Comparative analysis of different modalities of assessment of lower extremity peripheral artery disease and its prevalence amongst diabetic patients

Abstract

Background: Diabetes mellitus is an important risk factor for development of atherosclerosis and by extension, lower extremity peripheral artery disease (LEAD). The prevalence of LEAD may vary depending on the diagnostic tool applied.
Objective: To determine the effect of applied diagnostic tool on the prevalence of LEAD in type 2 diabetes mellitus patients in a tertiary hospital in Nigeria.
Materials and Methods: Three hundred and eighty eight diabetic patients aged between 35 and 88 years were consecutively enrolled in the study. Fifty age and sex matched controls were also recruited for the study. LEAD was assessed in all the patients using:
1. History of intermittent claudication using the Edinburgh Claudication Questionnaire.
2. Palpation of pedal pulses for diminished or absent dorsalis pedis and/or posterior tibial artery pulsations.
3. Ankle Brachial Index <0.9 in either leg, using hand-held Doppler ultrasonography
Results: The study showed that the prevalence of LEAD was 35.6% with Doppler ABI <0.9 in either leg. The prevalence of LEAD using history of intermittent claudication and diminished or absent pedal pulses determined by palpation were 5.4% and 13.9%, respectively. Determination of LEAD by history of intermittent claudication and physical examination of pedal pulses both had low sensitivity but high specificity. The ratio of symptomatic to asymptomatic disease was found to be 2: 15.
Conclusion: LEAD is common among type 2 diabetes patients in Nigeria and majority of the patients had asymptomatic disease. We recommend that patients with type 2 diabetes mellitus be screened for LEAD using ABI <0.9.

Key Words: Diabetes Mellitus, Ankle Brachial Index (ABI)