# Differences Between Brachial-Ankle Pulse Wave Velocity and Lower Leg Circumference Ratio in Patients With and Without Type 2 Diabetes Mellitus

## TL;DR

This study found that leg circumference ratio is linked to arterial stiffness in type 2 diabetes patients, suggesting it could be used as a simpler alternative to pulse wave velocity measurements.

## Contribution

The study identifies a novel association between leg circumference ratio and arterial stiffness specifically in type 2 diabetes patients.

## Key findings

- A decreased lower leg circumference ratio was significantly associated with increased brachial-ankle pulse wave velocity in type 2 diabetes patients.
- The interaction between leg circumference ratio and T2DM status was significantly associated with arterial stiffness measurements.
- No significant relationship was found between leg circumference ratio and arterial stiffness in non-diabetic individuals.

## Abstract

Background

Vascular endothelial dysfunction in type 2 diabetes mellitus (T2DM) patients causes atherosclerosis and microvascular damage. This study investigated the relationship between leg circumference and arterial stiffness in patients with T2DM compared to non-T2DM individuals.

Methods

Data from two studies were combined to form T2DM (T2DM group) and non-T2DM (N group) cohorts. The variables included age, sex, systolic blood pressure (SBP), brachial-ankle pulse wave velocity (ba-PWV), ankle-brachial index, height, weight, maximum leg circumference, lower leg circumference ratio, duration of T2DM, Achilles tendon reflex disorder, and the hemoglobin A1c level. Multiple regression analysis was performed with ba-PWV as the dependent variable and the interaction term between leg circumference ratio and T2DM as the independent variable. The control variables included leg circumference ratio, T2DM, SBP, Achilles tendon reflex disorder, age, and sex. IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, USA) was used for the statistical analysis, with the significance level set to p < 0.05.

Results

The interaction term between the lower leg circumference ratio and T2DM (β = -0.17, 95% CI: -46.11 to -10.92; p < 0.01) was significantly associated with ba-PWV (AdjR² = 0.51, variance inflation factor <4.12). Simple slope analysis indicated that a decreased lower leg circumference ratio was significantly associated with an increased ba-PWV (β = -0.20, p < 0.05) in the T2DM group. No significant relationship was found in the N group (β = -0.03, p = 0.69).

Conclusion

A significant interaction was found between the lower leg circumference ratio and T2DM presence, indicating an association between ba-PWV and the leg circumference ratio specific to patients with T2DM. This result suggests that the leg circumference ratio can be substituted for the ba-PWV to evaluate arterial stiffness in T2DM.