BACKGROUND: Diabetes mellitus is a known risk factor in the development of 
peripheral vascular disease. Hemoglobin A1c (HbA1c) has been used by clinicians 
as a means to measure short to intermediate term glucose control in diabetics. 
Trials evaluating tight glucose control using HbA1c measurements have recently 
been conducted for several medical conditions. The goal of this study is to 
determine if the level of hemoglobin A1c has any effect on disease severity in 
diabetic patients with limb threatening ischemia.
METHODS: A retrospective review of all patients presenting with limb threatening 
ischemia between January 1 and December 31, 2007 was conducted. All patients 
underwent conventional arteriography prior to intervention. Of 148 patients, 73 
were diabetics with a hemoglobin A1c level performed within 3 mo of 
presentation. Patients were placed into high (>7) and low (<7) hemoglobin A1c 
groups and data was collected on type of presentation, comorbidities, anatomic 
level of disease, tibial artery patency, need for amputation, contralateral 
disease, need for an open versus an endovascular procedure, and freedom from 
intervention. Fisher's exact t-test was used to compare the two groups. A P 
value <0.05 was considered statistically significant.
RESULTS: Thirty-six patients had HbA1c levels above 7.0 and 37 had levels below 
7.0 (mean 7.64 ± 2.04, range 5.1-14.7). There were no statistically significant 
differences in the two groups in comorbities, average age, initial gangrene at 
presentation, aspirin or statin use, or smoking status. Patients in the high 
group were more likely to have had a previous attempt at revascularization (23 
versus 11, P = 0.0049). There was no difference in the presence of contralateral 
disease (7 versus 4, P = 0.3447) or in the number of patent tibial vessels. 
Patients with low HbA1c levels were more likely to have the peroneal artery 
affected (17 versus 8, P = 0.048). In addition, TASC II classifications of iliac 
and femoral popliteal disease was similar between the two groups. Freedom from 
intervention is depicted graphically by life table analysis.
CONCLUSION: Glucose control measured by hemoglobin A1c does not appear to affect 
severity of disease or need for reintervention in diabetics with limb 
threatening ischemia. This suggests other factors related to diabetes may play a 
role in peripheral vascular disease. Larger, prospective studies are needed to 
assess the affect of glucose control in limb threatening ischemia.