High Prevalence of Peripheral Arterial Disease and Low Treatment Rates in Elderly Primary Care Patients with Diabetes

S. Lange; C. Diehm; H. Darius; R. Haberl; J. R. Allenberg; D. Pittrow; A. Schuster; B. von Stritzky; G. Tepohl; H. J. Trampisch

doi:10.1055/s-2004-830408

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2004; 112(10): 566-573
DOI: 10.1055/s-2004-830408

Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

High Prevalence of Peripheral Arterial Disease and Low Treatment Rates in Elderly Primary Care Patients with Diabetes

S. Lange¹ , C. Diehm² , H. Darius³ , R. Haberl⁴ , J. R. Allenberg⁵ , D. Pittrow⁶ , A. Schuster⁷ , B. von Stritzky⁸ , G. Tepohl⁹ , H. J. Trampisch¹

¹Department of Medical Informatics, Biometry, and Epidemiology, University of Bochum, Bochum, Germany
²Department of Internal Medicine/Vascular Medicine, Affiliated Teaching Hospital, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
³Medical Clinic I, Klinikum Berlin-Neukölln, Vivantes Netzwerk für Gesundheit, Berlin, Germany
⁴Department of Neurology, Municipal Hospital München-Harlaching, Munich, Germany
⁵Department of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
⁶Department of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Dresden, Germany
⁷3P Consulting, Pöcking, Germany
⁸Medical Department, Sanofi-Synthelabo GmbH, Berlin, Germany
⁹Internist/Vascular Medicine, Munich, Germany

Abstract

Representative data on peripheral arterial disease (PAD) in community-based office practice are scarce while at the same time of high interest. Thus, we aimed to determine the prevalence of peripheral arterial disease (PAD), comorbidity of atherothrombotic manifestations, and treatment intensity among elderly diabetic patients in primary care.

In this monitored cross-sectional study, 344 general practitioners throughout Germany determined the ankle-brachial index (ABI) of 6880 consecutive, unselected patients aged 65 years or older with bilateral Doppler ultrasound measurements. PAD was defined according to the recent American Heart Association guidelines (using the higher of the 2 systolic ankle pressures: ABI < 0.9) or peripheral revascularisation, or amputation because of PAD. Coronary events (CAD) and cerebrovascular events (CVD) were taken from the patient's history without additional diagnostic measures. Diabetes was defined according to the clinical diagnosis of the physician and/or HbA1c ≥ 6.5 % and/or intake of oral antidiabetic medication and/or application of insulin.

1.743 patients were classified as diabetics: the median disease duration was 6 years (1st; 3rd quartile: 2; 11), median HbA1c 6.6 % (5.9; 7.3), mean age 72.5 ± 5.4 years, and 51.4 % were females. Diabetics had in comparison with non-diabetics a higher prevalence of PAD defined as ABI < 0.9 (26.3 % vs. 15.3 %, univariate odds ratio 2.0 [95 % confidence interval: 1.7; 2.3]), intermittent claudication (5.1 % vs. 2.1 %, OR: 2.5 [1.9; 3.4]), known CAD (16.1 % vs. 10.6 %, OR: 1.6 [1.4; 1.9]), and known CVD (6.8 % vs. 4.8 %; OR: 1.4 [1.2; 1.8]). 57.4 % of the diabetics with previously known PAD (as only atherothrombotic manifestation) received antiplatelet therapy (vs. 75.1 % with CAD and/or CVD only).

The ABI was suitable as screening measure in the primary care setting. In elderly diabetics in comparison to non-diabetics, the prevalence of PAD was very high. Despite the known benefits of antiplatelet therapy, PAD patients were less intensively treated than patients with CAD or CVD.

Key words

Peripheral arterial disease - diabetes - prevalence - atherosclerosis - coronary artery disease - cerebrovascular disease - cross sectional study

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PD Dr. Stefan Lange

Abteilung für Medizinische Informatik, Biometrie und Epidemiologie
Ruhr-Universität Bochum

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