HbA1c and Peripheral Arterial Disease in Diabetes: The Atherosclerosis Risk in Communities study

Pathophysiology/Complications

HbA_1c and Peripheral Arterial Disease in Diabetes

¹Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
²Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
³Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
⁴Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota

Address correspondence and reprint requests to Elizabeth Selvin, PhD, MPH, Department of Epidemiologythe Welch Center for Prevention, EpidemiologyClinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205-2223. E-mail: lselvin{at}jhsph.edu

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Figure 1—
Risk of PAD-related hospitalizations by tertile of A1C (%) in people with diabetes during 10 years of follow-up (n = 1,894).

Table 1—

Characteristics of study population of people with diabetes by manifestations of PAD (n = 1,894)

	PAD
		No incident PAD	Intermittent claudication	Hospitalization, amputation, or revascularization	Low ABI
n	1,690	41	57	123
Male (%)	48	52	51	38
Age (years)	58 ± 5.7	60 ± 5.0	60 ± 5.1	58 ± 6.1
White (%)	60	78	61	59
Current smoking (%)	18.4	20.0	35.1	24.6
Pack-years of smoking	16.1 ± 23.4	27.7 ± 29.5	23.3 ± 23.9	18.9 ± 23.8
LDL cholesterol (mmol/l)	3.5 ± 1.0	3.4 ± 0.9	3.7 ± 0.9	3.6 ± 1.0
HDL cholesterol (mmol/l)	1.1 ± 0.4	1.0 ± 0.3	1.1 ± 0.2	1.1 ± 0.4
Systolic blood pressure (mmHg)	128 ± 19	125 ± 15	131 ± 22	131 ± 20
Hypertension medication (%)	45.9	43.9	54.4	60.2
BMI (kg/m²)	31.0 ± 5.9	30.2 ± 4.9	30.2 ± 6.	32.2 ± 6.3
Waist-to-hip ratio	0.97 ± 0.07	0.99 ± 0.06	0.98 ± 0.05	0.97 ± 0.07
Less than high school education (%)	31.6	39.0	36.8	38.2
Use of sulfonylurea (%)	21.9	46.3	17.5	22.8
Use of insulin (%)	16.0	19.5	31.6	17.1
A1C (%)	7.0 (2.1)	8.3 (2.2)	8.2 (2.5)	7.3 (2.1)

Table 2—

Tertiles of A1C different manifestations of PAD in people with diabetes

	A1C				P value for trend
		<5.9%	6.0–7.4%	>7.5%	P value for trend
n	651	611	632
Intermittent claudication cases (n = 41)
Model 1	1.00 (ref)	3.31 (1.19–9.21)	6.32 (2.37–16.85)	<0.001
Model 2	1.00 (ref)	3.14 (1.07–9.15)	4.55 (1.52–13.06)	0.007
Hospitalization, amputation, or revascularization cases (n = 57)
Model 1	1.00 (ref)	2.49 (1.09–5.72)	4.38 (1.98–9.68)	<0.001
Model 2	1.00 (ref)	2.73 (1.16–6.40)	4.56 (1.86–11.18)	<0.001
Low ABI cases (n = 123)
Model 1	1.00 (ref)	1.66 (1.05–2.63)	1.61 (1.01–2.58)	0.05
Model 2	1.00 (ref)	1.53 (0.95–2.47)	1.64 (0.94–2.87)	0.08

Data are RR (95% CI), unless otherwise indicated. Model 1: adjusted for age, sex, race, and ARIC field center. Model 2: adjusted for age, sex, race, and ARIC field center, LDL and HDL cholesterol, systolic blood pressure, hypertension medication use, diabetes medication, cigarette pack-years, smoking status (ever/never/former), waist-to-hip ratio, BMI, and education level.