Impact of pre-operative glycated haemoglobin A1C level on 1-year outcomes of endovascular treatment in patients with critical limb ischemia in the course of diabetes mellitus

Folia Med Cracov. 2019;59(1):49-60.

Abstract

Introduction: Peripheral arterial occlusive disease (PAOD) is a disease with worldwide increasing occurrence. Diabetic patients are greatly exposed on the risk of PAOD and its complications. The aim of the study was to check the influence of preoperative HbA1C on the outcomes of patients with diabetes undergoing PAOD related endovascular treatment.

Material and methods: The study was conducted among 59 patients with PAOD referred from the diabetic foot outpatient for endovascular treatment. They were included in one-year observation based on follow-up visits in 1, 3, 6 and 12 months a er angioplasty and divided into 2 groups basing on their preoperative glycaemia. The clinical condition of the lower limbs was assessed by use of the Rutherford classification, ankle-brachial index (ABI) and toe-brachial index (TBI). Changes in patients' quality of life (QoL) were also evaluated.

Results: Reintervention within 12 months were less frequent in patients with HbA1C ≤8.0% than in HbA1C >8.0% patients (9.09% vs. 35.48%, p = 0.03). TBI of the treated limb was lower in patients with elevated than in patients with proper glycaemia at 6 month [0.2 (0.0-0.38) vs. 0.38 (0.31-0.46); p <0.008] and 12 month follow-up [0.17 (0.0-0.27) vs. 0.32 (0.25-0.38); p <0,001]. The rate of healed ulcerations after 6 months was higher in patients HbA1C ≤8.0% (45.0% vs. 16.13%; p = 0.02) and they had significantly greater improvement of QoL.

Conclusion: Results of this study shows that preoperative level of glycaemia is an important factor for long-term prognosis in diabetic patients with PAOD. Elevated HbA1C level decreases significantly long-term improvement of QoL in DM patients undergoing endovascular treatment.

Keywords: HBA1C; diabetes mellitus; endovascular treatment; peripheral arterial occlusive disease; quality of life.

MeSH terms

  • Aged
  • Angioplasty*
  • Ankle Brachial Index
  • Arterial Occlusive Diseases / therapy*
  • Computed Tomography Angiography
  • Diabetes Complications / therapy*
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / metabolism*
  • Endovascular Procedures
  • Female
  • Glycated Hemoglobin / metabolism*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Ischemia / therapy*
  • Longitudinal Studies
  • Lower Extremity / blood supply
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / therapy*
  • Preoperative Period
  • Prognosis
  • Prospective Studies
  • Quality of Life
  • Recurrence
  • Stents
  • Ultrasonography, Doppler

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human