Predictive factors and diagnostic value of vascular markers for carotid artery disease in type 2 diabetes mellitus patients

This study investigates the clinical and vascular predictors of carotid intima-media thickening and plaque formation in patients with type 2 diabetes mellitus (T2DM) and evaluates the potential diagnostic value of changes in ankle-brachial index (ABI) and pulse wave velocity (PWV) over time. A retrospective analysis was conducted on 466 patients with T2DM who underwent carotid ultrasound between October 2023 and October 2024. Patients were categorized into a carotid artery disease group (n = 201) and a non-lesion group (n = 265) based on intima-media thickness and plaque presence. Data collected included demographics, metabolic profiles, cardiovascular comorbidities, vascular indicators, and laboratory markers. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Receiver operating characteristic curve analysis was performed to assess the predictive accuracy of ABI and PWV changes at 3-month follow-up. Compared to the non-lesion group, patients with carotid artery disease were significantly older, had a longer diabetes duration, and higher prevalence of hypertension and coronary artery disease (all P < .05). They also showed significantly lower ABI and toe-brachial index, and higher PWV. Glycemic parameters such as glycated hemoglobin, postprandial glucose, and insulin/C-peptide ratio were also elevated in this group. Multivariate analysis identified age, diabetes duration, hypertension, coronary disease, ABI, and PWV as independent predictors. Receiver operating characteristic analysis demonstrated that the change in ABI over 3 months had an area under the curve of 0.83, while PWV change yielded an area under the curve of 0.79, indicating good predictive performance. The presence of carotid artery disease in T2DM patients may be associated with traditional cardiovascular risk factors as well as changes in vascular stiffness markers. Serial monitoring of ABI and PWV may aid in the early identification of subclinical atherosclerosis and support risk stratification in clinical practice.