A Triplex Ultrasound Evaluation of Preclinical Changes in Type 2 Diabetes in Foot Arteries

Abstract

Background and objective: Type 2 diabetes mellitus (T2DM) is a significant health problem that is becoming more prevalent worldwide. This study aimed to assess hemodynamic and morphological parameters in diabetic patients' foot arteries and compare them to those obtained in asymptomatic control group.Materials and methods: This is a cross-sectional case-control study. B-mode ultrasound, color Doppler, and pulse wave Doppler were conducted to assess the dorsalis pedis arteries (DPAs) and posterior tibial arteries (PTAs). The morphological, total vascular diameter, wall thickness, and flow Doppler indices were measured. A total of 200 hundred participants were selected randomly using a random sampling technique. One hundred diabetic patients and 100 non-diabetic persons were determined.Results: In diabetic patients, the overall grayscale diameter and wall thickness of foot arteries were statistically significantly larger than the asymptomatic group in the right DPA (p<0.01), left DPA (p<0.001), right PTA (p<0.001), and left PTA (p<0.001). In the diabetic group, the level of hemoglobin A1c (HbA1c) was positively correlated with blood flow resistive index (RI) in the right DPA (r=0.839; p<0.001), left DPA (r=0.801; p<0.001), right PTA (r=0.801; p<0.001), and left PTA (r=0.801; p<0.001). No significant differences were noted in both groups in blood flow Doppler parameters -pulsatility index (PI) and resistive index (RI).Conclusion: Overall grayscale diameters of foot arteries are larger in the diabetes group than in the control group, indicating arterial wall thickening as an early indicator of diabetes-related alterations. PI of both DPA and RI of right DPA were increased in diabetic patients more than the control group. The level of glycosylated hemoglobin A1c (HbA1c) was strongly linked with the blood flow resistive index in diabetes patients.

Diabetic Foot Complications in Saudi Arabia: A Retrospective Study

“…A biphasic waveform indicates mild to moderate disease, while a monophasic waveform indicates significant disease [40]. In previous studies, the prevalence of LEPAD was reported as 14% in Sudanese diabetic patients, 25% in India, 28% in South Korea, 30% in Poland, 30% in Ethiopia, 33% in Nigeria, 54% in Germany, and 65% in Pakistan [40,[42][43][44][45][46][47].…”

Comparative Doppler Ultrasound Findings of Foot Arteries in Patients with Type 2 Diabetes Mellitus and Normoglycaemic Patients

“…The prevalence of LEPAD in diabetic patients as reported by previous studies include Hur et al [ 22 ] in South Korea (ABI = 5.6%, abnormal Doppler spectral waveform = 28.7%); Leoniuk et al [ 14 ] in Poland (ABI = 0%, Doppler = 30.4%); Adebayo[ 23 ] in Ile-Ife, Nigeria (ABI = 19.7%, Doppler= 33.9%); Agboghoroma[ 24 ] in Jos, Nigeria (ABI = 38.5%); Shaheen et al [ 7 ] in Pakistan (ABI = 46%, Doppler = 62%); Janssen[ 25 ] in Germany (Doppler = 54%); Akalu et al [ 26 ] in Ethiopia (Doppler = 30.7%); Ali[ 27 ] in Sudan (Doppler = 14%); and Das et al [ 28 ] in India (Doppler = 25.5%). The reported prevalence of LEPAD is affected by the method of detection (history of intermittent claudication vs. palpation of arterial pulses vs. ABI vs. arterial intima-media thickness vs. Doppler arterial waveform abnormality vs. Doppler velocimetry and indices vs. conventional/CT/MR angiography), arterial site evaluated (femoropopliteal vs. infrapopliteal arteries), age of the study population, race, and the duration of diabetes mellitus.…”

“…These two arteries were also the only vessels assessed in some of the previous studies. [ 14 20 27 ] Janssen[ 25 ] examined the anterior tibial artery (ATA) and the PTA only, while Das et al [ 28 ] analysed the ATA, PTA, and the DPA. Some previous studies evaluated all the lower limb arteries from the common femoral artery (CFA) to the DPA.…”