Abstract Background: Over 100 million people in the United States (U.S.) have diagnosed diabetes or pre-diabetes. People with this condition are at an increased risk of Peripheral Arterial Disease (PAD). There is a high prevalence of people with risk factors of diabetes especially in the rural Central Appalachia region. People with diabetes are at a higher risk of developing atherosclerosis, which is the most common cause of PAD. Although about 20–30% of 12 million people affected with PAD in the U.S. have diabetes, little is known about diabetes in PAD patients in Central Appalachia. Therefore, this study aimed to examine the risk factors of diabetes in patients with PAD within the Central Appalachian region. Methods: The study population consisted of patients with PAD with medical comorbidities of Cardiovascular disease (CVD). All patients were admitted to a large health system in Central Appalachia between 2008 and 2018. 13,455 index cases were extracted from the Electronic Medical Records (EMR) using the ICD-9 and ICD-10 codes. With diabetes as the outcome variable under study, the risk factors included Myocardial Infarction (MI) history, hypertension, smoking status and hypercholesterolemia. Socio-demographic variables considered in the study included gender, age, ethnicity and marital status and the covariates were Body Mass Index (BMI), Low density lipoproteins (LDL), High density lipoproteins (HDL), Total Cholesterol, and Triglycerides (TG). Multivariable logistic regression was performed to examine potential risk factors of diabetes in PAD patients. Results: The results showed that BMI {OR =1.056 (CI: 1.039, 1.073)}, HDL {OR =0.980 (CI: 0.965, 0.995)}, TG {OR=1.003 (CI: 1.001, 1.005)}, MI history {OR= 1.375 (CI: 1.111, 1.703)}, hypertension {OR=2.822 (CI: 1.804, 4.415)} and smoking {OR =0.802(CI: 0.641, 1.003)} were significant for diabetes in known PAD. To control for potential confounders, Stratification was used. Among males and females with PAD, diabetes was associated with last BMI, MI, hypertension and TG. HDL seemed to be negatively associated with hypertension and female diabetics while smoking seemed to be negatively associated in males. Upon stratification with hypertension, diabetes in PAD patients was significant with BMI, TG, MI history and HDL. After stratification with MI, diabetes in PAD female patients was associated with BMI, and previous MI history. On the other hand, patients without MI had an elevated TG level and an increased risk of hypertension. Conclusion: CVD risk factors are strongly associated with PAD comorbidities, which are worsened in the presence of diabetes. We suggest that hospitals and health care systems should strongly control for the risk factors of diabetes and adopt a multi-risk-factor approach for improving health outcomes for PAD patients.

Background: Over 100 million people in the United States (U.S.) have diagnosed diabetes or pre-diabetes. People with this condition are at an increased risk of Peripheral Arterial Disease (PAD). There is a high prevalence of people with risk factors of diabetes especially in the rural Central Appalachia region. People with diabetes are at a higher risk of developing atherosclerosis, which is the most common cause of PAD. Although about 20–30% of 12 million people affected with PAD in the U.S. have diabetes, little is known about diabetes in PAD patients in Central Appalachia. Therefore, this study aimed to examine the risk factors of diabetes in patients with PAD within the Central Appalachian region. Methods: The study population consisted of patients with PAD with medical comorbidities of Cardiovascular disease (CVD). All patients were admitted to a large health system in Central Appalachia between 2008 and 2018. 13,455 index cases were extracted from the Electronic Medical Records (EMR) using the ICD-9 and ICD-10 codes. With diabetes as the outcome variable under study, the risk factors included Myocardial Infarction (MI) history, hypertension, smoking status and hypercholesterolemia. Socio-demographic variables considered in the study included gender, age, ethnicity and marital status and the covariates were Body Mass Index (BMI), Low density lipoproteins (LDL), High density lipoproteins (HDL), Total Cholesterol, and Triglycerides (TG). Multivariable logistic regression was performed to examine potential risk factors of diabetes in PAD patients. Results: The results showed that BMI {OR =1.056 (CI: 1.039, 1.073)}, HDL {OR =0.980 (CI: 0.965, 0.995)}, TG {OR=1.003 (CI: 1.001, 1.005)}, MI history {OR= 1.375 (CI: 1.111, 1.703)}, hypertension {OR=2.822 (CI: 1.804, 4.415)} and smoking {OR =0.802(CI: 0.641, 1.003)} were significant for diabetes in known PAD. To control for potential confounders, Stratification was used. Among males and females with PAD, diabetes was associated with last BMI, MI, hypertension and TG. HDL seemed to be negatively associated with hypertension and female diabetics while smoking seemed to be negatively associated in males. Upon stratification with hypertension, diabetes in PAD patients was significant with BMI, TG, MI history and HDL. After stratification with MI, diabetes in PAD female patients was associated with BMI, and previous MI history. On the other hand, patients without MI had an elevated TG level and an increased risk of hypertension. Conclusion: CVD risk factors are strongly associated with PAD comorbidities, which are worsened in the presence of diabetes. We suggest that hospitals and health care systems should strongly control for the risk factors of diabetes and adopt a multi-risk-factor approach for improving health outcomes for PAD patients.