Older Age, Diabetes Duration, and CAD Are Leading Risk Factors for PAD in Patients With T2DM

diabetic woman testing glucose
A mature diabetic woman checking her blood sugar levels at home.
Researchers report the results of a systematic review assessing risk factors for peripheral artery disease in populations with type 2 diabetes.

The following article is a part of conference coverage from the American Association of Clinical Endocrinology Annual Meeting 2021: ENVISION, being held virtually from May 26 to May 29, 2021. The team at Endocrinology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the AACE Annual Meeting 2021: ENVISION.


Factors contributing significantly to the risk for peripheral arterial disease (PAD) among patients with type 2 diabetes include age ≥70 years, diabetes duration ≥5 years, history of coronary artery disease (CAD), hypertension, and increased low-density lipoprotein (LDL) level, according to research presented at the 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021).

Investigators conducted a systematic and comprehensive review of the risk factors for PAD in populations with type 2 diabetes and assessed the pooled effect estimates. They conducted literature searches on PubMed/MEDLINE, EMBASE, and ProQuest through October 10, 2020, to identify risk factors including age, sex, duration of diabetes, hypertension, history of CAD or stroke, obesity, glycated hemoblogin (HbA1c) level, estimated glomerular filtration rate, dyslipidemia, smoking, and fibrinogen level.

The researchers included 10 studies in the qualitative synthesis and 9 studies in the meta-analysis. A total of 6 cohort studies included 71,450 patients, and 4 case-control studies included 2393 patients. All the included studies were of good quality with a low risk of bias.

One study found a lower risk for PAD among patients who had HbA1c ≤7.4% (hazard ratio [HR] 0.67; CI 95%, 0.53-0.86) and blood pressure ≤145/85 mm Hg (HR 0.81; CI 95%, 0.66-0.99) during their first year of treatment. Another study found a higher risk of PAD in women (HR 1.86; CI 95%, 1.33-2.59; P <.001).

The pooled effect estimate (odds ratio [OR]) for the 2 studies that found age ≥70 years to be a risk factor for PAD was 3.44. The OR in 2 studies that found diabetes duration greater than 5 years as a risk factor for PAD was 1.81. The OR in 3 studies that found a history of CAD as a risk factor for PAD was 1.55. The OR in 8 studies that found hypertension as a risk factor for PAD was 1.43. In 2 studies that found increased LDL as a risk factor for PAD, the study authors reported a subtotal OR of 2.51.

Considering the numerous factors that contribute to the increased risk of developing PAD in the setting of type 2 diabetes, a multidisciplinary approach has the potential to improve outcomes in this population.

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Rosana M, Saragih N, Soewondo P, et al. Risk factors of peripheral arterial disease in type 2 diabetes mellitus patients: a systematic review and meta-analysis. Presented at: 2021 AACE Virtual Annual Meeting, May 26-29, 2021.