Assessment of toe brachial index validity in diabetic patients - interim results

Machaczka, Ondřej; Homza, Miroslav; Macounová, Petra; Kovaľová, Martina; Janoutová, Jana; Janout, Vladimí­r

doi:10.36290/vnl.2021.061

Cited by 4 publications

(15 citation statements)

References 14 publications

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“…increases the pre-test probability by a moderate to large amount, that is, the person is likely to have PAD [33][34][35]37,38,[40][41][42][43]46,48,50,51,53,54,56,59,60,62,64,65,67,69,70 and therefore may be a useful test for diagnosing PAD. In contrast, for populations with DFU, the same ABI threshold (<0.9) appears to increase the pre-test probability of disease by a relatively small amount.…”

Section: Discussionmentioning

confidence: 99%

“…83 Several studies in this review investigated the high and low ABI methods of calculating the ABI on diagnostic accuracy. 47,50,54 Based on the limited available evidence, an ABI calculated using the low ABI method has a slightly improved ability to rule the presence of PAD both in and out than an ABI calculated using the high ABI methods.…”

Section: Discussionmentioning

confidence: 99%

“…47,50,54 Using the lowest pressure to calculate ABI was associated with a slightly higher PLR in 2 of the 3 studies (1.47 and 2.66 vs. 1.28 and 1.93). 50,54 CHUTER ET AL.…”

Section: Ankle-brachial Indexmentioning

confidence: 96%

“…Of the 40 studies relating to diagnostic accuracy undertaken in populations with diabetes, 28 of the studies used prospective recruitment 33,[36][37][38][39][41][42][43][44]46,47,[52][53][54][55][56][57][58][59][60]62,65,[67][68][69][70][71][72] and the remainder used retrospective recruitment. 34,35,40,45,[48][49][50][51]61,63,64,66 Eight studies reported including participants with active DFU, 39,43,44,48,57,58,69,72 with the proportion of the study population affected ranging from 6.6% to 100%.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…52 In addition, 3 studies investigated the comparative diagnostic accuracy of ABI calculated from the highest of the two ankle systolic pressures (dorsalis pedis and posterior tibial) and the lowest of the two systolic ankle pressures. 47,50,54 For the 38 studies using the ABI as an index test, the threshold used to indicate a positive (i.e., abnormal) test varied. Nine studies used a threshold of <0.9, 38,42,54,56,59,60,70-72 8 studies used a threshold of ≤0.9, 34,39,41,43,52,53,58,64,65 7 studies use a threshold of <0.9 and >1.3, 33,46,50,55,57,61,69 2 studies used a threshold of ≤0.9 and ≥1.3, 37,40 3 studies used a threshold of <0.9 and >1.4 51,62,65 one used ≤0.9 and ≥1.4 48 and the remainder did not state a threshold.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes‐related foot ulcer (DFU) development, non‐healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non‐invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non‐invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra‐ and inter‐rater reliability of non‐invasive bedside tests in adults with diabetes. A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective and retrospective investigations of the diagnostic accuracy of bedside testing in people with diabetes using an imaging reference standard and reliability studies of bedside testing techniques conducted in people with diabetes were eligible. Included studies of diagnostic accuracy were required to report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) which were the primary endpoints. The quality appraisal was conducted using the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability quality appraisal tools. From a total of 8517 abstracts retrieved, 40 studies met the inclusion criteria for the diagnostic accuracy component of the review and seven studies met the inclusion criteria for the reliability component of the review. Most studies investigated the diagnostic accuracy of ankle ‐brachial index (ABI) (N = 38). In people with and without DFU, PLRs ranged from 1.69 to 19.9 and NLRs from 0.29 to 0.84 indicating an ABI <0.9 increases the likelihood of disease (but the extent of the increase ranges from a small to large amount) and an ABI within the normal range (≥0.90 and <1.3) does not exclude PAD. For toe‐brachial index (TBI), a threshold of <0.70 has a moderate ability to rule PAD in and out; however, this is based on limited evidence. Similarly, a small number of studies indicate that one or more monophasic Doppler waveforms in the pedal arteries is associated with the presence of PAD, whereas tri‐ or biphasic waveform suggests that PAD is less likely. Several forms of bedside testing may also be useful as adjunct tests and 7 studies were identified that investigated the reliability of bedside tests including ABI, toe pressure, TBI, transcutaneous oxygen pressure (TcPO2) and pulse palpation. Inter‐rater reliability was poor for pulse palpation and moderate for TcPO2. The ABI, toe pressure and TBI may have good inter‐ and intra‐rater reliability, but margins of error are wide, requiring a large change in the measurement for it to be considered a true change rather than error. There is currently no single bedside test or a combination of bedside tests that has been shown to have superior diagnostic accuracy for PAD in people with diabetes with or without DFU. However, an ABI <0.9 or >1.3, TBI of <0.70, and absent or monophasic pedal Doppler waveforms are useful to identify the presence of disease. The ability of the tests to exclude disease is variable and although reliability may be acceptable, evidence of error in the measurements means test results that are within normal limits should be considered with caution and in the context of other vascular assessment findings (e.g., pedal pulse palpation and clinical signs) and progress of DFU healing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…47,50,54 Using the lowest pressure to calculate ABI was associated with a slightly higher PLR in 2 of the 3 studies (1.47 and 2.66 vs. 1.28 and 1.93). 50,54 CHUTER ET AL.…”

Section: Ankle-brachial Indexmentioning

confidence: 96%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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Case series of macroalbuminuria and toe-brachial index in type 2 diabetes mellitus

Mathew,

Varughese,

Manoharan

et al. 2023

Int J Basic Clin Pharmacol

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Diabetes mellitus is a growing health problem with a significant global disease burden. The complications and mortality rate associated with diabetes are increasing. Albuminuria is one of its complications and evidence of established nephropathy. Low toe–brachial index (TBI) is more strongly associated with albuminuria and may be a suitable tool for evaluating peripheral arterial disease in patients with type 2 diabetes mellitus. Our study evaluated the association between macro albuminuria and low toe brachial index in type 2 diabetic patients to identify those who need specialized foot care and adequate renal protection.

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Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients

Ghirardini,

Martini

2024

Medicina

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Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, it is often made difficult by the characteristics of such diseases. Diagnosing PAD makes it possible to identify patients at a very high cardiovascular risk who require intensive treatment in terms of risk factor modification and medical therapy. The purpose of this review is to discuss the diagnostic methods that allow for a diagnosis of PAD in diabetic patients. Non-invasive tests that address PAD diagnosis will be discussed, such as the ankle-brachial index (ABI), toe pressure (TP), and transcutaneous oxygen pressure (TcPO2). Furthermore, imaging methods, such as duplex ultrasound (DUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are described because they allow for diagnosing the anatomical localization and severity of artery stenosis or occlusion in PAD. Non-invasive tests will also be discussed in terms of their ability to assess foot perfusion. Foot perfusion assessment is crucial in the diagnosis of critical limb ischemia (CLI), the most advanced PAD stage, particularly in DFD patients. The impacts of PAD diagnosis and CLI identification in diabetic patients are clinically relevant to prevent amputation and mortality.

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Assessment of toe brachial index validity in diabetic patients - interim results

Cited by 4 publications

References 14 publications

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Case series of macroalbuminuria and toe-brachial index in type 2 diabetes mellitus

Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients

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