# Factors associated with severe lower extremity artery disease in type 2 diabetes based on a large scale claims database in Japan

## TL;DR

This study identifies medications that may help prevent severe lower extremity artery disease in people with type 2 diabetes.

## Contribution

The study identifies SGLT2 inhibitors, metformin, and fibrates as factors associated with reduced severe LEAD progression in T2D patients.

## Key findings

- SGLT2 inhibitors, metformin, and fibrates are linked to reduced severe LEAD in T2D patients.
- Logistic regression analysis showed significant odds ratios for these medications in preventing LEAD progression.
- Individualized patient management is needed due to potential adverse events of these medications.

## Abstract

Diabetic foot lesions are becoming increasingly prevalent due to increases in type 2 diabetes (T2D), aging populations, and atherosclerotic diseases. Individuals with T2D with comorbid lower extremity artery disease (LEAD) are particularly susceptible. Although pharmacological therapies are often combined with risk management strategies, like exercise and smoking cessation, their roles in preventing LEAD progression are unclear. Herein, we investigated factors suppressing LEAD progression in T2D. Using data from the DeSC database, this retrospective cross-sectional study defined severe LEAD as a diagnosis requiring revascularization (Revasc). Logistic regression analysis was used to calculate odds ratios (ORs) for associated factors. The analysis included 243,606 patients with T2D divided into two groups; those with (n = 890) and without (n = 242,716) Revasc. Subgroup analysis of patients with LEAD (n = 27,258) with (n = 890) and without (n = 26,368) Revasc was also conducted. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) (OR 0.50), metformin (OR 0.78), and fibrates (OR 0.75) were associated with a significant reduction in severe LEAD in the primary and subgroup analyses. In conclusion, the active use of SGLT2 inhibitors, metformin, and fibrates may help prevent LEAD progression. However, these medications are associated with adverse events, making it essential to manage patients individually to optimize benefits while minimizing risks.

The online version contains supplementary material available at 10.1038/s41598-025-03797-9.