RISK FACTORS IN DIABETIC ANGIOPATHY: SPECIAL ROLE OF HbA1C
Terzić, M. Dilić, S. Pehar, A. Mlaćo, S. Kazić and A. Kurtćehajić
of Vascular Disease, Clinical Center University of Sarajevo,
Bosnia and Herzegovina
The role of multiple risk factors (MRF) in development of occlusive
arterial disease (AOD) in diabetics is well known from the literature.
Aim of the study is to show the value of score for multiple risk
factors, especially fibrinogen and HbA1C, in prediction and outcome
of diabetic angiopathy
Methods: Group of 61 diabetics (41 M, 20F) in various
stages of diabetic angiopathy, average age of 63.6 y and average
diabetes lasting 14.8 y was observed. Two groups were formed according
to AOD: group with insufficiency of arterial flow without ischaemia
(clinical stage Fontaine II)-20 pts. (32.8%), and group with clear
ischaemic changes, diabetic ulceration or gangrene (clinical stage
FIII/FIV)- 41 pts. (67.2%). We observed 9 clinical variables:
age, gender, hypertension (HTA), hyperlipoproteinemia (hlp), fibrinogen
(fib), HbA1C, coronary heart disease (CHD), obesity (obes) and
tobacco (tob). Patients were distributed as follows: age>60y 70.5%,
male 67%, HTA 47.5%, hlp 29.5%, fib 46% (average 14.21 nmol/l),
HbA1C above normal 90.2% (average 8.33%), CHD 56%, obes. 20% and
tob 52.5%. Score of MRF for entire group is 4.68 (X/9).
Results: Group of patients within clinical stage FII has score
of MRF of 4.9, average fibrinogen 12.16 nmol/l and HbA1C 7.66%.
After treatment result is convenient: clinical improvement in
17 pts. (85%), with no changes 3 (15%) and no one worsen. Group
of pts. within clinical stage FIII/FIV has score of MRF of 4.95,
but average fibrinogen 15.22 nmol/l and HbA1C 8.66%. After treatment
result is clinical improvement in 10 pts. (24.4%), with no changes
in 5 (12.2%) pts and 26 (63.4%) had lower limb amputation. In
a group with amputation observed parameters were worse: score
of MRF is 5.42, average fibrinogen 15.47 and HbA1C 8.84. Patients
with clinical improvement after treatment had score of MRF 4.37,
average fibrinogen was 12.91 nmol/l and HbA1C 8.0%.
Conclusion: According to clinical variables, group was in
a high risk. Values of fibrinogen and HbA1C were highly significant
in patients who had inconvenient outcome of their AOD, which correlate
with high score of MRF (5.42).