Article: Complications Exercise treadmill testing in patients with claudication, with and without diabetes

Aim Tocomparesymptomsandwalkingcapacitiesofpatientswithandwithoutdiabetesreportingvascular-typeclaudication. Methods Werecordedself-reportedmaximalwalkingdistance,maximalwalkingdistanceontreadmilltest(3.2 km h )1 ,10% slope),exercisetranscutaneousoxygenpressureDROPindex[limbtranscutaneousoxygen pressure (TcpO2)changesfromrest minus chest TcpO2 changes from rest] and symptoms on treadmill in 230 patients with diabetes and 982 patients without diabetes. Exercise-induced proximal and distal symptoms were analysed in the perspective of underlying proximal and distal ischaemia (DROP value < negative 15 mmHg). Results Self-reported maximal walking distance did not differ between groups, whereas maximal walking distance on treadmill test was lower in patients with diabetes vs. patients without diabetes (261 257 and 339 326 m, respectively; P < 0.05whenadjustedforpotentialconfounders).Inpatientswithischaemia,thenumberofischaemicareas(proximaland ⁄or distal on right and ⁄or left) was comparable between the two groups. Patients with diabetes had more distal ischaemia than patients without diabetes (38 vs. 29%, respectively; P < 0.01), whereas proximal ischaemia was similar between groups. The prevalence of lower-limb exercise-related symptoms without ischaemia was comparable between groups. There were more symptoms other than lower-limb pain in patients with diabetes than patients without diabetes (29.6 vs. 18.3%, respectively; P < 0.01). Conclusions Patients with diabetes show more severe limitation on the treadmill and more non-limb symptoms than patients withoutdiabetes,althoughself-reportedwalkingcapacityiscomparablebetweenthetwogroups.UsingTcpO2,weconfirmthat patients with diabetes reporting claudication show more distal ischaemia than patients without diabetes, with no difference at the buttock level. Treadmill testing is of interest in patients with peripheral artery disease and diabetes.