Peripheral arterial disease in diabetic patients: A long-term population-based study on occurrence, outcomes and cost

BACKGROUND: Diabetes mellitus (DM) is a highly prevalent disease with severe long-term consequences, and a known risk factor for peripheral artery disease (PAD). These two diseases combined are responsible for high morbidity and mortality. The aim of this study is to investigate the burden of PAD in patients with DM, the effect of revascularization on outcomes, and geographical variation in the access to PAD courses of treatment. METHODS: From the healthcare claims of the Lombardy residents (16% of the Italian population) we identified diabetic patients with PAD as the study population, distinguishing between patients who received revascularization procedures (Revasc) and those who did not (NoRevasc). Patients were classified by sex, age, comorbidities, mortality, amputation received and direct healthcare cost. RESULTS: The DM with PAD study population consisted of 18,344 patients (61% male), aged on average 72 (±10.1) years. Most of them (64%) did not receive any revascularization procedures and 12% of the latter had at least one major amputation. The major amputation rate was significantly lower for the Revasc group when compared to the NoRevasc group. Geographical heterogeneity in DM and PAD occurrences as well as in revascularization procedures was detected in the area under study. CONCLUSIONS: The present study gives an up-to-date description of the dramatic epidemiologic and economic burden of PAD in diabetic subjects using a truly population-based data and longitudinal follow-up of up to 9 years. It represented a useful tool to evaluate the impact of revascularization and to provide evidence of different outcomes associated with different levels of access to services.