title: No association of diabetic duration or insulin use with the prognosis of critical limb ischemia after endovascular therapy.
abstract: OBJECTIVE
  To examine whether diabetic duration and insulin use are independently associated with the prognosis of critical limb ischemia (CLI) after endovascular therapy.
  
  
  METHODS
  We recruited 312 Japanese patients who underwent endovascular therapy for CLI. The outcome measures were major amputation and mortality. Cox proportional hazards regression analyses were performed.
  
  
  RESULTS
  The prevalence of diabetes mellitus (DM) was 69%, and 47% of the DM population were treated with insulin. DM patients with insulin use had hemoglobin A1c (HbA1c) of 7.5 ± 1.3% and diabetic duration of 21 ± 11 years, whereas those without insulin use had HbA1c of 6.6 ± 1.4% and diabetic duration of 19 ± 11 years. Follow-up period was 93 ± 72 weeks; 55 patients underwent major amputations and 102 died. Diabetic duration and insulin use had significant associations with major amputation in each univariate model, with an unadjusted hazard ratio (HR) and 95% confidence interval (CI) of 1.019 [1.000, 1.039] in one-year increments and 2.321 [1.368, 3.938], respectively. In the multivariate model, however, diabetic duration and insulin use were not significantly associated with limb prognosis, as HbA1c level was, with an adjusted HR [95% CI] of 1.332 [1.114, 1.593] in 1% increment. Mortality had no statistical association with any of these DM-related variables.
  
  
  CONCLUSIONS
  Diabetic duration and insulin use were not independent risk factors for the prognosis of CLI after endovascular therapy.
authors.affiliation: Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Takahara
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneto
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Naoto
authors.initials: N
authors.lastname: Katakami
authors.forename: Fumie
authors.initials: F
authors.lastname: Sakamoto
authors.forename: Taka-aki
authors.initials: TA
authors.lastname: Matsuoka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ikeda
authors.forename: Iichiro
authors.initials: I
authors.lastname: Shimomura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007511:Ischemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D007328:Insulin