{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:20:25Z","timestamp":1790774425376,"version":"4.1.0"},"reference-count":35,"publisher":"American Diabetes Association","issue":"12","license":[{"start":{"date-parts":[[2016,11,22]],"date-time":"2016-11-22T00:00:00Z","timestamp":1479772800000},"content-version":"vor","delay-in-days":56,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/501100008966","name":"Soci\u00e9t\u00e9 Francophone du Diab\u00e8te","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008966","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100016395","name":"Association Diab\u00e8te Risque Vasculaire","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016395","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors of major macrovascular and microvascular events, death, and cognitive decline in this population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28\u20131.69], P &amp;lt; 0.0001), myocardial infarction (1.45 [1.13\u20131.87], P = 0.003), stroke (1.57 [1.23\u20132.00], P = 0.0003), cardiovascular death (1.61 [1.33\u20131.95], P &amp;lt; 0.0001), heart failure (1.49 [1.21\u20131.84], P = 0.0002), all-cause mortality (1.48 [1.29\u20131.71], P &amp;lt; 0.0001), major microvascular events (1.17 [1.00\u20131.36], P = 0.04), nephropathy (1.24 [1.00\u20131.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12\u20133.70], P = 0.02), and peripheral neuropathy (1.13 [1.05\u20131.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Absent dorsalis pedis and\/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc16-1594","type":"journal-article","created":{"date-parts":[[2016,9,28]],"date-time":"2016-09-28T02:19:01Z","timestamp":1475029141000},"page":"2270-2277","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":30,"title":["Absence of Peripheral Pulses and Risk of Major Vascular Outcomes in Patients With Type 2 Diabetes"],"prefix":"10.2337","volume":"39","author":[{"given":"Kamel","family":"Mohammedi","sequence":"first","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Woodward","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"The George Institute for Global Health, University of Oxford, Oxford, U.K."},{"name":"Department of Epidemiology, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Zoungas","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Harrap","sequence":"additional","affiliation":[{"name":"The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anushka","family":"Patel","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Marre","sequence":"additional","affiliation":[{"name":"INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France"},{"name":"Department of Diabetology, Endocrinology and Nutrition, Assistance Publique-H\u00f4pitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France"},{"name":"Universit\u00e9 Paris Diderot, Sorbonne Paris Cit\u00e9, UFR de M\u00e9decine, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chalmers","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2016,9,27]]},"reference":[{"key":"2022031222084223500_B1","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(16)00618-8","article-title":"Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants","volume":"387","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2016","journal-title":"Lancet"},{"key":"2022031222084223500_B2","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1056\/NEJMoa1008862","article-title":"Diabetes mellitus, fasting glucose, and risk of cause-specific death","volume":"364","author":"Seshasai","year":"2011","journal-title":"N Engl J Med"},{"key":"2022031222084223500_B3","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1056\/NEJMoa1504347","article-title":"Excess mortality among persons with type 2 diabetes","volume":"373","author":"Tancredi","year":"2015","journal-title":"N Engl J Med"},{"key":"2022031222084223500_B4","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1001\/archinte.164.13.1422","article-title":"The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up","volume":"164","author":"Almdal","year":"2004","journal-title":"Arch Intern Med"},{"key":"2022031222084223500_B5","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.amjcard.2015.12.057","article-title":"Comparison of long-term mortality for cardiac diseases in patients with versus without diabetes mellitus","volume":"117","author":"Cordero","year":"2016","journal-title":"Am J Cardiol"},{"key":"2022031222084223500_B6","first-page":"2215","article-title":"Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies [published correction appears in Lancet 2010;376:958]","volume":"375","author":"Sarwar","year":"2010","journal-title":"Lancet"},{"key":"2022031222084223500_B7","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1161\/CIRCULATIONAHA.115.016424","article-title":"Population-based study of incidence, risk factors, outcome, and prognosis of ischemic peripheral arterial events: implications for prevention","volume":"132","author":"Howard","year":"2015","journal-title":"Circulation"},{"key":"2022031222084223500_B8","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00125-015-3781-7","article-title":"Substantial reduction in the number of amputations among patients with diabetes: a cohort study over 16 years","volume":"59","author":"Rasmussen","year":"2016","journal-title":"Diabetologia"},{"key":"2022031222084223500_B9","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1038\/sj.eye.6701476","article-title":"Epidemiology of diabetic retinopathy and macular oedema: a systematic review","volume":"18","author":"Williams","year":"2004","journal-title":"Eye (Lond)"},{"key":"2022031222084223500_B10","doi-asserted-by":"crossref","first-page":"A7","DOI":"10.1053\/j.ajkd.2013.11.001","article-title":"US Renal Data System 2013 annual data report","volume":"63","author":"Collins","year":"2014","journal-title":"Am J Kidney Dis"},{"key":"2022031222084223500_B11","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2105\/AJPH.2011.300616","article-title":"Aging, diabetes, and the public health system in the United States","volume":"102","author":"Caspersen","year":"2012","journal-title":"Am J Public Health"},{"key":"2022031222084223500_B12","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1016\/S0140-6736(12)61728-0","article-title":"Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet 2013;381:628]","volume":"380","author":"Lozano","year":"2012","journal-title":"Lancet"},{"key":"2022031222084223500_B13","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1056\/NEJMoa1310799","article-title":"Changes in diabetes-related complications in the United States, 1990-2010","volume":"370","author":"Gregg","year":"2014","journal-title":"N Engl J Med"},{"key":"2022031222084223500_B14","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.300.2.197","article-title":"Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis","volume":"300","author":"Fowkes","year":"2008","journal-title":"JAMA"},{"key":"2022031222084223500_B15"},{"key":"2022031222084223500_B16","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1007\/s001250100612","article-title":"Study rationale and design of ADVANCE: Action in Diabetes and Vascular Disease\u2014Preterax and Diamicron MR Controlled Evaluation","volume":"44","author":"ADVANCE Management Committee","year":"2001","journal-title":"Diabetologia"},{"key":"2022031222084223500_B17","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/S0140-6736(07)61303-8","article-title":"Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial","volume":"370","author":"Patel","year":"2007","journal-title":"Lancet"},{"key":"2022031222084223500_B18","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1056\/NEJMoa0802987","article-title":"Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes","volume":"358","author":"Patel","year":"2008","journal-title":"N Engl J Med"},{"key":"2022031222084223500_B19","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1002\/sim.1802","article-title":"Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation","volume":"23","author":"Pencina","year":"2004","journal-title":"Stat Med"},{"key":"2022031222084223500_B20","doi-asserted-by":"crossref","first-page":"3333","DOI":"10.2337\/diacare.26.12.3333","article-title":"Peripheral arterial disease in people with diabetes","volume":"26","author":"American Diabetes Association","year":"2003","journal-title":"Diabetes Care"},{"key":"2022031222084223500_B21","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/PL00013177","article-title":"Distal pulse palpation: is it reliable","volume":"23","author":"Lundin","year":"1999","journal-title":"World J Surg"},{"key":"2022031222084223500_B22","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1136\/pmj.78.926.746","article-title":"Dorsalis pedis arterial pulse: palpation using a bony landmark","volume":"78","author":"Mowlavi","year":"2002","journal-title":"Postgrad Med J"},{"key":"2022031222084223500_B23","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1161\/01.ATV.16.8.978","article-title":"Medial artery calcification. A neglected harbinger of cardiovascular complications in non-insulin-dependent diabetes mellitus","volume":"16","author":"Lehto","year":"1996","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2022031222084223500_B24","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1161\/CIR.0b013e318276fbcb","article-title":"Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association","volume":"126","author":"Aboyans","year":"2012","journal-title":"Circulation"},{"key":"2022031222084223500_B25","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.1007\/s00125-009-1521-6","article-title":"Medial arterial calcification in diabetes and its relationship to neuropathy","volume":"52","author":"Jeffcoate","year":"2009","journal-title":"Diabetologia"},{"key":"2022031222084223500_B26","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1161\/01.CIR.71.3.516","article-title":"The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population","volume":"71","author":"Criqui","year":"1985","journal-title":"Circulation"},{"key":"2022031222084223500_B27","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/0895-4356(90)90164-K","article-title":"Diagnostic methods for peripheral arterial disease in the San Luis Valley Diabetes Study","volume":"43","author":"Hiatt","year":"1990","journal-title":"J Clin Epidemiol"},{"key":"2022031222084223500_B28","first-page":"38","article-title":"An absent pulse is not sensitive for the early detection of peripheral arterial disease","volume":"38","author":"Collins","year":"2006","journal-title":"Fam Med"},{"key":"2022031222084223500_B29","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/0002-8703(46)90228-1","article-title":"The incidence of palpable dorsalis and pedis and posterior tibial pulsations in soldiers; an analysis of over 1,000 infantry soldiers","volume":"32","author":"Silverman","year":"1946","journal-title":"Am Heart J"},{"key":"2022031222084223500_B30","doi-asserted-by":"crossref","first-page":"e346","DOI":"10.1016\/S0828-282X(10)70467-0","article-title":"The accuracy of the physical examination for the detection of lower extremity peripheral arterial disease","volume":"26","author":"Armstrong","year":"2010","journal-title":"Can J Cardiol"},{"key":"2022031222084223500_B31","article-title":"Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes","author":"Mohammedi","journal-title":"Diabetes Care"},{"key":"2022031222084223500_B32","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.atherosclerosis.2008.03.002","article-title":"Impact of peripheral arterial disease in patients with diabetes\u2014results from PROactive (PROactive 11)","volume":"202","author":"Dormandy","year":"2009","journal-title":"Atherosclerosis"},{"key":"2022031222084223500_B33","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jalz.2010.08.228","article-title":"Intracranial atherosclerosis as a contributing factor to Alzheimer\u2019s disease dementia","volume":"7","author":"Roher","year":"2011","journal-title":"Alzheimers Dement"},{"key":"2022031222084223500_B34","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1161\/STR.0b013e3182299496","article-title":"Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"42","author":"Gorelick","year":"2011","journal-title":"Stroke"},{"key":"2022031222084223500_B35","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1136\/jnnp-2014-310095","article-title":"Risk factors for predicting progression from mild cognitive impairment to Alzheimer\u2019s disease: a systematic review and meta-analysis of cohort studies","volume":"87","author":"Li","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/care.diabetesjournals.org\/syndication\/doi\/10.2337\/dc16-1594","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/39\/12\/2270\/544704\/dc161594.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/39\/12\/2270\/544704\/dc161594.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T00:22:34Z","timestamp":1647130954000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/39\/12\/2270\/31941\/Absence-of-Peripheral-Pulses-and-Risk-of-Major"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,27]]},"references-count":35,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2016,9,27]]},"published-print":{"date-parts":[[2016,12,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc16-1594","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9,27]]}}}