Prevalence and Associations of Subclinical Peripheral Artery Disease among Patients with Type 2 Diabetes without Clinical Macrovascular Disease

Abstract

Background: Peripheral arterial disease (PAD) is an important marker of cardiovascular (CV) risk and the risk of PAD is markedly increased in patients with type 2 diabetes mellitus (T2DM). Consequently, early diagnosis and treatment of PAD in patients with T2DM are critically important to reduce the risk of CV events. The aim of this study was to determine the prevalence of asymptomatic PAD in patients with T2DM and to investigate the demographic and clinical associations of PAD among them.

Methods: This cross‑sectional study included 2423 diabetic patients >20 years old, who were regularly followed up at the regional diabetes clinic, Galle, Sri Lanka. Data were obtained using structured questionnaires for information on demographic characteristics and risk factors. Assessment of ankle‑brachial pressure index (ABPI) was performed in all. PAD was diagnosed when ABPI was < 0.9 on either leg.

Results: The overall prevalence of PAD was 15.3% with no signifcant age
or gender difference. Patients with PAD had signifcantly higher systolic blood pressure (SBP) (127 vs 125 mmHg, P = 0.002) and diastolic blood pressure (DPB) (80 vs 78 mmHg, P = <0.001) and signifcantly lower estimated glomerular fltration rate (eGFR) (80 vs 84 ml/min, P = 0.007) than those without PAD. No signifcant relationships were found between the duration of diabetes mellitus, hypertension, dyslipidemia, and PAD.

Conclusions: Prevalence of PAD was relatively high in the
diabetic population of this study when compared with fndings from other countries. There is a signifcant association of subclinical PAD with reduced eGFR among patients with T2DM.

Keywords: Diabetes complications, diabetes mellitus, peripheral arterial disease, Sri Lanka