Temporal trends regarding clinical impact of diabetes mellitus on peripheral artery disease
Authors: Schmitt V , Hobohm L , Vosseler M , Brochhausen C , Munzel T , Espinola-Klein C , Keller K 
Published: October 2022

Abstract

Introduction
Patients with peripheral artery disease (PAD) and Diabetes mellitus (DM) suffer from higher morbidity and mortality rates compared to non-diabetic PAD patients. Huge efforts are made to improve medical care of patients with DM including chronic disease programs.

Purpose
To investigate temporal trends of the clinical burden of DM on PAD patients between the years 2005 and 2019.

Methods
All patients hospitalized due to PAD between 2005 and 2019 in Germany based on the diagnosis related groups [DRG] system were stratified according to presence or absence of DM (source: Federal Statistical Offices of Germany, DRG statistics 2005–2019 and own calculations). Morbidity and mortality of both groups were compared in time trend.

Results
The number of hospitalisations due to PAD increased from 142,778 in the year 2005 to 190,135 in 2019 (β 3956 per year [95% CI 3034–4878], P&lt;0.001). In the same period also the amount of PAD patients with additional diagnosis of DM inclined (2005: 41,609 patients corresponding 29.1% of all PAD patients vs. 2019: 65,302 patients corresponding 34.3% of all PAD patients; β 2019 per year [95% CI 1593–2446], P&lt;0.001). While the portion of patients with type 1 DM decreased during the observational period (β −1.43 [95% CI −1.49 to −1.37]; P&lt;0.001), type 2 DM was progressive (β 2.27 [95% CI 2.23–2.32]; P&lt;0.001). PAD patients with DM suffered from lower rates of pulmonary embolism (β −0.64 [95% CI −0.89 to −0.40]; P&lt;0.001) and intracerebral bleeding (β −0.45 [95% CI −0.94 to 0.04]; P=0.072) in the last years of the investigation period, whereas the amount of patient-cases with pneumonia (β 0.29 [95% CI 0.23–0.35]; P&lt;0.001), shock (β 0.75 [95% CI 0.66–0.84]; P&lt;0.001) and gastrointestinal bleeding (β 0.33 [95% CI 0.20–0.46]; P&lt;0.001) increased. Fortunately, less amputations had to be performed in diabetics over time (amputations regardless of minor or major amputations: β −0.42 [95% CI −0.44 to −0.40]; P&lt;0.001; minor amputations: β −0.03 [95% CI −0.06 to −0.01]; P=0.015; major amputations: β −1.24 [95% CI −1.28 to −11.20]; P&lt;0.001) and in-hospital mortality decreased during the observational-time (2005: 4.7%, 2019: 2.8%; β −0.64 [95% CI −0.69 to −0.59]; P&lt;0.001). Despite the improvement in morbidity and mortality within the investigated time period, diabetics with DM were still associated with increased risk for morbidity and mortality compared to PAD patients without DM.

Conclusions
We observed an improvement regarding morbidity and mortality in hospitalized PAD patients with DM in Germany within the investigation period between 2005 and 2019. However, DM remained to be associated with increased morbidity and mortality compared to non-diabetics. Hence, despite the achieved improvements within the period 2005 to 2019, DM still represents an outstanding risk factor for morbidity and mortality in patients with PAD.

Funding Acknowledgement
Type of funding sources: None.