SOURCE: Mohammedi K, Woodward M, Zoungas S, et al. Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes. Diabetes Care 2016;39:2270-2277.
Cardiovascular disease is the most common cause of death for patients suffering from type 2 diabetes. Even though it is also common for type 2 diabetes patients to suffer from dyslipidemia and hypertension, the cardiovascular disease risk is disproportionate to these burdens. How might we better identify type 2 diabetes patients who are at particularly high risk?
Creators of the ADVANCE trial enrolled type 2 diabetes patients (n = 11,120) and compared tight vs. standard glucose control for cardiovascular disease outcomes. However, the authors were unable to confirm any macrovascular benefit of tight control.
At enrollment into ADVANCE, researchers sought and recorded peripheral pulses (dorsalis pedis and posterior tibial, bilaterally) on physical exam.
Over a median of five years of follow-up, absence of either pulse predicted increased risk for myocardial infarction, stroke, cardiovascular death, heart failure, and all-cause mortality.
The absence of either of the pulses had similar predictive value, and risk of adversity increased with the number of missing pulses.
Diabetic patients deserve our best efforts to prevent, forestall, or mitigate cardiovascular events. The simple clinical maneuver of peripheral pulse palpation can help us identify a subgroup of type 2 diabetes patients who are at measurably increased risk.