Impact of diabetes on mortality in peripheral artery disease: a meta-analysis

Background There are accumulating studies showing the association between diabetes and all-cause mortality in peripheral vascular disease. However, the results in these studies are conflicting regarding the impact of diabetes on outcome. Hypothesis Diabetes is associated with increased risk of mortality in peripheral artery disease. Methods Using MEDLINE and Scopus, we searched for studies published before January 2016. Additionally, studies were identified by manual search of references of original articles or review studies on this topic. Of the 1072 initially identified records, 21 studies with 15,857 patients were included in the final analysis. Results Diabetes was associated with a statistically significant increased risk of all-cause mortality (odds ratio: 1.89, 95% confidence interval: 1.51-2.35, P < 0.001), without detected publication bias (Egger bias = 0.75, P = 0.631). The stronger effect on outcome was obtained in patients with critical limb ischemia (odds ratio: 2.38, 95% confidence interval: 1.22-4.63, P < 0.001) as the most severe form of peripheral vascular disease. Conclusions Diabetes is associated with an increased risk of mortality in peripheral vascular disease, and the effect is even more pronounced in patients with critical limb ischemia.