title: Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty.
abstract: Diabetes mellitus (DM) is a significant risk factor for loss of patency after endovascular intervention, but the contribution of glycemic control to infrapopliteal artery patency among patients with DM is unknown. All percutaneous infrapopliteal interventions among patients with DM from 2006 to 2013 were reviewed and pre-procedure fasting blood glucose (FBG) was recorded. The primary endpoint was primary patency at 1 year as determined by duplex ultrasound. A total of 309 infrapopliteal lesions in 149 patients with DM were treated with balloon angioplasty during the study period. The median FBG was 144 mg/dL. At 1 year, the rate of primary patency was 16% for patients with FBG above the median, compared to 46% for patients with FBG below the median (hazard ratio (HR) 1.82 for FBG ≥144, p=0.005). Amputation rates at 1 year trended higher among patients with high versus low FBG (24% vs 15%, p=0.1). One year major adverse limb event rates were also higher for patients with high versus low FBG (35% vs 23%, p=0.05). Although patients with high FBG were more likely to have insulin-requiring DM (73% vs 50%, p=0.003) the association of high FBG with loss of primary patency remained significant even after adjusting for insulin use as well as other lesion-specific characteristics (adjusted HR 1.8, 95% CI 1.2-2.8). In conclusion, high fasting blood glucose at the time of infrapopliteal balloon angioplasty is associated with significantly decreased primary patency and may also be a risk factor for major adverse limb events among patients with a threatened limb.
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Satinder
authors.initials: S
authors.lastname: Singh
authors.affiliation: Division of Cardiology, University of Colorado and VA Eastern Colorado Healthcare System, Denver, CO, USA.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Sherif
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Bejan
authors.initials: B
authors.lastname: Alvandi
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Westin
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Gagan D
authors.initials: GD
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Ezra A
authors.initials: EA
authors.lastname: Amsterdam
authors.affiliation: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, CA, USA john.laird@ucdmc.ucdavis.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
keywords: balloon angioplasty; critical limb ischemia; diabetes; fasting blood glucose; percutaneous intervention; peripheral artery disease