Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis

Abstract

Aim To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort. Methods A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta‐analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed. Results Thirty‐three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72. Conclusions These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort.

Comparison of Doppler and oscillometric methods of assessing ankle-brachial index in non-diabetic premenopausal women in Ghana

“…Systolic and diastolic BP calculated from this mean, rather than measured directly, can be affected by stiffened arteries, as observed in older and diabetes patients. Therefore, in diabetes patients with a high proportion of stiffened arteries, ABI measurement has increased speci city, while sensitivity is compromised, compared to duplex Doppler ultrasound or digital subtract angiography in a meta-analysis 15 . Excluding diabetes patients from our study population improved the sensitivity of the oscillometric method.…”

Peripheral arterial disease progression and ankle brachial index: a cohort study with newly diagnosed patients with type 2 diabetes

“…ABI has been considered a viable test to detect PAD, its diagnostic sensitivity ranges from 29 to 95% (average = 63%) and its specificity varies from 58 to 97 (average = 93%) [ 4 ]. In a recent meta-analysis, Chuter et al reported sensitivity and specificity of 60% and 87%, respectively, for ABI in patients with diabetes [ 8 ]. It is influenced by several factors, decreasing the test's sensitivity in renal failure and advanced stages or other disorders that result in vascular calcification (incompressible arteries) [ 21 , 33 ].…”

“…ABI has been considered a viable test to detect PAD, its diagnostic sensitivity ranges from 29 to 95% (average = 63%) and its specificity varies from 58 to 97 (average = 93%) [ 4 ]. In a recent meta-analysis, Chuter et al reported sensitivity and specificity of 60% and 87%, respectively, for ABI in patients with diabetes [ 8 ].…”

Taking measure

“…However, a meta-analysis in this issue of the journal highlights a low sensitivity, meaning peripheral arterial disease may not be diagnosed in people with diabetes when using the test. 5 This is a hugely exciting time for diabetes care. Rapid, accurate and precise measurement of multiple analytes and variables is possible with advanced data and bioinformatics tools to process those data and provide incredible insights into pathophysiology.…”

“…The ankle‐brachial pressure index is non‐invasive, readily available, rapid, reproducible and widely understood. However, a meta‐analysis in this issue of the journal highlights a low sensitivity, meaning peripheral arterial disease may not be diagnosed in people with diabetes when using the test 5 …”