Endocrine Abstracts

Background and aims: In many developing countries, diabetic foot is considered as a problem only when the patient develops a wound on the foot. Until that moment, the detection of changes in the neurovascular condition of the feet is rarely applied. The aim of this prospective, single centre study was to define factors associated with early cardiovascular mortality in diabetes.

Materials and methods: 1345 patients under age 75 were included who were undergoing assessment of their diabetes between January 2008 and May 2010 as part of standard practice in a specilaist clinic at a regional teaching hospital in Serbia. Peripheral artery disease (PAD) and peripheral neuropathy was assessed. Evidence of other comorbidities was also collected. Outcome was determined in 2021 and baseline characteristics were compared between those who had and had not suffered cardiovascular death under age 75 years within 10 years of review in two casually selected cohorts.

Results: Those who died (n2=70) were more frequently male (60 vs. 45.3%, P=0.08), younger (66.4±7.4 vs. 79.9±3.4, P<0.000), had a shorter period of follow-up (3.6±2.3 vs. 11.2±1.7 years, P<0.000) when compared to those still alive (n1=75). Those who died were also significantly (P<0.01) more likely to have had PAD (48.6 vs. 9.3%), diabetic foot ulcer (25.7 vs. 9.3%), major amputation (17.1 vs. 1.3%) at baseline. Minor amputations were significantly more likely (8.6 vs. 1.3%, P<0.04). Following multivariable logistic regression analysis significant differences between groups remained for only creatinine (123±45 vs. 88.9±16.9 mmol/l, P<0.003) and vibration perception threshold <5 (7.8 [95% CI: 3.7-16.4)], P=0.008), estimated maximum lifetime BMI (3.4 [95% CI: 1.7-6.8)], P<0.000), alcohol usage (4.7 [95% CI: 1.5-14.7)], P=0.005), smoking habit (2.2 [95% CI: 1.1-4.3)], P<0.03) and earlier age of diabetes onset (43.4±12.5 vs. 49.2±9.9, P=0.0029). When the 72 patients with impaired vibration sense were compared with 73 with VPT>6 and there were significant differences in and PAD (3.9 [95% CI: 1.8-8.8)], P<0.001) and estimated maximum lifetime BMI (9.4 [95% CI: 3.4-25.7), P<0.000). Those who had had a previous MI at baseline (n=46) was associated with increased death rate (3.2[95% CI: 1.5-6.6)], P=0.002) and PAD (2.9[(1.3-6.1)], P=0.007).

Conclusion: Decreased VPT, the presence of PAD on clinical testing and higher maximum estimated lifetime BMI are strongly associated with premature cardiovascular death. Early detection of independent markers of greater risk of reduced life expectancy might improve management of their diabetes.