Association between retinopathy and impaired peripheral arterial circulation in insulin-dependent diabetic patients

This study was undertaken to investigate whether, in insulin-dependent diabetic patients, an association exists between microangiopathy (evaluated as retinopathy) and macroangiopathy (evaluated as impaired arterial circulation of the lower limbs). A total of 38 diabetic outpatients with either background (n = 25) or proliferative (n = 13) retinopathy, plus 18 diabetic outpatients of similar age (46.8 +/- 13.4 vs. 43.0 +/- 11.0 yrs) and duration of diabetes (16.8 +/- 5.8 vs. 14.8 +/- 15.1 yrs) without retinopathy were studied. Retinopathy was defined according to fluorescein angiography. The arterial circulation of the lower limbs was evaluated by the ankle/arm systolic pressure index with ultrasonic Doppler end-point detection and echo-Doppler examination of the pelvic vessels. The ankle/arm index was significantly lower in diabetic patients with retinopathy (0.98 +/- 0.16 vs. 1.12 +/- 0.11, p less than 0.002) and the percentage of persons with definitely impaired arterial circulation of the legs (ankle/arm systolic blood pressure less than 0.95) was significantly higher in this group (36.8% vs. 5.5%, p = 0.038). Of 14 patients with retinopathy and peripheral arterial disease, only three (21%) had detectable stenoses of the pelvic vessels. The overall profile of cardiovascular risk factors was similar in the two groups. The multivariate analysis indicated that retinopathy was the best correlate of impaired peripheral arterial circulation. In conclusion, in our study population, an association between retinopathy and impaired peripheral arterial circulation of the legs existed independently of major cardiovascular risk factors.