Introduction: Patients with peripheral arterial disease (PAD) and coexisting diabetes mellitus (DM) have an increased rate of PAD progression and reduced walking performance as compared with non-diabetic PAD patients. It is unknown, however, whether patients with PAD and comorbid diabetes also experience worse PAD-specific health status (symptoms, functioning, quality of life) and what factors might mediate such a difference.
Methods: PORTRAIT is a 16-center international registry that includes patients with exacerbated or new-onset symptomatic PAD presenting to specialty clinics. We measured PAD-specific health status at the time of PAD evaluation, 3, 6 and 12 months using the Peripheral Artery Questionnaire (PAQ). Hierarchical, multivariable, repeated measures analysis was used to assess the association between DM and health status at baseline and over time. Sequential adjustments for demographics, socioeconomic factors, PAD severity, comorbidities, psychosocial characteristics, primary treatment strategy and quality of care were made.
Results: Of 1,204 patients, 398 patients had diabetes (33%, of whom 94% had Type II). Patients with PAD and DM had lower unadjusted PAQ summary scores at 0, 3, 6 and 12 months respectively (46.1 vs. 50.8, p < 0.001; 63.6 vs. 68.2, p < 0.01; 65.7 vs. 71.7, p < 0.001; 65.4 vs. 72.6, p <0.001). Patients with PAD and DM were more likely to be unemployed, depressed, of non-White race and to have more cardiovascular comorbidities, bilateral disease, non-healing ulcers and prior peripheral vascular interventions. When sequentially adjusting for relevant confounders, the effect for diabetes was mostly explained by comorbidities and psychosocial factors (Figure 1).
Conclusion: Patients with PAD and co-existing DM have poorer health status upon PAD diagnosis and the year thereafter as compared with those who do not have DM, potentially explained by a higher burden of clinical comorbidities and psychosocial factors. Future work will need to further evaluate whether more emphasis on psychosocial aspects of care in these patients can improve their PAD-specific health status.