The association between diabetes mellitus and the prevalence of intermittent claudication: the HUNT study

Abstract

The objective of this study was to investigate the association between diabetes mellitus (DM) and the prevalence of intermittent claudication (IC). Between 1995 and 1997, all residents aged 20 years or older in Nord-Trøndelag County, Norway were mailed an invitation to participate in a health survey (HUNT 2). A total of 19,712 participants aged 40–69 years old completed and returned the questionnaire included with the invitation. They also attended an examination where brachial blood pressure was measured and non-fasting venous blood was collected. The venous blood sample was subsequently analysed for concentrations of blood lipids. Responses to 12 questions on IC were previously tested against ankle blood pressure measurements (ABPI < 0.9) and the algorithm with the best test properties was used to identify individuals with IC. Participants reported a history of DM by simple questions in the questionnaire. Logistic regression analysis was then used to compute age-adjusted prevalence odds ratios for the association between exposure variables and the prevalence of IC. Potential confounding by smoking, blood lipids and brachial blood pressure was investigated in multivariate analyses. For both sexes IC was more common in individuals with DM (OR_women = 3.8, CI, 1.9–7.6; OR_men = 2.8, CI, 1.4–5.8) compared to participants without DM. Adjustment for smoking, blood lipids and brachial blood pressure did not substantially change these results. In conclusion, the prevalence of IC was more than three times higher in patients with DM compared to non-diabetic participants.

Keywords

diabetes mellitus epidemiology intermittent claudication prevalence

References

1 Jensen SA Vatten LJ Romundstad PR Myhre HO . The prevalence of intermittent claudication. Sex-related differences have been eliminated. Eur J Vasc Endovasc Surg 2003; 25: 209–212.

2 Tierney S Fennessy F Bouchier-Hayes D . The arterial organ in cardiovascular disease: ADAPT (arterial disease assessment, prevention, and treatment). BMJ 2000; 320: 1262–1265.

3 Adler AI Boyko EJ Ahroni JH Smith DG . Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care 1999; 22: 1029–1035.

4 Jeffcoate WJ van Houtum WH . Amputation as a marker of the quality of foot care in diabetes. Diabetologia 2004; 47: 2051–2058.

5 Diehm C Schuster A Allenberg JR . High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172: 95–105.

6 Evans JM Barnett KN Ogston SA Morris AD . Increasing prevalence of type 2 diabetes in a Scottish population: effect of increasing incidence or decreasing mortality. Diabetologia 2007; 50: 729–732.

7 Jensen SA Vatten LJ Nilsen TI Romundstad PR Myhre HO . The association between smoking and the prevalence of intermittent claudication. Vasc Med 2005; 10: 257–263.

8 Rosenbloom AL Joe JR Young RS Winter WE . Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999; 22: 345–354.

9 Al-Delaimy WK Merchant AT Rimm EB Willett WC Stampfer MJ Hu FB . Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Am J Med 2004; 116: 236–240.

10.

10 Population projections. National and regional figures, 1999–2050. Statistics Norway, 1999.

11.

11 Holmen J Midthjell K Krüger Ø Langhammer A Holmen T . The Nord-Trøndelag Health Study 1995–97 (HUNT 2): objectives, contents, methods and participation. Norsk Epidemiologi 2003; 13: 19–32.

12.

12 National Institute of Health, National Heart and Lung Institute. . Manual of Laboratory Operations: Lipid Research Clinics Program. Lipid and Lipoprotein Analysis 1975; 1: 75–628.

13.

13 Jensen SA Vatten LJ Romundstad PR Myhre HO . The prevalence of asymptomatic arterial obstruction in the lower extremities among men and women 60 to 69 years of age. Int Angiol 2003; 22: 340–343.

14.

14 Leng GC Fowkes FG . The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. J Clin Epidemiol 1992; 45: 1101–1109.

15.

15 Rose GA . The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ 1962; 27: 645–658.

16.

16 Criqui MH Fronek A Klauber MR Barrett-Connor E Gabriel S . The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 1985; 71: 516–522.

17.

17 Rose G McCartney P Reid DD . Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med 1977; 31: 42–48.

18.

18 Kannel WB Skinner JJ Schwartz MJ Shurtleff D . Intemittent claudication. Incidence in the Framingham Study. Circulation 1970; 41: 875–883.

19.

19 Kannel WB McGee DL . Diabetes and cardiovascular disease. The Framingham study. JAMA 1979; 241: 2035–2038.

20.

20 Jensen SA Vatten LJ Myhre HO . The prevalence of chronic critical lower limb ischaemia in a population of 20,000 subjects 40–69 years of age. Eur J Vasc Endovasc Surg 2006; 32: 60–65.

21.

21 Jensen SA Vatten LJ Nilsen TI Romundstad PR Myhre HO . Serum lipids and anthropometric factors related to the prevalence of intermittent claudication. Eur J Vasc Endovasc Surg 2005; 30: 582–587.

22.

22 Sigal RJ Kenny GP Wasserman DH Castaneda-Sceppa C White RD . Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 1433–1438.