Predictors of decrease in ankle–brachial index among patients with diabetes mellitus

Abstract

Our study suggests that, within two years, one in five patients with diabetes and a normal ankle-brachial index may have significant progression of peripheral arterial disease. Annual ankle-brachial index assessment and better control of hyperlipidaemia may thus be required for at-risk patients with poor glycaemic control, renal impairment and retinopathy.

Association of diabetes mellitus with decline in ankle-brachial index among patients on hemodialysis: A 6-year follow-up study

“…In the present study, the mean ABI decrease in HD patients with DM is about -0.017 per year, significantly higher compared to the findings of previous studies (ABI decline rates of -0.004 to -0.013 per year) [14,15]. Besides, our study showed there were 49.6% of patients with a normal ABI experienced a decrease at least 0.1 of ABI from baseline, and 35.3% had a final ABI < 0.9, which frequency were also higher than previous studies [8,13,16]. There is growing evidence that uremia itself promotes PAOD progression [17,18].…”

“…The study by Bird [14] surveyed ABI changes in 508 PAOD patients and found a mean ABI change of -0.019 over a 4.6-year average follow-up (about -0.004 per year). Similarly, Hoe et al[8] assessed ABI change in 82 DM patients over a mean follow-up of 27.6 months and demonstrated that one in five DM patients had a significant decrease in ABI > 0.1 [8]. In addition, Jiwakanon et al[16] evaluated ABI changes in 167 proteinuric DM patients after a mean interval of 23 ± 6 months and found that 17% of patients had either an ABI decrease of ≥ 0.1 or a final ABI < 0.9 [16].…”

“…In previous cross-sectional studies, the identified risk factors of PAOD in HD patients are old age, hypertension, DM, previous coronary artery disease or cerebrovascular disease, wider pulse pressure, hyperlipidemia, malnutrition, and smoking [18]. Some longitudinal studies also support the role of lipid profile in PAOD progression [8,9,13]. High triglyceride and LDL-cholesterol are major risk factors of atherosclerosis [21,22], which was consistent with our results.…”

“…Some studies have looked at the progression of PAOD in selected patient populations via serial measurements of ABI in two readings [8,13–16]. The study by Bird [14] surveyed ABI changes in 508 PAOD patients and found a mean ABI change of -0.019 over a 4.6-year average follow-up (about -0.004 per year).…”

“…The American Diabetes Association recommends measuring ABI for asymptomatic patients aged ≥ 50 years and for younger patients with DM or other vascular risk factors, and repeating the measurement every 5 years if the first result is normal [7]. Approximately 20% DM patients had a significant decrease in ABI > 0.1 [8], which was higher than that seen in the general population [9,10]. …”