Poor diabetes control tied to leg artery disease

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In adults with diabetes, elevated hemoglobin A1c (HbA1c) levels—an indicator of poor glucose control—are associated with an increased risk of reduced blood flow to the legs, a condition known as Peripheral arterial disease (PAD).

Among 1,894 middle-aged adults with diabetes, the risk of hospitalization related to PAD increased with increasing tertiles of HbA1c level, doctors found, as did the risk of intermittent claudication—a cramping leg pain that occurs in patients with PAD.

Specifically, patients in the second and third tertiles of HbA1c level were 53 percent and 64 percent more likely, respectively, than those with the lowest HbA1c to have PAD, the results indicate.

The researchers note that trends toward higher risk of PAD with higher HbA1c level were evident for all manifestations of PAD, regardless of whether or not diabetes had been diagnosed.

“Our results suggest that poor (blood sugar) control, as indicated by elevated HbA1c levels in individuals with diabetes, is associated with an increased risk of PAD independently of other known risk factors,” said Dr. Elizabeth Selvin from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

“This association was particularly strong for the symptomatic, more severe manifestations of PAD, including intermittent claudication and PAD-related hospitalizations.”

“Ultimately, our results suggest that efforts to improve glycemic control in persons with diabetes may substantially reduce the risk of PAD development,” Selvin added.

SOURCE: Diabetes Care April, 2006.

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