Age and Diabetes Duration as Determinants of Vascular Anatomical Abnormalities According to GLASS Criteria in Type 2 Diabetes Mellitus Patients with Peripheral Artery Disease

Background: Type 2 diabetes mellitus (T2DM) is strongly associated with peripheral artery disease (PAD), which often presents with distal arterial involvement. The Global Limb Anatomic Staging System (GLASS) standardizes infrainguinal anatomical assessment and assists revascularization planning; however, evidence linking patient characteristics with GLASS-based anatomical complexity remains limited. This study described arterial anatomical patterns according to GLASS criteria and evaluated associations of age and diabetes duration with lesion distribution and GLASS stage in patients with T2DM and PAD. Materials and Methods: A retrospective cohort study was conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta. Adult patients with T2DM and PAD who underwent lower-extremity computed tomography angiography (CTA) between August 2024 and August 2025 were included using consecutive sampling. Arterial lesions were classified into femoropopliteal and infrapopliteal segments and staged using GLASS. Age and diabetes duration were independent variables, while sex, HbA1c, hypertension, and dyslipidemia were confounders. Multinomial logistic regression analyses were performed. Results: Seventy patients were analyzed (mean age 65.4 years). Femoropopliteal disease was generally mild, whereas infrapopliteal lesions were more severe. Most limbs were classified as GLASS Stage II. Older age and longer diabetes duration were significantly associated with more severe infrapopliteal disease and higher GLASS stage in bivariate analysis, but not after adjustment. Conclusion: PAD in patients with T2DM predominantly affects distal arterial segments and is commonly of intermediate anatomical complexity. Age and diabetes duration show anatomical associations, particularly infrapopliteal involvement. GLASS provides a useful framework for anatomical assessment and risk stratification.