Ankle-brachial Index and Incident Diabetes Mellitus: The Atherosclerosis Risk in Communities (ARIC) Study.

diabetes;ankle-brachial index;Epidemiology

Hua, SiminMatsushita, Kunihiro ;

Johns Hopkins University

关键词: diabetes;    ankle-brachial index;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/38128/HUA-THESIS-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Introduction: Individuals with peripheral artery disease (PAD) often have reduced physical function and activity, which may increase the future risk of diabetes. Although diabetes is a risk factor of PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. Methods: We examined the association of ABI with incident diabetes after accounting for potential confounders using Cox proportional hazards models in the ARIC Study. ABI was measured on a randomly selected leg in 12,247 black and white participants without prevalent diabetes at baseline (1987-1989). Incident diabetes cases were identified by glucose measurements (fasting ≥126 mg/dl or non-fasting ≥200 mg/dl) at subsequent three visits (1990-92, 1993-95, and 1996-98) and self-reported diagnosis or medication use at those visits or during annual phone interview through 2011. Results: A total of 3,305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91-1.00) ABI had 30-40% higher risk of future diabetes as compared to those with ABI of 1.10-1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.90-1.00 (HR=1.17, 95%CI 1.04-1.31) and marginally significant for ABI ≤0.90 (HR=1.19, 0.99-1.43). Although the association was largely consistent across demographic and clinical subgroups, we observed borderline significant interaction for hypertension status and fasting glucose, with a stronger association between ABI and diabetes risk in participants without hypertension and those with normal fasting compared to their counterparts.Conclusions: Low ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI.