Ankle Brachial Index as Diagnostic Marker for Asymptomatic Peripheral Arterial Disease in Diabetes Mellitus

Authors

  • Syed Yasir Abbas Department of Medicine, Combined Military Hospital, Hyderabad/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Mohammad Naeem Qureshi Department of Medicine, Combined Military Hospital, Hyderabad/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Muhammad Muttahar Asim Niaz Department of Surgery, Combined Military Hospital, Hyderabad/National University of Medical Sciences (NUMS) Pakistan
  • Sara Aziz Janjua Department of Medicine, Combined Military Hospital, Hyderabad/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Mirza Waseem Javed Department of Medicine, Combined Military Hospital, Badin/National University of Medical Sciences (NUMS) Pakistan
  • Hafsa Urooj Department of Medicine, Liaquat University of Medical and Health Sciences Hospital, Jamshoro Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i1.9376

Keywords:

Asymptomatic peripheral arterial disease, Ankle brachial index, Intermittent claudication, Glycated hemoglobin, Diabetes complications

Abstract

Objective: To determine ankle brachial index (ABI) as a diagnostic marker for asymptomatic peripheral arterial disease (PAD) in diabetes mellitus (DM).

Study Design: Cross-sectional study.

Place and Duration of Study: Combined Military Hospital, Hyderabad, Pakistan from Jan to Sep 2022.

Methodology: A total of one hundred and seventy (n=170) asymptomatic patients with DM were included. Specific details
were recorded, which include HbA1c levels, duration of diabetes and ankle brachial index.

Results: There were 60.0% male and 40.0% female patients. With the mean age of 50.60±11.55 years. The mean duration of
diabetes mellitus was 4.20±1.97 years. Mean HbA1c was 7.41±1.27%, mean ABI was 1.03±0.13. Peripheral arterial disease was observed in 17.05% of asymptomatic cases using ABI, with ABI sensitivity of 82.86% and specificity of 97.24% in detecting asymptomatic PAD patients. It was significantly associated with an increase in the duration of diabetes.

Conclusion: Asymptomatic peripheral arterial disease diagnosed through the ankle brachial index showed that it is a reliable source for diagnosing patients with asymptomatic PAD in diabetes mellitus reported in routine clinical visits.

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References

Suwannasrisuk P, Sattanon S, Taburee W, Singkheaw P,

Sowanna N, Boonprasert P, et al. Prevalence and predictors of

peripheral arterial disease determined by ankle brachial index in

diabetes population treated within primary care services in a

non-urban area of lower northern Thailand. Diab Vasc Dis Res

; 17(6): 1-3. https://doi.org/10.1177/1479164120966997.

Song P, Rudan D, Zhu Y, Fowkes FJI, Rahimi K, Fowkes FGR, et

al. Global, regional, and national prevalence and risk factors for

peripheral artery disease in 2015: an updated systematic review

and analysis. Lancet Glob Health 2019; 7(8): e1020-e1030.

https://doi.org/10.1016/S2214-109X(19)30255-4.

McClary KN, Massey P. Ankle Brachial Index. Treasure Island

(FL): StatPearls Publishing; 2023.

Bernstein J, Esterhai JL, Staska M, Reinhardt S, Mitchell ME. The

prevalence of occult peripheral arterial disease among patients

referred for orthopedic evaluation of leg pain. Vasc Med 2008;

(3): 235-238. https://doi.org/10.1177/1358863X08091970.

Mishra N. Use of ABI to detect peripheral arterial disease in

diabetes – A recommendation for primary care physicians. J

Family Med Prim Care 2021; 10(1): 154-157.

http://doi.org/10.4103/jfmpc.jfmpc_1546_20.

Ishaq M, Khan G, Zulfiqar S. Role of ankle brachial index in the

diagnosis of peripheral arterial disease. Gomal J Med Sci 2012;

(1): 149–152.

Hennion DR, Siano KA. Diagnosis and treatment of peripheral

arterial disease. Am Fam Physician 2013; 88(5): 306-310.

Ankle Brachial Index Collaboration; Fowkes FG, Murray GD,

Butcher I, Heald CL, Lee RJ, et al. Ankle brachial index combined

with Framingham Risk Score to predict cardiovascular events

and mortality: a meta-analysis. JAMA 2008; 300(2): 197-208.

http://doi.org/10.1001/jama.300.2.197.

Umer A, Khan KA, Naz S, Mushtaq S, Khan SN, Raza T, et al.

Frequency of peripheral arterial disease in high risk type-2

diabetes mellitus using ankle-brachial index and its association

with the risk factors among patients presenting in Jinnah

Hospital, Lahore. Pak Armed Force Med J 2018; 68(4): 761–766.

Cardoso CRL, Melo JV, Salles GC, Leite NC, Salles GF.

Prognostic impact of the ankle-brachial index on the

development of micro- and macrovascular complications in

individuals with type-2 diabetes: the Rio de Janeiro Type-2

Diabetes Cohort Study. Diabetologia 2018; 61(11): 2266-2276.

http://doi.org/10.1007/s00125-018-4709-9.

Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V.

Prevalence and risk factors of peripheral vascular disease in a

selected South Indian population: the Chennai Urban Population

Study. Diabetes Care 2000; 23(9): 1295-300.

http://doi.org/10.2337/diacare.23.9.1295.

Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO,

McDermott MM, et al. Comparison of global estimates of

prevalence and risk factors for peripheral arterial disease in 2000

and 2010: a systematic review and analysis. Lancet 2013;

(9901): 1329-1340.

http://doi.org/10.1016/S0140-6736(13)61249-0.

Haregu TN, Byrnes A, Singh K, Sathish T, Pasricha N,

Wickramasinghe K, et al. A scoping review of noncommunicable disease research capacity strengthening initiatives

in low and middle-income countries. Glob Health Res Policy

; 4: 31. http://doi.org/10.1186/s41256-019-0123-1.

Bundo M, Munoz L, Perez C, Montero JJ, Montella N, Toran P et

al. Asymptomatic Peripheral arterial disease in type 2 diabetes

patient: A 10 year follow-up study of the utility of the ankle

brachial index as a prognostic marker of cardiovascular disease.

Ann Vasc Surg 2010; 24(8): 985-993.

http://doi.org/10.1016/j.avsg.2010.06.001.

Hirsch AT, Duval S. The global pandemic of peripheral artey

disease. Lancet 2013; 382(9901): 1312-1314.

http://doi.org/10.1016/S0140-6736(13)61576-7.

Khan AM, Lohana P, Anvekar P, Mustafa SH, Kumar R, Lnu A,

et al. Risk factors of peripheral vascular disease in diabetes

mellitus in abbottabad, Pakistan: A cross-sectional study. Cureus

; 13(8): e17556. http://doi.org/10.7759/cureus.17556.

Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of

classification systems in peripheral artery disease. Semin

Intervent Radiol 2014; 31(4): 378-388.

http://doi.org/10.1055/s-0034-1393976.

Siddiqui FJ, Awan BI, Mahmud S, Nanan DJ, Jabbar A, Assam

PN, et al. Uncontrolled Diabetes Mellitus:Prevalence and risk

factors among people with type 2 diabetes mellitus in an urban

district of Karachi, Pakistan. Diabetes Res Clin Pract 2015; 107(1):

-156.

Felício JS, Koury CC, Abdallah-Zahalan N, de Souza- Resende F,

Nascimento de Lemos M, Jardim da Motta-Corrêa Pinto R, et al.

Ankle-brachial index and peripheral arterial disease: An

evaluation including a type-2 diabetes mellitus drug-naïve

patients cohort. Diab Vasc Dis Res 2019; 16(4): 344-350.

http://doi.org/10.1177/1479164119829385.

Kravos A, Bubnič-Sotošek K. Ankle–brachial index screening for

peripheral artery disease in asymptomatic patients between 50

and 70 years of age. J Int Med Res 2009; 37(5): 1611–1619.

http://doi.org/10.1177/147323000903700540.

Alagha M, Aherne TM, Hassanin A, Zafar AS, Joyce DP,

Mahmood W, et al. Diagnostic performance of ankle-brachial

pressure index in lower extremity arterial disease. Surg J 2021;

(3): e132–e137. http://doi.org/10.1055/s-0041-173144

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Published

28-02-2024

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Original Articles

How to Cite

1.
Abbas SY, Qureshi MN, Niaz MMA, Janjua SA, Javed MW, Urooj H. Ankle Brachial Index as Diagnostic Marker for Asymptomatic Peripheral Arterial Disease in Diabetes Mellitus. Pak Armed Forces Med J [Internet]. 2024 Feb. 28 [cited 2024 Jul. 27];74(1):76-9. Available from: https://pafmj.org/PAFMJ/article/view/9376