DEVELOPMENT OF OCCLUSIVE ARTERIAL DISEASSE OF LOWER EXTREMITIES IN PATIENTS WITH DIABETES MELITUS TYPE 2 IN CORRELATION WITH HBA1C LEVEL AND INDPENDENT RISK FACTOR

Abstract

In clinical practice, the development of peripheral artery complications in the lower extremities is a significant issue among patients with type 2 diabetes. The progression of stenotic-occlusive disease can be predicted based on the SCORE risk factor assessment and HbA1c levels. Color Doppler findings are crucial for evaluating hemodynamic flow in the arteries of the lower extremities. Aim: To determine HbA1c levels in patients with stenotic-occlusive disease of the lower extremities, correlate risk factor scores and HbA1c levels in the progression of stenotic-occlusive disease, and assess the significance of elevated HbA1c levels in relation to the clinical grade of stenotic-occlusive disease. Patient and methods: The study included 113 patients with type 2 diabetes (52.1%) and 104 non-diabetic patients (47.9%) as the control group, making a total of 217 participants. Both groups were classified as high-risk due to the presence of independent risk factors such as hyperlipidemia, smoking, obesity, and arterial hypertension. When the cumulative SCORE risk factor for the total group of participants (n=217) was analyzed, the results indicated a high level of risk with statistical significance, p<0.0001.

Results: Patients with predominantly occlusive changes in the type 2 diabetes group had HbA1c values of 8.25%, which was significantly higher compared to those with stenotic changes, whose HbA1c values were 7.3% (p=0.002). According to the SCORE tables, a value >5% indicates high risk for developing cardiovascular disease, while a SCORE value of 7% was identified as a predictor for disease progression in patients with type 2 diabetes, with high significance (p=0.0001). In the non-diabetic group, lower values of peak systolic velocity (PSV) in the superficial femoral artery (p=0.051) were observed. In the type 2 diabetes group, PSV values in the profunda femoral artery were lower (p=0.053), while significantly lower PSV values were recorded in the anterior tibial artery (p=0.008). Occlusive disease of the lower extremity arteries was present in 89.6% of cases in the type 2 diabetes group, with 90 patients affected, which was significantly higher compared to stenotic disease (p<0.0001). Conclusion: Subjects in the DM2T group with dominant occlusive changes had significantly higher HbA1c values ​​compared to the HbA1c group with dominant stenotic changes p<0,002. The risk factor score for the examined group, DM2T, was 7% (SCORE of high cardiovascular risk), and in the control group, non-diabetics, it was 8%, and both groups are high risk. HbA1c can be a predictor for the development of occlusions on the arteries of the lower extremities in subjects with DM2T.4. DM2T group subjects with occlusive changes had high HbA1c values, ≥8.25.