Screening for peripheral arterial disease by means of the ankle-brachial index in newly diagnosed Type 2 diabetic patients

University of Milan, Milano, Lombardy, Italy
Diabetic Medicine (Impact Factor: 3.12). 10/2005; 22(10):1310-4. DOI: 10.1111/j.1464-5491.2005.01612.x
Source: PubMed


To evaluate the prevalence of peripheral arterial disease (PAD) with the ankle-brachial index (ABI) in newly diagnosed Type 2 diabetic subjects.
Between autumn 2002 and spring 2003, 2559 newly diagnosed Type 2 diabetic subjects (about 15% of the cases/year in Italy) were enrolled in 265 diabetology centres. Family history of diabetes, smoking, height, weight, waistline, fasting glycaemia, glycosylated haemoglobin, total and HDL-cholesterol and triglyceride values were collected. Claudication, cyanosis, cold foot, foot hair anomalies, skin thinning and femoral, popliteal, posterior tibial and dorsalis pedis pulses were assessed. The ABI was measured with a portable Doppler continuous-wave instrument.
An ABI < 0.9 was found in 539 (21.1%) patients. Claudication was present in 187 (7.3%). Femoral pulse was absent in 218 (8.5%), popliteal in 316 (12.3%), tibial in 563 (22.0%) and dorsalis pedis in 578 (22.6%). Foot cyanosis was observed in 88 (3.4%), cold foot in 359 (13.9%), skin thinning in 468 (18.3%) and hair anomalies in 857 (33.5%). Multivariate analysis of the variables associated with ABI < 0.9 in the univariate analysis confirmed the independent role of age [relative risk (RR) 1.02, P < 0.001, confidence interval (CI) 1.01, 1.04], claudication (RR 4.53, P < 0.001, CI 2.97, 6.93), absence of tibial pulse (RR 3.45, P < or = 0.001. CI 2.54, 4.68) and pedis pulse (RR 1.96, P < or = 0.001, CI 1.4, 2.68).
PAD, as represented by ABI < 0.9, is common in newly diagnosed Type 2 diabetic patients.

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    • "These are unsuitable for surgical revascularisation , but a percutaneous procedure (technically reduced to the minimum possible invasiveness) can still be considered in order to improve their quality of life. Angioplasty does not require general anaesthesia and can be carried out with few contraindications in cardio-and nephropathic subjects at high surgical and anaesthetic risk [2] [15] [111]. In complex cases, it can be divided into various steps in order to reduce stress and the volume of contrast medium administered, by evaluating the clinical result and renal function after each step. "
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    ABSTRACT: Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. Prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients it is still very high. Many PAD diabetic patients are not revascularized due lack of technical expertise of, ever worse, negative believes because of poor experience. This is despite the progresses obtained in the technics of distal revascularization that nowadays allow to re-open distal arteries of the leg and of the foot . Italy has one of the lowest prevalence rates of major amputations in Europe and we have a long tradition in the field of limb salvage with aggressive approach in debridment, antibiotic therapy and distal revascularization. Therefore we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 01/2013; 24(4). DOI:10.1016/j.numecd.2013.12.007 · 3.32 Impact Factor
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    • "In a U.S. population aged 50 to 70 years, the prevalence of PAD in diabetic patients was 22.0% [17]. PAD was found in 21.1% of newly diagnosed type 2 diabetic Italian patients aged >30 years [18]. "
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    ABSTRACT: Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. Diabetes is known to increase the risk of PAD two- to four-fold. The prevalence of PAD in Korean diabetic patients has not been established. In this study, we investigated the prevalence of PAD in Korean patients with type 2 diabetes attending a large university hospital and analyzed the factors associated with PAD. A total of 2,002 patients with type 2 diabetes who underwent ankle-brachial index (ABI) measurement in an outpatient clinic were enrolled. PAD was defined as an ABI ≤0.9. Clinical characteristics of 64 patients with PAD were compared with those of 192 age- and sex-matched control patients without PAD. Of the 2,002 type 2 diabetic patients, 64 (3.2%) were diagnosed as having PAD. PAD was associated with higher prevalences of retinopathy, nephropathy, neuropathy, cerebrovascular and coronary artery disease. Patients with PAD had higher systolic blood pressure and serum triglyceride level and reported higher pack-years of smoking. Multivariate analysis showed that the presence of micro- and macrovascular complications and high systolic blood pressure are factors independently associated with PAD. The prevalence of PAD in diabetic patients was 3.2%, suggesting that the prevalence in Korean diabetic patients is lower than that of patients in Western countries.
    Diabetes & metabolism journal 10/2011; 35(5):543-50. DOI:10.4093/dmj.2011.35.5.543
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    • "Previous cross-sectional and prospective studies [5,7,17–24] reported that PAD prevalence increases with diabetes duration and age up to 20–29% in patients 40–50 years. Finally, our data are close to the 21% prevalence reported in another Italian cohort by Faglia et al. [25], although we had more diabetic individuals with non-compressible arteries (i.e., ABPI > 1.3). It is noteworthy that the former study included only newly diagnosed diabetic patients while we studied patients with a wide range of diabetes duration. "
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    ABSTRACT: This study evaluated the prevalence of peripheral arterial disease (PAD) in type 2 diabetes and its association with traditional and non-traditional cardiovascular (CV) risk factors. In 1610 type 2 diabetics PAD was defined as ankle-brachial pressure index (ABPI)<0.9. PAD prevalence was 17%, increased with age, diabetes duration, HbA 1c levels, previous CV events. There were no significant differences in the prevalence of traditional CV risk factors between patients with and without PAD. PAD patients had higher levels of fibrinogen (10.88+/-2.32 versus 10.2+/-2.23micromol/L; p<0.0001), uric acid (327.1+/-89.2 versus 315.2+/-83.3micromol/L, p<0.01), pulse pressure (70+/-18 versus 60+/-16mm Hg, p<0.0001), higher rate of microalbuminuria (21.3% versus 13.7%; p<0.05) and lower glomerular filtration rate (GFR, 80.7+/-24 versus 89.9+/-22 ml/min/1.73 m2; p<0.001) than those without. In age-gender-adjusted analysis, smoking (OR 1.5; CI: 1.07-2.2), HbA 1c (OR 1.45; CI: 1.07-2.08), high pulse pressure (OR 2.81; CI: 1.63-4.82), reduced GFR (OR 2.16; CI: 1.4-3.3), microalbuminuria (OR 1.62; CI: 1.11-2.36), high fibrinogen levels (OR 2.03; CI: 1.34-3.07) were associated with PAD. In multivariate analysis age, male sex, smoking, high pulse pressure, low GFR, high fibrinogen levels, previous CV events were independent risk factors for PAD. PAD prevalence is high in Type 2 diabetic patients. Non-traditional cardiovascular risk factors may be involved in the development of this complication.
    Diabetes Research and Clinical Practice 11/2007; 78(2):246-53. DOI:10.1016/j.diabres.2007.03.020 · 2.54 Impact Factor
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