Study On The Relationship Between Borderline Ankle-brachial Index And Type 2 Diabetes Mellitus Complicated With Macrovascular Disease

Objective: The purpose of the study was to investigate the influence and significance of borderline ankle brachial index on type 2 diabetes mellitus(T2DM)with macrovascular disease,and by comparing the low ABI group(ABI?0.90)? borderline ABI group(0.90<ABI<1.00)and normal ABI group(1.00?ABI?1.40)in the clinical biochemical indexes and the incidence of macrovascular disease with T2 DM,to explore whether the borderline ABI patients can be included in the abnormal population,in the screening process in the timely detection of diabetic patients with macrovascular disease,to further assess and reduce the missed diagnosis rate.Methods: A total of 186 T2 DM patients were enrolled in the Department of Endocrinology,Affiliated Hospital of Yan'an University from October 2015 to October2016.The basic data of the patients(sex,age,duration of diabetes,personal history,past history),related clinical data including body mass index(BMI),fasting blood glucose(FBG),glycosylated hemoglobin(Hb A1c),triglycerides(TG),total cholesterol(TC),high density lipoprotein(HDL),low density lipoprotein(LDL),uric acid(UA),creatinine(CRE),urea nitrogen(Urea),the occurrence of T2 DM macrovascular disease(no matter what condition occur including coronary heart disease,cerebral infarction,carotid atherosclerotic lesions,lower extremity atherosclerotic lesions,can be deemed as macrovascular disease),etc,were collected and recorded.Using automatic atherosclerosis detector for ABI detection,according to the data,divided into three groups,low ABI group(ABI?0.90)is 33 cases,borderline ABI group(0.90<ABI<1.00)is 40 cases,and the normal ABI group(1.00?ABI?1.40)is 113 cases,the clinical data,the incidence of macrovascular disease and the degree of atherosclerosis in the carotid artery and lower extremities artery and other aspects among three groups were compared,and to compare the new cut point(ABI<1.0)and the general cut point(ABI<0.9),which the differences between the two different methods of division.Result:1.The levels of age,duration of diabetes,SBP,FBG,Hb A1 c,TG,TC,LDL,UA were showed statistically significant difference between the three groups,(P<0.05);compared with those in normal ABI group,the age,duration of diabetes,FBG,Hb A1 c,TG,TC,LDL-C and UA were elevated in low ABI group,(P<0.05),and the age,FBG,Hb A1 c,TG,TC,LDL-C and UA were elevated in the borderline ABI group,(P<0.05);compared with borderline ABI group,the age was elevated in low ABI group,(P<0.05).2.The incidence of carotid artery disease,lower extremity artery disease,carotid and lower extremity artery disease and coronary heart disease were showed significant difference between the three groups,(P<0.05).The incidence of carotid artery disease,lower extremity artery disease,carotid and lower extremity artery diseases,coronary heart disease in low ABI group was higher than normal ABI group,(P<0.05);the incidence of carotid artery disease,lower extremity artery disease,carotid and lower extremity artery diseases in borderline ABI group was higher than normal ABI group,(P<0.05).3.Selecting the levels of sex,history of smoking,history of hypertension,age,duration of diabetes,BMI,FBG,Hb A1 c,TG,TC,LDL-C,UA and ABI as independent variables;carotid artery disease,lower extremity artery disease,carotid and lower extremity artery diseases,coronary heart disease was respectively used as the dependent variable,logistic regression model showed that:(1)duration of diabetes,borderline ABI(compared with the normal ABI)are the risk factors of carotid artery disease;(2)Hb A1 c,borderline ABI(compared with the normal ABI)are the risk factors of lower extremity artery disease;(3)course of disease,borderline ABI(compared with the normal ABI)are the risk factors of carotid and lower extremity artery diseases;(4)age,duration of diabetes are the risk factors of coronary heart disease.(P<0.05).4.Correlation between the degree of arterial lesion in the carotid,lower extremity and the ankle-brachial index,the results showed: carotid,lower extremity arterial lesions were negatively correlated with the ABI value(rs=-0.304,p<0.01,rs =-0.672,p<0.01).5.Comparison of the degree of atherosclerosis between carotid and lower extremity in ABI group:5.1 The low ABI group was more obviously increased in the appearence of grade??? plaque lesions with carotid artery than that in normal group(P<0.05),and the borderline ABI group was more obviously increased in the appearence of grade ?plaque lesions with carotid artery than that in normal group(P<0.05).5.2 The low ABI group was more obviously increased in the appearence of grade????? plaque lesions with lower extremity artery than that in normal group(P<0.05),and the borderline ABI group was more obviously increased in the appearence of grade??? plaque lesions with lower extremity artery than that in normal group(P<0.05).6.The ROC curve was used to evaluate the accuracy of the ABI in the diagnosis of diabetes mellitus with macrovascular disease.The analysis of ROC curve indicated that the area was 0.797,p<0.001,ABI had a certain diagnostic value in the diagnosis of diabetes mellitus complicated with macrovascular disease.Compared with ABI<1 as a new cut point for diabetes mellitus with macrovascular disease with general cut point ABI<0.9,the results showed that the sensitivity of the general ABI cut point was 24.63%and the specificity of the general ABI cut point was 100%,the sensitivity of the new cut point was 50% and the specificity of the new cut point was 88.46%.Conclusion:1.ABI with 0.90<ABI<1.00 in type 2 diabetes patients also have a higher prevalence of macrovascular disease(mainly refers to peripheral arterial disease).2.Age,course of disease,glycosylated hemoglobin,borderline ABI(compared with the normal ABI)are risk factors for type 2 diabetes with macrovascular disease.3.Ankle-brachial index decreased with the severity of carotid artery and lower extremity artery;the incidence of grade ??? plaque lesions in the peripheral artery disease in the borderline ABI group was significantly higher than that in the normal ABI group.4.The ankle-brachial index(ABI)has a certain diagnostic value for tpye 2diabetes mellitus with macrovascular disease.By comparing the general cut point(ABI<0.9),the sensitivity of using the new cut point(ABI<1.0)to screen for diabetic macrovascular disease is higher,can reduce the missed diagnosis rates.5.The borderline ABI group(0.90<ABI<1.00)was included in the abnormal population,timely assessment,timely take measures to prevent atherosclerosis,to avoid further progress,resulting in serious consequences.