Which complication of diabetes can be diagnosed by the ankle-brachial index
Diabetic Foot Clinic, Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece http://orcid.org/0000-0002-0423-1370
DOI:https://doi.org/10.22141/2224-0721.15.7.2019.186053Keywords:diabetes mellitus, ankle-brachial index, diagnosis, peripheral arterial diseaseAbstractBackground. Diabetes mellitus (DM) remains one of the fastest growing and most challenging medical diseases today. The Ankle-Brachial Index (ABI) is the ratio of ankle systolic blood pressure divided by brachial systolic pressure. Generally, ABI has a high specificity and sensitivity for the diagnosis of peripheral arterial disease (PAD). In DM, ABI measurement is recommended by the American Diabetes Association for all subjects > 50 years old. The prevalence of an abnormal ABI is high in type 2 DM. An ABI ≥ 1.3 is associated with increased risk of cardiovascular disease and mortality in the general population, as well as with all-cause mortality in DM. The purpose of the study was to assess the potential association of a high ankle-brachial index with diabetes mellitus in a specific Greek population free from peripheral arterial disease. Materials and methods. Between July 2017 and August 2018, people over 30 years old with and without type 2 DM were examined. We included 240 subjects (118 men) with mean age 64.5 ± 14.6 years from Naxos island in Greece who did not have peripheral arterial disease (PAD). Of these, 144 had DM and 96 did not. DM duration was 10.6 ± 7.4 years. ABI was measured in all subjects. ABI was measured in the supine position after 5–10 minutes of rest, in normal room temperature (25 °C) after patients had taken off their shoes and socks. Results. We grouped ABI measurements into 4 groups: ABI 0.90–1.29; ABI 1.30–1.39; ABI 1.40–1.49; ABI > 1.50. ABI > 1.30 was seen in 44 % of participants with DM vs. 3.1 % of those without DM. There was a significant correlation (p < 0.001) between diabetes duration and ABI. Among participants with DM, those with ABI > 1.30 had DM duration of 14.2 ± 8.2 years, while those with ABI < 1.30 had DM duration of 8 ± 5 years. ABI was 0.21 (19 %) higher in DM vs. non-DM subjects (1.28 ± 0.20 vs. 1.07 ± 0.11, p < 0.001). Conclusions. A high ABI is more frequent in DM, PAD-free, Greek participants, especially among subjects with long-standing DM. DownloadsDownload data is not yet available. ReferencesCho N H, Shaw J E, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018 Apr;138:271-281. doi: 10.1016/j.diabres.2018.02.023. Norgren L, Hiatt W R, Dormandy J A, et al. Inter-society consensus for the management of peripheral arterial disease. J Vasc Surg. 2007 Jan;45 Suppl S:S5-67. doi: 10.1016/j.jvs.2006.12.037. Dachun X, Jue L, Liling Z, et al. Sensitivity and specificity of the ankle-brachial index to diagnose peripheral artery disease: a structured review. Vasc Med. 2010 Oct;15(5):361-9. doi: 10.1177/1358863X10378376. Nicolai SP, Kruidenier LM, Rouwet EV, Bartelink ML, Prins MH, Teijink JA. Ankle brachial index measurement in primary care: are we doing it right? Br J Gen Pract. 2009 Jun;59(563):422-7. doi: 10.3399/bjgp09X420932. Georgakarakos E, Papadaki E, Vamvakerou V, et al. Training to measure ankle-brachial index at the undergraduate level: can it be successful? Int J Low Extrem Wounds. 2013 Jun;12(2):167-71. doi: 10.1177/1534734613483768. Papanas N, Symeonidis G, Mavridis G, et al. Ankle-brachial index: a surrogate marker of microvascular complications in type 2 diabetes mellitus? Int Angiol. 2007 Sep;26(3):253-7. Daskalopoulou SS, Pathmarajah M, Kakkos SK, et al. Association between ankle-brachial index and risk factor profile in patients newly diagnosed with intermittent claudication. Circ J. 2008 Mar;72(3):441-8. doi: 10.1253/circj.72.441. Tziomalos K, Athyros V G, Karagiannis A, Mikhailidis DP. The role of ankle brachial index and carotid intima-media thickness in vascular risk stratification. Curr Opin Cardiol. 2010 Jul;25(4):394-8. doi: 10.1097/hco.0b013e328338c109. Manfredini F, Malagoni AM, Mandini S, et al. Near-infrared spectroscopy assessment following exercise training in patients with intermittent claudication and in untrained healthy participants. Vasc Endovascular Surg. 2012 May;46(4):315-24. doi: 10.1177/1538574412443318. Paraskevas KI, Kotsikoris I, Koupidis SA, Giannoukas AD, Mikhailidis DP. Ankle-brachial index: a marker of both peripheral arterial disease and systemic atherosclerosis as well as a predictor of vascular events. Angiology. 2010 Aug;61(6):521-3. doi: 10.1177/0003319710371620. American Diabetes Association. Standards of medical care in diabetes-2018 Abridged for Primary Care Providers. Clin Diabetes. 2018 Jan;36(1):14-37. doi: 10.2337/cd17-0119. Li X, Wang YZ, Yang XP, Xu ZR. Prevalence of and risk factors for abnormal ankle-brachial index in patients with type 2 diabetes. J Diabetes. 2012 Jun;4(2):140-6. doi: 10.1111/j.1753-0407.2011.00171.x. Allison MA, Hiatt WR, Hirsch AT, Coll JR, Criqui MH. A high ankle-brachial index is associated with increased cardiovascular disease morbidity and lower quality of life. J Am Coll Cardiol. 2008 Apr 1;51(13):1292-8. doi: 10.1016/j.jacc.2007.11.064. Aboyans V, Ho E, Denenberg JO, Ho LA, Natarajan L, Criqui MH. The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects. J Vasc Surg. 2008 Nov;48(5):1197-203. doi: 10.1016/j.jvs.2008.06.005. Signorelli S S, Fiore V, Catanzaro S, Simili M, Torrisi B, Anzaldi M. Prevalence of high ankle-brachial index (ABI) in general population of Southern Italy, risk factor profiles and systemic cardiovascular co-morbidity: an epidemiological study. Arch Gerontol Geriatr. 2011 Jul-Aug;53(1):55-9. doi: 10.1016/j.archger.2010.05.020. Ix JH, Katz R, Peralta CA, et al. A high ankle brachial index is associated with greater left ventricular mass MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2010 Jan 26;55(4):342-9. doi: 10.1016/j.jacc.2009.11.010. Potier L, Roussel R, Labreuche J, et al. Interaction between diabetes and a high ankle-brachial index on mortality risk. Eur J Prev Cardiol. 2015 May;22(5):615-21. doi: 10.1177/2047487314533621. Lilly S M, Jacobs D R, Jr., Kronmal R, et al. Arterial compliance across the spectrum of ankle-brachial index: the Multiethnic Study of Atherosclerosis. Atherosclerosis. 2014 Apr;233(2):691-696. doi: 10.1016/j.atherosclerosis.2014.01.029. Young MJ, Adams JE, Anderson GF, Boulton AJ, Cavanagh PR. Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects. Diabetologia. 1993 Jul;36(7):615-21. doi: 10.1007/bf00404070. Everhart JE, Pettitt DJ, Knowler WC, Rose FA, Bennett PH. Medial arterial calcification and its association with mortality and complications of diabetes. Diabetologia 1988;31:16-23. doi: 10.1007/bf00279127. Suominen V, Uurto I, Saarinen J, Venermo M, Salenius J. PAD as a risk factor for mortality among patients with elevated ABI ─ a clinical study. Eur J Vasc Endovasc Surg. 2010 Mar;39(3):316-22. doi: 10.1016/j.ejvs.2009.12.003. Ix JH, Katz R, De Boer IH, et al. Association of chronic kidney disease with the spectrum of ankle brachial index the CHS (Cardiovascular Health Study). J Am Coll Cardiol. 2009 Sep 22;54(13):1176-84. doi: 10.1016/j.jacc.2009.06.017. Sutton-Tyrrell K, Venkitachalam L, Kanaya AM, et al. Relationship of ankle blood pressures to cardiovascular events in older adults. Stroke. 2008 Mar;39(3):863-9. doi: 10.1161/STROKEAHA.107.487439. Novo S, Coppola G, and Milio G. Critical limb ischemia: definition and natural history. Curr Drug Targets Cardiovasc Haematol Disord. 2004 Sep;4(3):219-25. doi: 10.2174/1568006043335989. Adam DJ, Bradbury AW. TASC II document on the management of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2007 Jan;33(1):1-2. doi: 10.1016/j.ejvs.2006.11.008. Greenland P, Abrams J, Aurigemma GP, et al. Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III. Circulation. 2000 Jan 4;101(1):E16-22. doi: 10.1161/01.cir.101.1.e16. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560-72. doi: 10.1001/jama.289.19.2560. Reaven PD, Sacks J; Investigators for the VADT. Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes. Diabetologia. 2005 Feb;48(2):379-85. doi: 10.1007/s00125-004-1640-z. O'Hare AM, Katz R, Shlipak MG, Cushman M, Newman AB. Mortality and cardiovascular risk across the ankle-arm index spectrum: results from the Cardiovascular Health Study. Circulation. 2006 Jan 24;113(3):388-93. doi: 10.1161/CIRCULATIONAHA.105.570903. Resnick HE, Lindsay RS, McDermott MM, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular diseasemortality: the Strong Heart Study. Circulation. 2004 Feb 17;109(6):733-9. doi: 10.1161/01.CIR.0000112642.63927.54. Young MJ, Adams JE, Anderson GF, Boulton AJ, Cavanagh PR. Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects. Diabetologia. 1993 Jul;36(7):615-21. doi: 10.1007/bf00404070. Goss DE, de Trafford J, Roberts VC, Flynn MD, Edmonds ME, Watkins PJ. Raised ankle/brachial pressure index in insulin-treated diabetic patients. Diabet Med. 1989 Sep-Oct;6(7):576-8. doi: 10.1111/j.1464-5491.1989.tb01231.x. Maser RE, Wolfson SK Jr, Ellis D, et al. Cardiovascular disease and arterial calcification in insulin-dependent diabetes mellitus: interrelations and risk factor profiles. Pittsburgh Epidemiology of Diabetes Complications Study-V. Arterioscler Thromb. 1991 Jul-Aug;11(4):958-65. doi: 10.1161/01.atv.11.4.958. Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes. 2015 Jul 10;6(7):961-9. doi: 10.4239/wjd.v6.i7.961. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003 Dec;26(12):3333-41. doi: 10.2337/diacare.26.12.3333. Nam SC, Han SH, Lim SH, et al. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease. Angiology. 2010 May;61(4):392-6. doi: 10.1177/0003319709348295. Potier L, Halbron M, Bouilloud F, et al. Ankle-to-brachial ratio index underestimates the prevalence of peripheral occlusive disease in diabetic patients at high risk for arterial disease. Diabetes Care. 2009 Apr;32(4):e44. doi: 10.2337/dc08-2015. Suominen V, Rantanen T, Venermo M, Saarinen J, Salenius J. Prevalence and risk factors of PAD among patients with elevated ABI. Eur J Vasc Endovasc Surg. 2008 Jun;35(6):709-14. doi: 10.1016/j.ejvs.2008.01.013. Alnaeb ME, Crabtree VP, Boutin A, Mikhailidis DP, Seifalian AM, Hamilton G. Prospective assessment of lower-extremity peripheral arterial disease in diabetic patients using a novel automated optical device. Angiology. 2007 Oct-Nov;58(5):579-85. DOI: 10.1177/0003319707305685. Espinola-Klein C, Rupprecht HJ, Bickel C, et al. Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. Circulation. 2008 Aug 26;118(9):961-7. doi: 10.1161/CIRCULATIONAHA.107.763227. Clairotte C, Retout S, Potier L, Roussel R, Escoubet B. Automated ankle-brachial pressure index measurement by clinical staff for peripheral arterial disease diagnosis in nondiabetic and diabetic patients. Diabetes Care. 2009 Jul;32(7):1231-6. doi: 10.2337/dc08-2230. Brooks B, Dean R, Patel S, Wu B, Molyneaux L, Yue DK. TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med. 2001 Jul;18(7):528-32. doi: 10.1046/j.1464-5491.2001.00493.x. Janssen A. Pulsatility index is better than ankle-brachial doppler index for non-invasive detection of critical limb ischaemia in diabetes. Vasa. 2005 Nov;34(4):235-41. doi: 10.1024/0301-1526.34.4.235. Williams DT, Harding KG, Price P. An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care. 2005 Sep;28(9):2206-10. doi: 10.2337/diacare.28.9.2206. Sergis MG. Laografika kai Ethnografika apo to Glinado Naxou. Proodeftikos Omilos Glinadou Naxou, 1994, Athens. Gouveri E, Papanas N, Marakomichelakis G, et al. Post-exercise ankle-brachial index is not an indispensable tool for the detection of peripheral arterial disease in an epidemiological survey. A post-hoc analysis of the Athens Study. Int Angiol. 2013 Oct;32(5):518-25. Tsivgoulis G, Bogiatzi C, Heliopoulos I, et al. Low ankle-brachial index predicts early risk of recurrent stroke in patients with acute cerebral ischemia. Atherosclerosis. 2012 Feb;220(2):407-12. doi: 10.1016/j.atherosclerosis.2011.11.009. Downloads2021-09-01 Koufopoulos, G., Pafili, K., & Papanas, N. (2021). Correlation between type 2 diabetes mellitus and ankle-brachial index in a geographically specific Greek population without peripheral arterial disease. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 15(7), 517–522. https://doi.org/10.22141/2224-0721.15.7.2019.186053 |