Title: Study of Prevalence and Clinical Profile of Peripheral Arterial Disease in Type II Diabetes

Authors: Dr Goel S, Dr Bhuta K, Dr Rai S

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.181

Abstract

Introduction

Peripheral arterial disease, is clinically manifested as intermittent claudication or critical ischaemia, or identified by an ankle/brachial index (ABI) < 0.9, is present in at least one in every four patients with type 2 diabetes mellitus. Various risk factors like persistant hyperglycemia, smoking and hypertension, and dyslipidaemia are associated with Peripheral artery disease (PAD).

The increasing burden of diabetes is considered as one of the greatest global public health problem of our time1. The microvascular and macrovascular complications associated with this diabetes, as well as the resulting morbidity and mortality, the personal, medical, and societal costs are enormous.2,3 Despite of advances in diabetes pharmacotherapy, less than half of adults with type 2 diabetes mellitus (T2DM) attain therapeutic goals designed to reduce long-term risks of complications, especially for glycemic control4, and lifestyle interventions are disappointing in the long term.

Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus. Unlike other complications, it has received little attention, especially in the India. Hence, we carried out the present study to assess the prevalence and clinical profile of PAD in type 2 diabetes by measuring ankle brachial index using duplex Doppler ultrasound of the lower limbs and to correlated it with various risk factors.

References

  1. International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Available from http://www.diabetesatlas.org. Accessed 20 February 2016
  2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 reg-ions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet2012; 380:2197–2223
  3. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic anal-ysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet 2013;381:628]. Lancet2012;380:2224–2260
  4. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004;291:335–342pmid:14734596
  5. Yao JST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial diseases affecting the lower extremeties. Br J Surg 1969;56: 676-9.
  6. Al-Kaabi JM, Fatma Al Maskari, Taoufik Zoubeidi, Abdishakur Abdulle, Syed M Shah, Paul Cragg, Bachar Afandi, Abdul-Kader Souid. Peripheral Artery Disease in Type 2 Diabetic Patients from the United Arab Emirates. J Diabetes Metab. 2014:5(6)
  7. El Toony LF, Ahmad F. Thabet, Lobna Abdel-Wahid, Marwa M. Abo-Kreasha. Risk Factors of Peripheral Vascular Disease in Diabetic Patients at Assiut University Hospitals. Med. J. Cairo Univ. 2015:82(1):53-60 92
  8. Mourad JJ, Cacoub P, Collet JP. Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. J Vasc Surg. 2009;50(3):572-80.
  9. Khurana A, Preeti Dhoat, TS Marwaha. Peripheral vascular disease – a silent assassin: Its rising trend in Punjab. JIACM 2013;14(2):111-4
  10. Marinelli MR, Beach KW, Glass MJ et al. Non-Invasive testing vs clinical evaluation of arterial disease, a prosp-ective study. JAMA 1997;241:2031-34
  11. Janka HU, Standl E, and Mehnert H. Peripheral vascular disease in diabetes mellitus and its relation to cardiova-scular risk factors screening with Doppler. Diabetes Care 1980;3:207-13.
  12. Walter DP, Gatting W, Mullee MA, et al. The prevalence of diabetics and non-diabetic subjects in an English comm.-unity. Diab Medicine 1992;9:710-15.
  13. Migdolis LN, Kourpi A, Jochariadis D et al. Peripheral vascular disease in newly diagnosed non-insulin dependent diabetics. Int Angiol 1992;11:230-32
  14. Norman PE, Davis WA, Bruce DG, Davis TM. Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2006;29:575–580.
  15. Mohan V, Premalatha G, Sastry NG. Peripheral vascular disease in non-insulin dependant diabetes mellitus in South India. Diabetes Res Clin Pract 1995;27:235-40.
  16. Agrawal RP, Ranka M, Beniwal R et al. Prevalence of micro and macro vascular complications in type 2 diabetes and their risk factors. Int J Diabetes Dev Ctries 2004;24:11-16
  17. Madhu SV, Kant S. Preclinical evaluation of atherosclerosis. Int J Diabetes Dev Ctries 2006;26:105-11.
  18. Lekshmi NRM, Koh WP, Phang J. Peripheral arterial disease in community-based patients with diabetes in Singapore: Results from a Primary Healthcare Study. Ann Acad Med Singapore 2010;39(7):525-7.
  19. Papanas N, Tziakas D, Maltezos E. Risk factors for concomitant peripheral arte-rial occlusive disease in patients with coronary artery disease: is there a differ-ence between diabetic and non-diabetic patients? Acta Clin Belg.2005;60(3): 122-8.

Corresponding Author

Dr Saurabh Goel

Department of Medicine, MGM Medical College, Navi Mumbai