Profile of Peripheral Arterial Disease in Type 2 Diabetes Mellitus - A Hospital-based observational study in Coastal Karnataka

Introduction: Ankle Brachial Index (ABI) is one of the common non-invasive diagnostic tools available for diagnosing Peripheral Arterial Disease (PAD). However, it has been observed that for an individual diagnosed with both PAD and Type 2 Diabetes Mellitus (T2DM), ABI tends to give false diagnostic value because of the calcification of the major lower limb arteries. Therefore, the health care professionals are at times misled for the diagnosis of PAD. To overcome this another diagnostic tool Toe Brachial Index (TBI) was suggested to perform. However, there is limited literature on performing both ABI and TBI in the given population in a single study.

Aim: The main focus of this study is to report the profile of ABI and TBI along with classical symptoms like claudication pain, palpation of pulse and history of T2DM for the screening and diagnosis of PAD in T2DM.

Materials And Methods: In this cross-sectional observational study, a total of 121 participants diagnosed with T2DM were recruited for the study as per the inclusion criteria. Detailed demographic details of the participants were noted. Diagnostic tool including both ABI and TBI were performed for all the participants and the data was analysed.

Results: Among 121 participants, only 3 participants had both ABI and TBI positive indicating positive diagnostic test for PAD and 106 participants had both ABI and TBI negative. However, in the remaining 12 participants, 10 showed TBI positive but ABI negative and 2 had ABI positive but TBI negative.

Conclusions: Based on our study we have reported the profile of PAD in T2DM individuals, which is found to be 10.75.%. Therefore, it can be concluded that ABI and TBI both should be performed to rule out any complication. This will be beneficial in early screening and detection of neuro ischemic changes in foot and subsequently to prevent amputation.

1. Litwak L, Goh SY, Hussein Z, et al. Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A 1 chieve study. Diabetol Metab Syndr. 2013;5(1)57. doi: https://doi.org/10.1186/1758-5996-5-57.

2. Hernando S, Francisco J, Conejero AM. [Peripheral artery disease: pathophysiology, diagnosis and treatment. (In Spanish)]. RevEsp Cardiol. 2007;60(9):969-982. doi: https://doi.org/10.1157/13109651.

3. Agarwal AK, Singh M, Arya V, et al. Prevalence of peripheral arterial disease in type 2 diabetes mellitus and its correlation with coronary artery disease and its risk factors. J Assoc Physicians India. 2012;60(7):28-32.

4. Arora E, Maiya AG, Devasia T, et al. Prevalence of peripheral arterial disease among type 2 diabetes mellitus in coastal Karnataka. Diabetes Metab Syndr. 2019;13(2):1251-1253. doi: https://doi.org/10.10167j.dsx.2019.02.003.

5. Jude EB, Eleftheriadou I, Tentolouris N. Peripheral arterial disease in diabetes - a review. Diabet Med. 2010;27(1):4-14. doi: https://doi.org/10.1111Zj.1464-54912009.02866x

6. Andras A, Ferket B. Screening for peripheral arterial disease. Cochrane Database Syst Rev. 2014;(4):CD010835. doi: https://doi.org/10.1002/14651858.CD010835.pub2.

7. Romanos MT, Raspovic A, Perrin BM. The reliability of toe systolic pressure and the toe brachial index in patients with diabetes. J Foot Ankle Res. 2010;3(1):31. doi: https://doi.org/10.1186/1757-1146-3-31.

8. Collins R, Burch J, Cranny G, et al. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: a systematic review. BMJ. 2007;334(7606):1257. doi: https://doi.org/10.1136/bmj.39217.473275.55.

9. Tehan PE, Santos D, Chuter VH. A systematic review of the sensitivity and specificity of the toe-brachial index for detecting peripheral artery disease. Vasc Med. 2016;21(4):382-389. doi: https://doi.org/10.1177/1358863X16645854.

10. Park SC, Choi CY, Ha YI, Yang HE. Utility of toe-brachial index for diagnosis of peripheral artery disease. Arch Plast Surg. 2012;39(3):227-231. doi: https://doi.org/10.5999/aps.2012.393.227.

11. Cade WT. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting. Phys Ther. 2008;88(1 1):1322-1335. doi: https://doi.org/10.2522/ptj.20080008.

12. Eshcol J, Jebarani S, Anjana RM, et al. Prevalence, incidence and progression of peripheral arterial disease in Asian Indian type 2 diabetic patients. J Diabetes Complications. 2014;28(5):627-631. doi: https://doi.org/10.1016/jJdiacomp.2014.04.013.

13. Bowling FL, Rashid ST, Boulton AJ. Preventing and treating foot complications associated with diabetes mellitus. Nat Rev Endocrinol. 2015;11(10):606-616. doi: https://doi.org/10.1038/nrendo.2015.130.

14. Brooks B, Dean R, Patel S, et al. TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med. 2001;18(7):528-532. doi: https://doi.org/10.1046/j.1464-5491.2001.00493.x.

15. American Diabetes Association. Microvascular complications and foot care. Diabetes care. 2015;38(Suppl 1):S58-66. doi: https://doi.org/10.2337/dc15-S012.

16. Armstrong DG, Fisher TK, Lepow B, et al. 26. Pathophysiology and principles of management of the diabetic foot. In: Fitridge R, Thompson M. Mechanisms of vascular disease: a reference book for vascular specialists [Internet]. Adelaide (AU): University of Adelaide Press; 2011.