The Impact of Diabetes in Intermittent Claudication: A Prospective Cohort Study

Area of Science:

• Vascular Medicine
• Peripheral Artery Disease Research
• Clinical Outcomes

Background:

• Intermittent claudication (IC) significantly impacts lower limb function and quality of life.
• Identifying patients at high risk for disease progression is crucial for timely intervention.
• Current management strategies require refinement based on predictive factors for deterioration.

Purpose of the Study:

• To determine the lower-limb outcomes in patients diagnosed with intermittent claudication (IC).
• To identify significant predictors associated with the deterioration of lower limb health in IC patients.
• To assess the progression to chronic limb-threatening ischemia (CLTI) within a two-year timeframe.

Main Methods:

• Prospective observational cohort study involving 150 new patients with IC at a vascular surgery unit.
• Lower limb perfusion assessed via ankle-brachial index (ABI), toe-brachial index (TBI), Doppler analysis, and walking impairment questionnaire.
• Follow-up at 1 and 2 years to evaluate hemodynamic parameters, symptom severity, and clinical outcomes.

Main Results:

• Over 50% of the cohort experienced significant hemodynamic decline within two years.
• 23.3% of patients progressed to chronic limb-threatening ischemia (CLTI), characterized by rest pain or tissue loss.
• Predictors for deterioration included baseline ABI ≤ 0.5, TBI ≤ 0.39, infrapopliteal artery (IPA) disease, and elevated Hemoglobin A1c.

Conclusions:

• Patients with IC are at substantial risk of progressing to CLTI within two years.
• Infrapopliteal artery disease, low ankle/toe pressures, and uncontrolled diabetes triple the risk of adverse lower limb events.
• Early identification of high-risk patients may necessitate a paradigm shift in managing this vulnerable subgroup.