Pulse Pressure and Prediction of Incident Foot Ulcers in Type 2 Diabetes
- Matteo Monami, MD, PHD,
- Maria Vivarelli, RN,
- Carla Maria Desideri, MD,
- Claudia Colombi, MD,
- Niccolò Marchionni, MD and
- Edoardo Mannucci, MD
- Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.
- Corresponding author: Matteo Monami, mmonami{at}libero.it
Abstract
OBJECTIVE To assess the relevance of pulse pressure as a predictor of foot ulcers in type 2 diabetic subjects.
RESEARCH DESIGN AND METHODS A cohort study was performed on a consecutive series of 1,945 type 2 diabetic outpatients without a foot ulcer at baseline. Incident foot ulcers were identified through the regional hospital discharge system, which contains ICD codes of current diagnoses.
RESULTS During a follow-up of mean ± SD 4.2 ± 2.2 years, 86 ulcers were observed. After adjusting for confounders, the highest quartiles of pulse pressure had a 2.39-fold (95% CI 1.14–5.02) risk of foot ulcers. When ischemic ulcers were considered separately, the highest pulse pressure quartile was associated with an increased age- and sex-adjusted risk (2.08 [95% CI 1.02–4.24]), whereas no increase of risk was observed for neuropathic ulcers.
CONCLUSIONS Elevated pulse pressure represents an independent predictor of foot ulcers in diabetic patients; this parameter should be considered for the stratification of risk of ischemic or neuroischemic ulcers.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received September 12, 2008.
- Accepted January 30, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
