Health Status Implications for Comorbid Diabetes in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry
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Patients with peripheral artery 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, functional status, quality of life) and how that changes over time. The Patient-centered Outcomes Related to Treatment practices in peripheral Arterial disease: Investigating Trajectories (PORTRAIT) is a 16-center international registry that includes patients with exacerbated or new-onset symptomatic PAD presenting to specialty clinics. PAD-specific health status was measured at the time of initial PAD evaluation and 12 months later using the Peripheral Artery Questionnaire (PAQ). Multivariable linear regression, initially adjusted for demographics (partially adjustment) and then additionally adjusted for socioeconomic factors, PAD severity, comorbidities, psychosocial characteristics (fully adjusted), was used to assess the association between DM and health status at baseline and at 12 months. Interaction of diabetes with invasive PAD treatment on 12-month health status was tested to assess for the differential effect of treatment on follow-up health status by diabetes status. Of 1,204 patients, 397 patients had diabetes (96% Type II). Patients with PAD and DM had lower unadjusted PAQ summary scores at baseline, 3, 6 and 12 months, compared to patients with PAD without diabetes (46.1 vs. 50.8, p < 0.001; 63.6 vs. 68.2, p < 0.01; 65.6 vs. 71.7, p < 0.001; 65.3 vs. 72.6, p<0.001). After adjusting for age, sex, race and country; patients with diabetes had worse PAQ summary scores at baseline (mean difference= -4.04 (-6.58, -1.50), p <0.01) and at 12 months (mean difference= -6.06 (-9.13, -2.99), p<0.01). After additionally adjusting for socioeconomic, comorbidities, psychosocial characteristics and PAD severity (fully adjusted), the effect of diabetes on PAQ summary score at baseline (adjusted mean difference= -1.80 (-4.42, 0.82), p=0.18) and 12 months (adjusted mean difference= -2.11, (95% CI: -5.32, 1.11; p=0.20)) was no longer significant. There was no differential effect of invasive treatment on 12-month PAQ scores by patient diabetes status (diabetes*invasive treatment p≥0.32).In conclusion, patients with PAD and co-existing DM have poorer health status at initial visit and a year later. This finding was mostly explained by the differences in their socioeconomic, psychosocial, comorbidities and disease characteristics. Patients with diabetes and PAD experience similar improvement in health status with invasive PAD treatment as their non-diabetic counterparts. PAD patients with DM should be offered similar treatment options as those without DM as they have similar health status gains with time.
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Introduction -- Methodology -- Results -- Discussion -- Appendix
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M.S. (Master of Science)