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Home > Vascular Annual Meeting > PVSS19. Only Insulin Use Is Associated with Poorer...

PVSS19. Only Insulin Use Is Associated with Poorer Limb Salvage and Survival in Diabetic Patients with Chronic Limb Ischemia

Hasan H. Dosluoglu, MD; Purandath Lall, MD; Linda M. Harris, MD; Maciej L. Dryjski, MD
VA Western NY Healthcare System, SUNY at Buffalo, Buffalo, NY

OBJECTIVES: Our goal was to compare the outcomes in patients with disabling claudication (DC) or critical limb ischemia (CLI) in order to see if diabetics (DM) have poorer patency and limb salvage (LS) rates than non-DM, and how the treatment regimen affects these outcomes.

METHODS: All patients who presented with DC or CLI between 06/2001-09/2008 were included. Non-DM patients were compared to those with DM who are currently managed by diet only or oral medications (D-OM), oral medications plus insulin (OM+INS) or insulin (INS).

RESULTS: Of the 746 patients (886 limbs) there were 446 limbs in non-DM, 135 in D-OM, 118 in OM+INS, and 187 in INS groups. There were more patients with CAD, htn, and renal insufficiency (RI) in DM than non-DM, with INS having the highest RI/dialysis (46%/20%). Gangrene and foot sepsis were significantly more in patients in OM+INS (45%/3%) and INS (50%/6%) than non-DM (15%/0.2%) and D-OM groups (25%/1%, p<0.001). More patients in INS (14%) and OM+INS (9%) had primary amputation than non-DM (4%) and D-OM (4%, p<0.01). Overall survival following revascularization was similar in D-OM and non-DM, and OM+INS and INS, the latter group being significantly worse (p<0.001). LS rate in D-OM and non-DM was also identical, whereas OM-INS and INS had significant worse LS, with OM-INS marginally better than INS (p=0.091, Figure). PP was worse in EV treated patients on insulin than non-DM and D-OM patients (p<0.001), whereas PP was similar between groups in open-treated patients. Multivariate analysis showed that CAD, RI, COPD, insulin use, functional capacity, statin drug use and need for infrapopliteal interventions independently predicted survival, whereas insulin use, gangrene, need for infrapopliteal interventions and nonambulatory status predicted limb loss.

CONCLUSIONS: Diabetic patients who present with limb ischemia can be subgrouped into three distinct subgroups based on their diabetic regimen. The survival and LS rates of those controlled with diet or OM are nearly identical to non-diabetics, both of which are significantly better than OM+INS or INS. The PP rate in EV-treated patients are worse in patients who are on insulin. Being on insulin independently predicts survival and limb loss.

AUTHOR DISCLOSURES: H.H. Dosluoglu, None; P. Lall, None; L.M. Harris, None; M.L. Dryjski, None.

Table 1.

Figure 1.