PERIPHERAL ARTERIAL DISEASE

(PAD) IN TYPE 2 DIABETIC PATIENTS

Abstract

Background: The increase in prevalence of type 2 diabetes and its complications is alarming. The incidence of diabetic foot
ulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries.
This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiary
care settings in Abbottabad. Methods: This was a prospective descriptive study-being conducted at Northern Institue of Medical Sciences
(NIMS) and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer than
ten days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation of
peripheral arterial pulses in the lower limbs. Ankle-brachial index (ABI) is the ratio of the systolic blood pressure at the ankle to that in the arm.
Peripheral arterial disease (PAD) was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severe
according to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American Diabetes
Association. Results: A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age of
study subjects was 53.68±9.51 years. There were 33 (39.75%) males and 50 (60.24%) females with M to F ratio of 1:1.51. Mean duration of
diabetes was 13.67±5.80 years (ranging from 9-23 years). Majority 57 (68.67%) of our patients were obese having poor glycemic control.
Peripheral arterial disease has been found in 35(42.16%) patients, out of them 18(51.42%) had mild PAD as their ABI values remained between
0.70-0.90, 15(42.85%) had moderate PAD due to their ABI values between 0.50-0.69 and 2 (5.71%) had severe PAD as their ABI values lie
below 0.49. Conclusions: Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial disease
in type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients.