Diabetic Microvascular Disease and Risk of Peripheral Artery Disease, Foot Ulcer, Leg Infection, and Amputation

Patients with diabetes are at risk for developing peripheral artery disease, foot ulcer, and amputation. We conducted this study to compare the risk of peripheral artery disease, foot ulcer, and amputation between patients with type 2 diabetes with and without microvascular disease.

We identified 1,013,154 patients aged 18 to 80 years and newly diagnosed with type 2 diabetes between January 1, 2008, and December 31, 2018, as the study participants. Cox proportional hazard models were used to compare the risk of diabetic foot disease between patients with and without diabetic kidney disease, diabetic retinopathy, and diabetic neuropathy.

Patients with more types of microvascular disease were associated with a further increased risk of peripheral artery disease, foot ulcer, leg infection, and amputation compared to those without microvascular disease (p for trend <0.001). Patients with diabetic retinopathy were associated with a significantly increased risk of peripheral artery disease (aHR [95% CI] 1.12 [1.08, 1.16]), foot ulcer (1.50 [1.28, 1.75]), and amputation (2.53 [1.59, 4.01]) compared to those without microvascular disease. Individuals with diabetic neuropathy had a significantly higher risk of peripheral artery disease (1.27 [1.24, 1.29]), foot ulcer (1.27 [1.16, 1.40]), and leg infection (1.16 [1.12, 1.21]) compared to those without microvascular disease.

This nationwide cohort study showed that patients with type 2 diabetes and microvascular disease were associated with a higher risk of peripheral artery disease, foot ulcer, leg infection, and amputation than those without microvascular disease.