Summary:
Background – Purpose : Peripheral arterial disease (PAD) is a serious chronic macrovascular complication of diabetes mellitus (DM). Ankle-brachial index (ABI) measurement is widely used in clinical practice in order to evaluate the arterial circulation of lower extremities.
The purpose of the study was to estimate PAD prevalence in type 2 diabetic patients and also to evaluate the effects of cardiovascular comorbidity, smoking habits, glycemic control and lipid profile on ABI values.
Subjects and Methods : A cross-sectional real-life study was performend in 70 patients with type 2 DM. Subjects were randomly selected from urban population under regular medical follow-up at a primary care facility located in Chalkida city, Greece.
Personal medical history and treatment were recorded in detail and laboratory tests were performed in all patients including fasting plasma glucose, HbA1c and serum lipids (Total cholesterol, LDL, HDL, Triglycerides). Office-based ABI measurement by means of a portable doppler ultrasound device was made.
SPSS v.24.0 software was used in the statistical analysis of clinical and laboratory data. Chi-square test, T-test and bivariate correlation analysis were conducted.
Results : Abnormally low ABI values (< 0,9) were found in 15,7% of subjects (N=11). Positive personal history of macrovascular diabetic complications (Coronary artery disease, stroke, carotid stenosis, PAD) was present in 35,7% of patients (N=25).
Total cardiovascular comorbidity was significantly related to abnormal ABI values (Χ2=17,317 O.R.=3,57, p<0,001) that were lower in diabetics with positive medical history respectively, in comparison with controls (0,92 ± 0,15 vs 1,01 ± 0,06, p<0,001). Similar findings were verified for each macrovascular complication independently.
Insulin treatment was administered in 17,1% of study subjects (Ν=12) whereas oral antidiabetic agents as monotherapy or combination treatment were given in 82,9% (Ν=58) of them.
Patients that had diabetes for more than 10 years received insulin treatment at a significantly greater percentage in comparison with patients that had the disease for less than 10 years (X2=6,437, p=0,011).
Furthermore, diabetics on insulin treatment had significanly greater disease duration (17,1 ± 8,1 vs 9,7 ± 7,2 years, p=0,002), higher HbA1c levels (8,7 ± 1,6 vs 6,9 ± 1,02, p<0,001) and lower ABI values (0,92 ± 0,14 vs 0,99 ± 0,10, p=0,047) in comparison with diabetics under therapy with oral hypoglycemic agents.
Peripheral arterial pulse waveforms were related to ABI values and diabetic patients with monophasic doppler flow had significantly lower ABI in comparison with patients with biphasic or triphasic flow (0,75 ± 0,09 vs 0,99 ± 0,09 και 1,027 ± 0,05 respectively, p<0,001).
Significant negative bivariate correlations between smoking (Correlation coefficient -0,26, p=0,015), fasting plasma glucose (Correlation coefficient -0,262, p=0,024), HbA1c (Correlation coefficient -0,236, p=0,025), and Total Cholesterol/HDL (Correlation coefficient -0,289, p=0,029) with ABI values were found
Conclusions: In Chalkida study, abnormally low ABI < 0,9 and subsequently PAD prevalence in type 2 diabetics at the community was 15,7%.
Cardiovascular comorbidity, antidiabetic treatment, smoking, fasting plasma glucose, HbA1c and Total Cholesterol/HDL are related to ABI values and to PAD development risc.
