부산대학교 도서관

Objective: The purpose of this study was to evaluate the risk factors, including albuminuria, for peripheral arterial disease (PAD), and associated complications in patients with type 2 diabetes. Materials and Methods: All patients with type 2 diabetes 40 years old and over, were recruited consecutively from diabetic clinics at a medical center in eastern Taiwan. Information regarding each participant's sociodemographic characteristics and medical history was gathered from the patients and their medical records. A clinical examination which included anthropometric measurements and a direct ophthalmoscope check-up was performed. After an overnight fast, serum lipids, uric acid, fasting plasma sugar, A1C and urinary albumin concentration were measured. The anklebrachial index (ABI) was calculated by Doppler examination in both legs. PAD was diagnosed if the ABI in one of the legs was less than 0.9. Results: A total of 309 patients were recruited. PAD was present in 38 of the 309 diabetic subjects studied (12.3%; 12.7% of the men and 11.9% of the women). Of all subjects with PAD, 92.1% had a history of hypertension, 15.8% had stroke, 13.2% had coronary heart disease, and 47.4% had albuminuria. For those who completed the direct ophthalmoscope examination, 41.9% of patients with PAD had diabetic retinopathy. In univariate analysis, the significant associative risk factors for PAD were age, tobacco smoking, history of hypertension/stroke, duration of diabetes, insulin therapy, usage of angiotension-converting enzyme inhibitors/angiotension-receptor blockers (ACEI/ARB) and albuminuria. Multiple logistic regression analysis identified age as the most significant risk factor for PAD. The higher the age of the patient, the greater the likelihood of PAD, with a 1.11-fold increase in risk incurred for every 1-year increment. Cigarette smoking was also a significant factor with smokers incurring a 4.77-fold higher risk than non-smokers. Individuals suffering from macroalbuminuria were more likely to have PAD compared to those without albuminuria. Other significant risk factors included insulin usage. Conclusions: The occurrence of PAD in type 2 diabetic patients is associated with the age of the patient, smoking, insulin usage and albuminuria. Incorporation of albuminuria assessment and a smokingcessation program are recommended in clinical practice.