Ankle-Brachial Index Is Independently Associated With Cardiovascular Outcomes and Foot Ulcers in Asian Patients With Type 2 Diabetes Mellitus

Abstract

Background and AimsThe ankle-brachial index (ABI) is an efficient tool for objectively documenting the presence of lower-extremity peripheral arterial disease (PAD). The predictive factors of cardiovascular events and diabetic foot ulcer were not clear from the ABI examination in Taiwanese patients with type 2 diabetes mellitus (DM).MethodsWe enrolled 482 patients with type 2 DM who regularly visited the outpatient department of Chang Gung Memorial Hospital and received ABI as well as brachial-ankle pulse wave velocity (ba-PWV) examinations from 2010 to 2017. Age, gender, PAD symptoms, comorbidities, family history of chronic diseases, lifestyle (smoking, alcohol consumption, and exercise), height, weight, waist circumference, monofilament testing and foot ulcer status were studied.ResultsThere were 104 (22%) patients (mean age, 67.8 years) with the ABI <1.0. These patients with low ABI (ABI<1.0) had a significantly older age (p=0.001), higher delta PWV (p<0.001), higher rates of stroke (p=0.007), myocardial infarction (p=0.016), and foot ulcer (p=0.039). In a multivariable analysis model, the adjusted odds ratio (aOR) for myocardial infarction, stroke, and foot ulcers associated with low ABI were 1.219 (0.397-3.743, p=0.729), 1.204 (0.556-2.610, p=0.638), and 2.712 (1.199-6.133, p=0.017), respectively. The patients with low PWV (PWV<1400 cm/s) were significantly younger (p<0.001) and had a lower rate of hypertension (p<0.001), and higher percentages of stroke (p=0.027) and dialysis (p=0.041) family history.ConclusionsLow ABI was associated with cardiovascular events and diabetic foot ulcer independently in patients with type 2 DM.

Exercise intervention to reduce the risk of diabetic foot ulcers in diabetics with the health belief model approach

“…Although this research has a significant contribution to knowledge, there are some limitations to this research. Diabetic foot ulcers can be detected in various ways, including checking blood glucose, HbA1c (Miranda, Da Ros, and Marfella 2021), ankle brachial index (ABI) (Yang et al 2021), monofilament examination (Baldursdottir et al 2020), TcPO2 . examination (Fagher and Löndahl 2021) as well as regular foot checks.…”

“…Exercise can also improve motor function so that it can reduce the risk of falling (Dai and Li 2019) which can cause ulcers. Exercise can also increase Ankle-Brachial Index, because Diabetics with a low Ankle-Brachial Index have a higher risk of developing foot ulcers (Yang et al 2021). For this reason, it is important to carry out routine Ankle-Brachial Index examinations to detect peripheral arterial diseases and angiography to prevent amputations (Ravidas, P., and G. 2020).…”

“…To detect the risk of diabetic foot ulcers, an ABI examination is carried out. The ABI is an efficient method for detecting the presence of peripheral arterial disorders of the lower extremities (Yang et al 2021). The ABI is the ratio between lower extremity systolic blood pressure, specifically the ankle, and upper extremity.…”

Diabetes and Its Cardiovascular Complications: Comprehensive Network and Systematic Analyses

“…Since amputation risk of lower extremities is a common complication of patients with PAD and diabetes ( 230 ), it is important to be able to assess PAD risk among diabetic patients before they develop diabetic foot ulcers in which amputation then becomes more necessary. One major indicator of amputation risk that can be non-invasively assessed is by determining the ankle brachial index ( 231 ). The results of this study showed that patients who exhibited a lower ankle brachial index were at a higher risk for a foot ulcer and thus an amputation.…”

Application opportunity of Doppler ultrasound combined with CT angiography in diabetic lower extremity arterial disease and the analysis of the risk factors

“…There are many methods to check LEAD. Among them, ABI, as the preferred screening method for LEAD in diabetes, is simple and inexpensive, and can be used to predict diabetic foot and cardiovascular and cerebrovascular diseases ( 5 ). However, due to the influence of vascular calcification, its sensitivity in the examination of LEAD in diabetes is not high ( 6 ).…”