Analysis Of Factors Related To Progression Trend Of Lower Extremity Arterial Disease In Type 2 Diabetic Mellitus

Background:In recent years,several studies show that,the incidence of diabetes has risen sharply and tends to be younger.Diabetes complicated with macrovascular disease is the primary cause of death and disability in diabetic patients which is a major contributor to global mortality.Arterial disease of lower extremity is an important branch of macrovascular disease that is also the leading cause of non-traumatic lower limb amputations.The unsatisfactory diagnosis and treatment in China are in sharp contrast to the increasing annual incidence rate of diabetic lower extremity arterial disease in China.Up till now,the risk management of lower extremity arterial diseases in Type 2 diabetes in China is still running big risks.It is still in the absence of effective prevention and screening measures.Therefore,the occurrence and development of diabetic lower limb vascular lesions is important in clinical which may effectively reduce damage on physical and psychological.Guiding early prevention,early screening of lower limb vascular diseases and follow-up clinical diagnosis and treatment of diabetes patients would be significant to analyze the factors influencing the development and progression of lower extremity arterial diseases in type 2 diabetes.Purpose:To investigate the risk factors and predictive value of lower extremity arterial diseases in type 2 diabetes through a retrospective study.And providing more evidence for early clinical screening of lower extremity arterial diseases in type 2 diabetes and identification of high-risk population.We aim to provide more theoretical support for delaying the occurrence of lesions,guiding clinical diagnosis and treatment and improving the quality of life of patients.Method:We chose 190 T2DM patients admitted to the Department of Endocrinology of the Liaoning province people’s hospital from May 2016 to October 2019.All the patients were not associated with diabetic lower extremity arterial diseases at the first visit.After 36±3 months observation period,according to the progress of lower extremity atherosclerosis,the selected patients were divided into LEAD combined group and non-LEAD group.We collected and compared the clinical data,biochemical parameters and lower limb nerve conduction velocity between the two groups.Statistical software SPSS 25.0 was used to analyze the collected data.Binary logistic regression analysis was performed for factors with differences between groups.We screened the risk and protective factors for LEAD in T2DM patients and quantified the relationship between risk factors and LEAD.Finally,ROC curve was drawn,and AUC area was calculated to evaluate the predictive value of risk factors for lower extremity arterial diseases in type 2 diabetes.The nomogram prediction model is established by R software and RStudio,and the correction curve is used to evaluate the authenticity and effectiveness of the prediction model.Results:(1)190 T2DM patients were included in this study.After the observation period,127 patients(66.8%)with LEAD and 63 patients(33.2%)without LEAD were screened.(2)Compared with the non-LEAD group,the LEAD group had higher age(P=0.003),number of return visits(P=0.027),HbA1c(P=0.001),LDL-C(P<0.001)and NLR(P<0.001).The IBil(P=0.01)of LEAD group was lower than that of non-LEAD group,and the difference was statistically significant.(3)Binary logistic regression analysis showed that with the increase of age,HbA1c,LDL-C and NLR values,the risk of LEAD in T2DM patients increased(P < 0.05),while IBil was negatively correlated with lower extremity arterial diseases of diabetes mellitus(P < 0.05),which was a protective factor of LEAD.(4)ROC curve analysis indicated that LEAD was more likely to occur in T2DM patients with age > 48.5 years,HbA1c > 7.75%,LDL-C > 2.925 mmol/L,NLR > 1.5895,and IBil < 10.15μmol/L.(5)Age,HbA1c,LDL-C and IBil were 0.627,0.651,0.687 and 0.627 for predicting LEAD in T2DM patients,respectively.These four risk factors had a slightly lower value as independent risk factors in predicting T2DM+LEAD.The AUC of NLR in predicting LEAD occurrence in T2DM patients was 0.701,which was higher than age,HbA1c,LDL-C and IBil.The AUC of the area under the ROC curve predicted by five related factors is 0.777.The predictive value of T2DM+LEAD alone is lower than that of multiple factors combined.(6)A nomogram based on logistic regression model to predict the occurrence of LEAD in T2DM patients was constructed to facilitate clinical prediction application,and the calibration curve was in consistent with the prediction curve.Conclusion:Age,increase of HbA1c,LDL-C,NLR and decrease of IBil are risk factors for lower extremity vascular diseases in type 2 diabetes patients.For LEAD,it is affected by a combination of risk factors.The value of single factor in predicting the diagnosis of T2DM+LEAD is lower than the combined prediction of the above five factors.The predictive value of NLR for type 2 diabetes is higher than that of age,HbA1c,LDL-C and IBil,and the value of the above four risk factors as independent risk factors for predicting lower limb vascular lesions in type 2 diabetes is slightly lower.The predictive nomogram model can be used as an aid for clinical prediction of T2DM+LEAD,and the calibration curve suggests that the results are stable and reliable.