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

Yıl 2023, Cilt: 28 Sayı: 1, 1 - 14, 20.01.2023

İhsan Boyacı

https://doi.org/10.21673/anadoluklin.1104754

Öz

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.

Anahtar Kelimeler

Bilek-Brakial İndeksi, diyabetes mellitus, diyabetik anjiyopati, oksidatif stres

Destekleyen Kurum

Bu makale ile ilgili herhangi bir finansal kaynaktan yararlanılmamıştır.

Teşekkür

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.

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

Öz

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.

Anahtar Kelimeler

Ankle-brachial index, diabetes mellitus, diabetic angiopathies, oxidative stress

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