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Prospective study on clinical characteristics of Japanese diabetic patients with chronic limb-threatening ischemia presenting Fontaine stage IV

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Abstract

The aim of this prospective cross-sectional study was to reveal clinical characteristics of Japanese diabetic patients with chronic limb-threatening ischemia (CLTI) presenting ischemic unhealed ulcer/gangrene (Fontaine stage IV) in the real-world settings. The present study included 132 Japanese diabetic patients who underwent endovascular therapy for CLTI presenting Fontaine stage IV. The prevalence of diabetes-related complications, as well as prior history of ankle-brachial index (ABI) measurement before CLTI onset, was evaluated adopting multiple imputation (50 times). Duration of diabetes was referred to as time from diagnosis. The patients were aged 70 ± 10 years, with duration of diabetes 23 ± 12 years. The diabetes-related complications were so common that only 17% (95% confidence interval: 11–24%) and 25% (17–33%) of the population were free from advanced micro- and macroangiopathies, respectively. The clustering of advanced macroangiopathies was not significantly associated with duration of diabetes (P = 0.62). On the other hand, that of advanced microangiopathies was significantly positively associated with duration of diabetes (P = 0.004). However, even in patients with duration of diabetes < 10 years, as many as 63% (38–87%) of patients had at least one advanced microangiopathy. Only 31% (22–39%) of the patients had prior history of ABI measurement before CLTI onset. The history was inversely associated with age (P = 0.005). In conclusion, the advanced diabetes-related complications were highly prevalent, even in those whose diabetes was diagnosed less than a decade before. In addition, only a few patients had ever undergone ABI measurement before CLTI onset.

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Acknowledgements

This study was supported by a Grant-in-Aid (Nos. 201709007A and 201608012A) for Scientific Research from the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita City, Osaka, 565-0871, Japan

    Mitsuyoshi Takahara

  2. Cardiovascular Center, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo, 660-8511, Japan

    Shota Okuno, Izumi Nakamura, Osamu Iida, Takuya Tsujimura & Yosuke Hata

  3. Division of Metabolism and Biosystemic Science, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, 078-8510, Japan

    Yukihiro Fujita & Masakazu Haneda

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  1. Mitsuyoshi Takahara
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  2. Shota Okuno
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  3. Izumi Nakamura
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  4. Osamu Iida
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  7. Yukihiro Fujita
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  8. Masakazu Haneda
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Correspondence to Mitsuyoshi Takahara.

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Takahara, M., Okuno, S., Nakamura, I. et al. Prospective study on clinical characteristics of Japanese diabetic patients with chronic limb-threatening ischemia presenting Fontaine stage IV. Diabetol Int 11, 33–40 (2020). https://doi.org/10.1007/s13340-019-00399-5

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