Progression of atherosclerosis in diabetics

Two hundred seventy-four diabetic patients were studied over a 2-year period to evaluate the progression of lower extremity atherosclerotic occlusive disease (ASO). At initial evaluation, ASO was noted in 98 patients (36%). Incidence of new or more severe disease was noted in 92 patients (34%) at follow-up. Increased age, longer duration of diabetes, lower percent ideal body weight, elevated systolic blood pressure, and elevated serum cholesterol levels were all significantly associated with disease progression. Patients with disease progression were found to have significantly lower nerve motor velocities and sensory conduction, higher serum creatinine levels, and a higher prevalence of retinopathy, proteinuria, and carotid artery disease (perhaps indicating concomitant neuropathy and microvascular disease). Diastolic pressure, race, fasting and postprandial glucose, fasting and postprandial insulin, fasting and postprandial C peptides, and glycosylated hemoglobin levels did not correlate with disease progression. The strongest prognostic indicator of disease progression appeared to be preexisting disease. Significant disease progression over a relatively short period indicates that treatment of the diabetic patients who have symptoms should be early and aggressive.