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Ayak Bilek-Brakial İndeksi‘nin glisemik düzey, diyabet komplikasyonları ve oksidatif stres indeksi ile ilişkisi

Year 2023, , 1 - 14, 20.01.2023
https://doi.org/10.21673/anadoluklin.1104754

Abstract

Amaç: Ayak Bilek-Brakial İndeksi (ABİ), periferik arter hastalığını taramak ve kardiyovasküler prognozu değerlendirmek için kullanılan bir yöntemdir. Bu çalışmanın amacı, tip 2 diyabet (T2D) hastalarında ABİ’nin glisemik düzey, biyokimyasal parametreler, mikro-makrovasküler komplikasyonlar ve oksidatif stres indeksi (OSİ) ile olan ilişkisini incelemek ve iskemi için risk oluşturabilecek faktörleri belirlemektir.

Yöntemler: Kesitsel retrospektif olarak tasarlanan çalışmaya 153 kişi dâhil edildi. Katılımcılar, sağlıklı kontrol, prediyabet ve manifest T2D olarak glisemik düzeylerine göre ayrıldı. Ayrıca ABİ’ye göre de gruplandırılan katılımcıların, ABİ ve karotis arter incelemeleri, radyolog tarafından doppler ultrasonografi ile yapıldı. Diyabetik nöropati ve retinopati teşhis muayeneleri nörolog ve oftalmolog tarafından gerçekleştirildi. Antropoemetrik ölçümler, OSİ ve biokimyasal paramatreler tüm gruplar için çalışıldı.

Bulgular: Gruplar arasında ABİ düzeylerine göre yaş ve diyabet süresi açısından anlamlı fark vardı (p<0.05, p<0.001). ABİ iskemi düzeyi ile glisemik düzey arasında önemli ölçüde farklılık bulundu. ABİ grupları arasında, açlık kan glukozu, tokluk kan glukozu, insülin direnci, kreatinin ve albüminüri seviyeleri anlamlı şekilde farklıydı. Benzer şekilde ABİ iskemik grubu ile makrovasküler komplikasyonlar arasında da anlamlı fark gözlendi (p<0.001). Makrovasküler komplikasyon grupları ile ABİ, OSİ ve hemoglobin A1c (HbA1c) arasında anlamlı fark saptandı (p<0.001). Karotis doppler incelemesine göre 6 gruba ayrılmış kohort ile OSİ arasında anlamlı bir fark bulundu (p<0.05). Diğer yandan, mikrovasküler komplikasyon grupları ile HbA1c ve OSİ arasında dikkate değer bir değişiklik vardı (p<0.001, p<0.05). İskemi için risk oluşturabilecek faktörler diyabet süresi, açlık insülin düzeyi, tokluk kan glukozu ve insülin direnci olarak belirlendi. Modelin genel doğruluğu %68.6 olarak hesaplandı.

Sonuç: T2D’de periferik arter hastalığı taraması için belirli bir yaşı beklemek yerine diyabetin süresi dikkate alınabilir ve tarama buna göre öne çekilebilir. Diyabet süresi, açlık insülin düzeyi, tokluk kan glukozu ve insülin direnci iskemi için risk faktörleri olarak gösterilebilir.

Supporting Institution

Bu makale ile ilgili herhangi bir finansal kaynaktan yararlanılmamıştır.

Thanks

Nörolog Dr. Aslin TEKYAN, Oftalmalog Doç. Dr. Göktuğ DEMİRCİ, Radyolog Dr. Kayhan ERBİLEN, ve Prof. Dr. Handan ANKARALI’ya katkılarından ve emeklerinden dolayı teşekkür ederim.

References

  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37 Suppl 1:81-90.
  • International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, IDF guide for epidemiology studies. Belgium: 2021. [updated 2022 Jun 20; cited 2022 Aug 25] Available from https://diabetesatlas.org/idf-guide-for-epidemiology-studies/?dlmodal=active&dlsrc=https%3A%2F%2Fdiabetesatlas.org%2Fidfawp%2Fresource-files%2F2021%2F11%2FIDF-guide-diabetes-epidemiology-studies.pdf
  • Poznyak A, Grechko AV, Poggio P, Myasoedova VA, Alfieri V, Orekhov AN. The diabetes mellitus-atherosclerosis connection: the role of lipid and glucose metabolism and chronic ınflammation. Int J Mol Sci. 2020;21(5):1835.
  • Raghavan S, Vassy JL, Ho YL, et al. Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. J Am Heart Assoc. 2019;8(4):e011295.
  • Di Marco E, Jha JC, Sharma A, et al. Are reactive oxygen species still the basis for diabetic complications?. Clin Sci (Lond). 2015;129(2):199-216.
  • Yuan T, Yang T, Chen H, et al. New insights into oxidative stress and inflammation during diabetes mellitus-accelerated atherosclerosis. Redox Biol. 2019;20:247-60.
  • Newman AB, Tyrrell KS, Kuller LH. Mortality over four years in SHEP participants with a low ankle-arm index. J Am Geriatr Soc. 1997;45(12):1472-8.
  • Chen SC, Hsiao PJ, Huang JC, et al. Abnormally low or high ankle-brachial ındex ıs associated with proliferative diabetic retinopathy in type 2 diabetic mellitus patients. PLoS One. 2015;10(7):e0134718.
  • Kweon SS, Shin MH, Park KS, et al. Distribution of the ankle-brachial index and associated cardiovascular risk factors in a population of middle-aged and elderly koreans. J Korean Med Sci. 2005;20(3):373-8.
  • Doza B, Kaur M, Chopra S. Cardiovascular risk factors and distributions of the ankle-brachial ındex among type 2 diabetes mellitus patients. Int J Hypertens. 2012;2012:485812.
  • Zhang X, Bai R, Zou L, Zong J, Qin Y, Wang Y. Brachial-ankle pulse wave velocity as a novel modality for detecting early diabetic nephropathy in type 2 diabetes patients. J Diabetes Res. 2021;2021:8862573.
  • Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association standards of medical care in diabetes. Ann Intern Med. 2016;19:164(8):542-52.
  • Mohler ER. Peripheral arterial disease: identification and implications. Arch Intern Med. 2003;163(19):2306-14.
  • Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93-111.
  • Touboul PJ, Hennerici MG, Meairs S, et al. Board of the 3rd Watching the Risk Symposium 2004, 13th European Stroke Conference. Mannheim intima-media thickness consensus. Cerebrovasc Dis. 2004;18(4):346-9.
  • Sung KC, Ryu S, Lee JY, et al. Urine albumin/creatinine ratio below 30 mg/g is a predictor of incident hypertension and cardiovascular mortality. J Am Heart Assoc. 2016;5(9):e003245.
  • Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem. 2004;37(2):112–9.
  • Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38(12):1103–11.
  • Newman AB, Siscovick DS, Manolio TA, et al. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation. 1993;88(3):837–45.
  • Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol. 2006;47(5):921–9.
  • Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–24.
  • Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004;110(6):738-43.
  • Li X, Wang YZ, Yang XP, et al. Prevalence of and risk factors for abnormal ankle-brachial index in patients with type 2 diabetes. J Diabetes. 2012;4(2):140–6.
  • American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333–41.
  • Papazafiropoulou A, Kardara M, Sotiropoulos A, Bousboulas S, Stamataki P, Pappas S. Plasma glucose levels and white blood cell count are related with ankle brachial index in type 2 diabetic subjects. Hellenic J Cardiol. 2010;51(5):402-6.
  • Yürekli BŞ, Kocabaş GÜ, Mirili C, et al. Is the ankle-brachial index directly associated with current glycemic control in diabetic patients? Damar Cer Derg. 2018;27(3):117–23.
  • Wattanakit K, Folsom AR, Criqui MH, et al. Albuminuria and peripheral arterial disease: results from the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis. 2008;201(1):212-6.
  • Wu D, Xuan Y, Ruan Y, et al. Prevalence of macro- and microvascular complications in patients with type 2 diabetes and kidney disease with or without albuminuria in a single Chinese Diabetes Centre. Diab Vasc Dis Res. 2016;13(1):21-30.
  • Chevtchouk L, Da Silva MHS, Do Nascimento OJM. Ankle-brachial index and diabetic neuropathy: study of 225 patients. Arq Neuropsiquiatr. 2017;75(8):533–8.
  • Resnick HE, Lindsay RS, McDermott MMG, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109(6):733-9.
  • Sutton-Tyrrell K, Venkitachalam L, Kanaya AM, et al. Relationship of ankle blood pressures to cardiovascular events in older adults. Stroke. 2008;39(3):863–9.
  • Halcox JPJ, Donald AE, Ellins E, et al. Endothelial function predicts progression of carotid intima-media thickness. Circulation. 2009;119(7):1005-12.
  • Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial intima - media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128(4): 262-9.

The relationship of Ankle-Brachial Index with glycemic level, diabetes complications and oxidative stress index

Year 2023, , 1 - 14, 20.01.2023
https://doi.org/10.21673/anadoluklin.1104754

Abstract

Aim: The ankle-brachial index (ABI) is a method to screen peripheral arterial disease and evaluate cardiovascular prognosis. The aim of this study was to examine the relationship of ABI with glycemic level, biochemical parameters, micro-macrovascular complications, and oxidative stress index (OSI) in patients with type 2 diabetes (T2D) and to determine the factors that may pose a risk for ischemia.

Methods: This cross-sectional retrospective study was designed with 153 participants who were divided as healthy control, prediabetes, and manifest T2D according to glycemic levels. Examination of ABI and carotid artery, and diabetic neuropathy and retinopathy as well as anthropometric measurements, OSI, and biochemical parameters were performed.

Results: There was a significant difference between the groups in terms of age and duration of diabetes according to ABI levels. ABI ischemia levels and glycemic levels were also significantly different. ABI groups were meaningfully different from levels of fasting glucose, postprandial glucose, insulin resistance, creatinine, and albuminuria. Likewise, a significant difference was observed between the ABI ischemic group and macrovascular complications. There was a significant difference between macrovascular complication groups and ABI, OSI, and hemoglobin A1c (HbA1c). Carotid doppler examination showed a significant difference between the OSI and the cohort divided into 6 groups. On the other hand, there was a noteworthy alteration in HbA1c and OSI of the microvascular complication groups. Factors that may pose a risk for ischemia were determined as duration of diabetes, fasting insulin level, postprandial glucose, and insulin resistance. The overall accuracy of the model was calculated as 68.6%.

Conclusion: For peripheral artery disease screening in T2D, the duration of diabetes can be taken into account rather than waiting for a certain age, and the screening can be brought forward accordingly. Duration of diabetes, fasting insulin level, postprandial glucose, and insulin resistance can be suggested as risk factors for ischemia.

References

  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37 Suppl 1:81-90.
  • International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, IDF guide for epidemiology studies. Belgium: 2021. [updated 2022 Jun 20; cited 2022 Aug 25] Available from https://diabetesatlas.org/idf-guide-for-epidemiology-studies/?dlmodal=active&dlsrc=https%3A%2F%2Fdiabetesatlas.org%2Fidfawp%2Fresource-files%2F2021%2F11%2FIDF-guide-diabetes-epidemiology-studies.pdf
  • Poznyak A, Grechko AV, Poggio P, Myasoedova VA, Alfieri V, Orekhov AN. The diabetes mellitus-atherosclerosis connection: the role of lipid and glucose metabolism and chronic ınflammation. Int J Mol Sci. 2020;21(5):1835.
  • Raghavan S, Vassy JL, Ho YL, et al. Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. J Am Heart Assoc. 2019;8(4):e011295.
  • Di Marco E, Jha JC, Sharma A, et al. Are reactive oxygen species still the basis for diabetic complications?. Clin Sci (Lond). 2015;129(2):199-216.
  • Yuan T, Yang T, Chen H, et al. New insights into oxidative stress and inflammation during diabetes mellitus-accelerated atherosclerosis. Redox Biol. 2019;20:247-60.
  • Newman AB, Tyrrell KS, Kuller LH. Mortality over four years in SHEP participants with a low ankle-arm index. J Am Geriatr Soc. 1997;45(12):1472-8.
  • Chen SC, Hsiao PJ, Huang JC, et al. Abnormally low or high ankle-brachial ındex ıs associated with proliferative diabetic retinopathy in type 2 diabetic mellitus patients. PLoS One. 2015;10(7):e0134718.
  • Kweon SS, Shin MH, Park KS, et al. Distribution of the ankle-brachial index and associated cardiovascular risk factors in a population of middle-aged and elderly koreans. J Korean Med Sci. 2005;20(3):373-8.
  • Doza B, Kaur M, Chopra S. Cardiovascular risk factors and distributions of the ankle-brachial ındex among type 2 diabetes mellitus patients. Int J Hypertens. 2012;2012:485812.
  • Zhang X, Bai R, Zou L, Zong J, Qin Y, Wang Y. Brachial-ankle pulse wave velocity as a novel modality for detecting early diabetic nephropathy in type 2 diabetes patients. J Diabetes Res. 2021;2021:8862573.
  • Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association standards of medical care in diabetes. Ann Intern Med. 2016;19:164(8):542-52.
  • Mohler ER. Peripheral arterial disease: identification and implications. Arch Intern Med. 2003;163(19):2306-14.
  • Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93-111.
  • Touboul PJ, Hennerici MG, Meairs S, et al. Board of the 3rd Watching the Risk Symposium 2004, 13th European Stroke Conference. Mannheim intima-media thickness consensus. Cerebrovasc Dis. 2004;18(4):346-9.
  • Sung KC, Ryu S, Lee JY, et al. Urine albumin/creatinine ratio below 30 mg/g is a predictor of incident hypertension and cardiovascular mortality. J Am Heart Assoc. 2016;5(9):e003245.
  • Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem. 2004;37(2):112–9.
  • Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38(12):1103–11.
  • Newman AB, Siscovick DS, Manolio TA, et al. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation. 1993;88(3):837–45.
  • Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol. 2006;47(5):921–9.
  • Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–24.
  • Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004;110(6):738-43.
  • Li X, Wang YZ, Yang XP, et al. Prevalence of and risk factors for abnormal ankle-brachial index in patients with type 2 diabetes. J Diabetes. 2012;4(2):140–6.
  • American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333–41.
  • Papazafiropoulou A, Kardara M, Sotiropoulos A, Bousboulas S, Stamataki P, Pappas S. Plasma glucose levels and white blood cell count are related with ankle brachial index in type 2 diabetic subjects. Hellenic J Cardiol. 2010;51(5):402-6.
  • Yürekli BŞ, Kocabaş GÜ, Mirili C, et al. Is the ankle-brachial index directly associated with current glycemic control in diabetic patients? Damar Cer Derg. 2018;27(3):117–23.
  • Wattanakit K, Folsom AR, Criqui MH, et al. Albuminuria and peripheral arterial disease: results from the multi-ethnic study of atherosclerosis (MESA). Atherosclerosis. 2008;201(1):212-6.
  • Wu D, Xuan Y, Ruan Y, et al. Prevalence of macro- and microvascular complications in patients with type 2 diabetes and kidney disease with or without albuminuria in a single Chinese Diabetes Centre. Diab Vasc Dis Res. 2016;13(1):21-30.
  • Chevtchouk L, Da Silva MHS, Do Nascimento OJM. Ankle-brachial index and diabetic neuropathy: study of 225 patients. Arq Neuropsiquiatr. 2017;75(8):533–8.
  • Resnick HE, Lindsay RS, McDermott MMG, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109(6):733-9.
  • Sutton-Tyrrell K, Venkitachalam L, Kanaya AM, et al. Relationship of ankle blood pressures to cardiovascular events in older adults. Stroke. 2008;39(3):863–9.
  • Halcox JPJ, Donald AE, Ellins E, et al. Endothelial function predicts progression of carotid intima-media thickness. Circulation. 2009;119(7):1005-12.
  • Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial intima - media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128(4): 262-9.
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORIGINAL ARTICLE
Authors

İhsan Boyacı 0000-0001-7369-0426

Publication Date January 20, 2023
Acceptance Date September 30, 2022
Published in Issue Year 2023

Cite

Vancouver Boyacı İ. Ayak Bilek-Brakial İndeksi‘nin glisemik düzey, diyabet komplikasyonları ve oksidatif stres indeksi ile ilişkisi. Anadolu Klin. 2023;28(1):1-14.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.