PAOD (G1), 28 popliteocrural (G2), 36 femoropopliteal (G3) and 41 iliofemoral (G4). G1-4 and Controls were comparable in age and diabetes duration.

Results: At the begining there was no difference either in their age or the duration of the diabetes for G1-4 and Controls (65.9±9.2 vs 66.4±9.3, P 0.72; 16.8±8.1 vs 18.2±7.4, P 0.27). However at the end G1-4 died earlier (69.4±8.9) versus Controls (74.1±7.4; P0.045). At the end of this study, only 10 out of 167pts with PAOD (5.9%) and 7 out of the 27 Controls (25.9%) (X2, P<0.001) were alive. Comparison of G1-4 subgroups and Controls concerning age at death: G1 (P 0.85), G2 (P 0.11), G3 (P 0.07), G4 (P 0.01). T-test between G4 (n=21 died pts) and Controls (who died, n=20): 67±8.4 vs 74.1±8.95, P 0.01, at the time of death; Lec 9.4±2.5 vs 7.3±2.3×109/l, P 0.05; insulin dependens after 12.8±7.7 vs 18.8±7.9 years, P 0.05. X2 test: male 76 vs 52%, P 0.04; stroke 24% vs 10%, P 0.03. NDS(neuropathy disability scor) >4 86% vs 60%, P<0.01; smoking 90% vs 40%, P<0.01. In univariate analysis of both G4 and Control groups shorter life expectancy was connected with: HDL (r=+0.41, P<0.01), tg/HDL (r=−0.32, P 0.04), BMI before DM (r=−0.28 P 0.04), DM begining (r=+0.63, P<0.01), IRI (isnulinemia) 9 h (r=+0.40, P<0.01), age starting insulin therapy (r=+0.87, P<0.01); Thigh segmental pressure (r=+0.42, P<0.01), cigarette number (r=−0.54, P<0.01). In multiple logistic regression analysis statistically significant remaind: shorter DM duration, earlier insulin dependance and number of cigarettes per day.

Conclusion: PAOD, which reduced the life span most significantly was noticed in iliofemoral region; it was characteristic of diabetics whose disease started at earlier age, who were insulin restistant (tg/HDL) and whose pancreas was not as potent (IRI9h). Early introduction of rapid insulins is a very speculative therapeutic option.

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