Impact of Glucose Control and Regimen on Limb Salvage in Patients Undergoing Vascular Intervention
Moore, Johnston   (University of Alabama at Birmingham)
Mentor: Pearce, B.J. (University of Alabama at Birmingham)
Studies have demonstrated correlation between levels of glycosylated hemoglobin (HbA1c) in diabetic patients and the incidence of both peripheral artery disease and lower extremity amputation (AMP). However, the impact of these factors on outcomes in patients undergoing vascular intervention (VI) has not been examined. The purpose of this study is to assess the effect of glucose control and regimen on Amputation-Free Survival (AFS) in patients undergoing VI for limb salvage. Patients undergoing VI for limb salvage with a baseline HbA1c within one month of the intervention were identified from a prospectively maintained vascular registry queried from 2010-2017. A total of 306 limbs were retrospectively analyzed from 273 patients. The patients’ records were examined and instances of AMP, type of VI (ENDO v OPEN), baseline demographics, co-morbidities, and diabetic glycemic control modalities were recorded and subsequently analyzed with respect to the hypothesis. Patients’ diabetic status was determined by a combination of HbA1c, physician diagnosis, and usage of diabetic control medication. In our cohort we had 172 (56.2%) males and 125 (40.8%) non-whites. Poor AFS (AMP and/or death) was associated with non-white race (56.5%, p=0.006), dialysis (26.1%, p<0.001), diabetes (82.6%, p=0.002), and insulin diabetic control (57.6%, p<0.001). HbA1c was not found to be significantly associated with AFS. Survival analysis (Kaplan-Meier plots) revealed diagnosis of diabetes was significantly associated with worse outcomes regarding AFS in the whole cohort (Log rank=0.012) as well as in the chronic ischemia subgroup (Log rank=0.016) (Rutherford =3). Logistic regression analysis of the data shows an association between age (p=0.004, AOR=1.037), male gender (p=0.029, AOR=1.835), non-white race (p=0.044, AOR=0.580), dialysis (p=0.002, AOR=3.388), and insulin diabetic control (p=0.001, AOR=2.352) with worse AFS across all limbs surveyed. Dialysis was found to have a significant association with decreased AFS in all limbs, patients with CI, and diabetic patients with CI (p=0.001). The findings of this study suggest that diabetes severity requiring insulin control is significantly associated with worse VI outcomes. It is possible that modifying patients’ diabetic control regimen to include insulin sensitizing medications may lead to improved amputation free survival, but further data is necessary to support this speculation.