Study Of Diabetic Macrovascular Diseases Diagnosed By The Combination Of Carotid And Lower Extremity Ultrasonography

Objective:To evaluate the prevalence of atherosclerosis detected by the combination of carotid and lower extremity ultrasonography in hospitalized newly diagnosed type2diabetic patients; to compare the value in diagnosis of atherosclerosis, using either carotid or lower limb ultrasound examination; and analysis the relationship between the different atherosclerosis type and the cardio-cerebrovascular events.Methods:Totally,407newly diagnosed type2diabetic patients (men259, women148) from the Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital between August2007and July2008were included. Both carotid and lower extremity atherosclerosis were assessed by Doppler ultrasound. Ultrasonographic assessments of intima-media thickness (IMT), plaques and stenosis in the carotid and lower limb arteries were evaluated. Carotid atherosclerosis was defined as the presence of atherosclerotic plaques in any carotid arteries segments. Lower limb atherosclerosis was defined as the presence of atherosclerotic plaques in any lower limb arteries segments. Diabetic atherosclerosis was defined as the presence of either the carotid atherosclerosis or lower extremity atherosclerosis. The prevalence of atherosclerosis was calculated. A kappa value was computed to document the agreement between the isolated carotid/lower limb atherosclerosis and diabetic atherosclerosis. Meanwhile, we compared the relationship between the different atherosclerosis type and the cardio-cerebrovascular events. SPSS17.0was applied for statistical analyses.Results:The prevalence of atherosclerosis in newly diagnosed type2diabetic was62.2%in all patients,61.0%in male and64.2%in female, respectively. There was no significant difference in the prevalence of atherosclerosis in patients between the sexes. The prevalence of atherosclerosis was significantly higher in the lower extremity arteries than in the carotid arteries (55.5%and33.9%, respectively, P<0.01). The kappa values for the agreement between the carotid/lower limb atherosclerosis and diabetic atherosclerosis were0.48/0.82(95%confidence interval0.22-0.42for the carotid and0.84-0.98for the lower extremity, respectively). After adjusting for age-and sex-related differences, the prevalence of cardio-cerebrovascular events in the patients with both carotid and lower extremity arterial atherosclerosis (15.3%) was significantly higher than that in the patients with either the carotid (3.70%) or lower extremity arterial atherosclerosis (6.1%)(all p<0.05).Conclusions:Carotid ultrasonography severely underestimates the prevalence of atherosclerosis in patients with type2diabetes. The combination of carotid and lower extremity ultrasound examination can significantly improve the detection of atherosclerosis in type2diabetes. Because the type2diabetics with both carotid and lower extremity atherosclerosis had the higher prevalence of cardio-cerebrovascular events than that of the patients with either the carotid or lower extremity arterial atherosclerosis, the combination of carotid and lower extremity ultrasound examination may help to identify the subjects who are at high risk of cardio-cerebrovascular events in newly diagnosed type2diabetes.