BACKGROUND The subjects with diabetes mellitus are at high risk for peripheral vascular disease (PVD). The ABI (Ankle-Brachial Index) was done for diagnosis of PVD in diabetes. Numerous studies have been conducted to determine the risk factors for diabetes PVD. Most of the risk factors have been found are largely affected by the age and patients nutritional status to some extent. Especially in older diabetes, risk factors cannot be evaluated by numerical values only, for most patients are in background of poor nutritional support. Therefore, in this study, our aim was to evaluate on the influences of the nutritional status as the risk factors for PVD in older patients, ie., 60 years and older. METHODS: We selected 59 patients who are above 60 years old and took neither anti-hypertensive drug nor lipid lowering agents. All subjects ABI was measured by IMEXLAB 9000 and the study group was stratified according to the ABI values: the normal (ABI >10), PVD group (ABI <0.9). The ABI (Ankle-Brachial Index) was measured by The data were analyzed using one-way analysis of variance. If statistically significant effect was found, post hoc analysis (e.g., Newman-Keuls' test) was performed to evaluate the difference between the groups. The values are expressed as the mean+/-standard error (SE). RESULT: There was significant difference in smoking (ABI < 0.9; 0.54+/-0.16 packs/day, ABI > 1.0; 0.35+/-0.08 packs/day), the serum level triglyceride(ABI < 0.9; 1.960.19 mmol/L, ABI > 1.0; 1.56 + 0.21 mmol/L), HDL-cholesterol(ABI < 0.9; 0.88+/-0.11 mmol/L, ABI > 1.0; 1.10+/-0.08 mmol/1) when compared between the normal and ABI decreased subjects(P < 0.05). However, we found no significant differences in systolic blood pressure, total cholesterol and LDL-C between the two groups. Serum level of the nutritional factors such as albumin, transferrin, total lympocyte count, folate, zinc were lower than the normal values in both groups. However, these levels were not statistically significant when two groups compared. CONCLUSION: The relationship between the known PVD risk factors and PVD in older diabetes was weak. Therefore, based on the findings from this study, we suggest that when investigators interpretate the risk factors of PVD in elderly patients one must consider nutritional effects along the other factors.
Sung Jin Nam, Sung Rae Cho, Choo Sung Kim, Sang Gyun Woo, Hee Jin Choi, Sang Ki Kim, Jae Hong Park, In Kyu Lee, Seong Bum Han, Seung Yup Han, Chung Chul Kim
Korean Diabetes J. 1999;23(1):55-61. Published online January 1, 2001
OBJECTIVES The plasminogen activator inhibitor-1 (PAI-I) and lipoprotein(a) are considered as important fibrinolysis inhibitors. We evaluated PAI-1 and Lp(a) concentrations in Korean non-insulin- dependent diabetes mellitus (NIDDM) patients with or without peripheral vascular disorder. METHODS: By using National Diabetes Data Group (NDDG) criteria as a diabetes mellitus diagnostic criteria, a total of 127 Korean NIDDM patients were seleeted. The ankle brachial index was measured by segrnental volume plethysmography to diagnose peripheral vascular disease. We also examined clinical and biochemical parameters in NIDDM patients. RESULTS: The duration of diabetes, systolic and diastolic pressures was significantly higher in diabetic patients with peripheral vascular disease (Group 2) than in diabetic patients without peripheal vascular disease (Group 1). The 24 hour urine microalbumin and PAI-1 levels in Group 2 were also significantly higher and the HDL-cholesterol level was lower than in Group 1. There were significant correlations between the plasma level of PAI-1 and BMI (r=0.466, p=0,007) or C-peptide level(r=0.517, p=0.012). Multivariate logistic regression analysis showed that Lp(a) and PAI-1 are independent risk factors for peripheral vascular disease. CONCLUSION: In the light of these results, it seems reasonable to suggest that high levels of PAI-1 and Lp(a) in NlDDM patients may play a role in the pathogenesis of peripheral vascular disease.