Evaluation of peripheral arterial disease in type 2 diabetic patients using computed tomography angiography

Introduction: Peripheral arterial disease (PAD) is a macrovascular complication of diabetes mellitus. PAD is linked strongly with cardiovascular morbidity and mortality.Objectives: To detect the burden of PAD in type 2 diabetes patients using the ankle-brachial pressure index (ABI) and to find its correlation with glycaemic control as well as duration of diabetes mellitus.Methodology: This study was conducted on 300 type 2 diabetes mellitus patients aged 30-70 years, with diabetes for a minimum period of five years. All patients were screened for PAD by a vascular Doppler instrument using the ABI. Patients with ABI < 0.9 are subjected to colour Doppler to confirm the presence of PAD. Blood investigations, like fasting and postprandial blood glucose and glycated haemoglobin (HbA1C), were also done. Data were analysed by SPSS version 20 (IBM Corp., Armonk, NY) using appropriate tests.Results: A total of 68 (22.7%) patients out of 300, who had diabetes mellitus for more than five years, had PAD. Prevalence increases with age and duration of diabetes. There was no difference between males and females. The possibility of PAD increases with raised body mass index (BMI). A total of 38 (55.9%) out of 68 patients with PAD were asymptomatic. Claudication was the most common symptom of PAD, found in 30 (44.1%) patients. Increased systolic pressure was found to be associated with PAD. The sensitivity and specificity of ABI in diagnosing PAD were found to be 89% and 94%, respectively. Chronic hyperglycaemia (high HbA1C) was found to be associated with a higher prevalence of PAD. ABI correlated significantly with the duration of diabetes, systolic hypertension, age, BMI, postprandial blood sugar level, and HbA1C.Conclusion: Prevalence of PAD in diabetes mellitus is positively associated with duration of diabetes, age, BMI, systolic hypertension, and chronic hyperglycaemia (high HbA1C). It can be easily and reliably diagnosed using the ABI (less than 0.9), which will help in early detection and management.

Introduction: Peripheral Arterial Disease (PAD) is a major macrovascular complication of type 2 diabetes (T2D). Though data is limited, studies have indicated a lower prevalence of PAD in Indian diabetes patients as compared to western population. Present study assessed prevalence of PAD in T2D patients in Delhi, North India. Methodology: This study is a retrospective analysis of patient records of T2D patients. A total of 1000 patient were screened, 195 patients were excluded due to incomplete data and 8patients were included in the study. Diagnosis of PAD was based on ankle brachial index (ABI) measurement. An ABI value of &amp;lt;0.9 indicated diagnosis of PAD, 0.9 to 1.3 was taken as normal, and ABI&amp;gt;1.3 as indicator of non-compressible arteries. Results: Study population consisted of 470 male and 335 female T2D patients (n=805), group 22 to 83 years. PAD (ABI &amp;lt;0.9) was present in 12 patients (1.49%), 9males (75% of PAD) and 3 females (25% of PAD). Diabetes patients with PAD had a higher mean age (57.±10.96 vs. 50.97 ±10.03years) a longer duration of diabetes (12.67 ±7.9 vs. 8.±8.06years, p=0.02) and significantly lower BMI (24.92kg/m2±2.42 vs. 29.55±5.87 kg/m2, p=0.0066) as compared to nondiabetic patients. More patients with PAD had hypertension (58.33% vs. 47.79%, p=0.96) and coronary artery disease (16.67% vs. 7.44%, p=0.908) which, however, were not statistically significant. PAD patients had significantly higher levels of total cholesterol (198.75±66.39 vs. 162.23±44.71mg/dl, p=0.0055) and LDL cholesterol (120.66±40.48mg/dl, p=0.039). No difference was seen in triglyceride levels (165.67±70.92mg/dl vs. 165.4±110.14,p=0.99) and A1c levels (8.97±3.vs. 9.08±2.54%, p=0.87) in two groups. Conclusion: Our study shows that prevalence of PAD in T2D patients in Delhi, North India, is much lower than that reported in western population (∼20%) and from south India (6.3%). Prevalence of PAD was higher in patients with higher age, longer duration of diabetes, lower BMI, and higher total and LDL cholesterol. Disclosure B.M. Makkar: None. J.K. Sharma: None. S. Jaggi: None. K. Soota: None. V. Gupta: None. G. Khurana: None.

Introduction: Diabetes is growing at an exponential rate all around the world and soon is to be an epidemic in many countries including India. India topped the list of maximum reported cases of diabetes in year 2000 with 31.7 million (reported cases) it was followed by China (20.8 million) and the United States (17.7 million) in second and third place respectively. Material and methods: A Cross Sectional Study was done in the department of General Medicine at Muzaffarnagar Nagar Medical college, Muzaffarnagar, UP from September 2021 to August 2022. All type 2 diabetic patients attending the department were invited to participate in the study those fulfilling the inclusion criteria and giving consent for inclusion in the study during the period of study were enrolled in the study. A total of 200 such patients were recruited in the study. Measurement of ABPI was made in supine position after 10 minutes of rest and in a quiet room. Results: Out of 200 patients of type 2 diabetes mellitus, 72 (36.0%) were suffering from peripheral arterial disease. Prevalence of peripheral arterial disease in patients of type 2 diabetes mellitus in our institution (a teaching hospital) was 36.0%. Mean Fasting blood sugar levels of diabetic patients with PAD (187.90+100.64 mg/dl) was found to be higher than that of without PAD (182.15+74.29 mg/dl). Mean Post-prandial blood sugar (PPBS) levels of diabetic patients with PAD (280.58+121.11 mg/dl) were also found to be higher than that of without PAD (253.22+85.30 mg/dl). Conclusion: The findings of present study thus suggested that diabetic population is at a substantial risk of peripheral arterial disease and was significantly dependent on duration of diabetes, obesity (waist circumference) and presence of other comorbidities and complications likehypertension, retinopathy and neuropathy.

Anti-thyroid peroxidase antibody (TPOAb) affects metabolic and thyroid function parameters, which may worsen macrovascular complications. This study aims to find the association between chronic hyperglycemia, thyroid autoantibody, and peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) patients, as well as examine important clinical demographic and metabolic variables. This is a retrospective cohort study. Data from 2017-2023 of T2DM patients were collected. A total of 300 patients were included. Further, the T2DM patients are subdivided by TPOAb values. TPOAb categorized (0-60 IU/mL) as negative; TPOAb titer (>60 IU/mL) as positive. To analyze the data, IBM SPSS Statistics for Windows, Version 29.0.2.0 (Released 2022; IBM Corp., Armonk, New York, United States) was utilized. For continuous variables, the independent samples t-test for normally distributed dataand the Mann-Whitney U test for non-normally distributed datawere performed. The chi-square test was used to assess the association between categorical variables. The risk of PAD was assessed using univariate and multivariate binary logistic regression analysis. P<0.05 was set as statistically significant. The prevalence of PAD was significantly higher in the TPOAb-positive group (38.5%) compared to the TPOAb-negative group (21.6%, p = 0.004). Multivariate analysis finds that poorly controlled HbA1c had an increased risk of PAD compared to well-controlled individuals (OR: 2.14, p = 0.046). Those who had diabetes for >10-15 years showed the highest risk (OR: 3.67, P = 0.002), followed by those with diabetes for more than 15 years (OR: 2.22, P = 0.038). Similarly, TPOAb positivity was independently correlated with increased odds of PAD (OR: 2.48, P = 0.003) and therefore potentially heightened the risk of macrovascular complications in association with thyroid autoimmunity. TPOAb positivity is associated with an increased risk of PAD. In addition, poor glycemic control and longer diabetes duration were associated with PAD.

Background:Peripheral Arterial Disease (PAD) is a significant complication among patients with Type 2 Diabetes Mellitus (T2DM), characterized by atherosclerosis that leads to reduced blood flow to the extremities. This article assesses the traditional risk factors for PAD and the predictive value of the new inflammatory biomarkers like fibrinogen and C-reactive protein (CRP), and the implications of PAD in T2DM patients, drawing from recent studies and findings. The presence of PAD in T2DM patients poses serious health risks, including increased risk of foot ulcers, limb amputation, and cardiovascular events, necessitating comprehensive cardiovascular risk management. The study aims to assess the effectiveness of various diagnostic tests for PAD, particularly the Ankle-Brachial Index (ABI), in detecting PAD and stratifying cardiovascular risk in T2DM patients.Methodology:The study population comprises the recruitment of 112 Type 2 DM patients and an equal number and sex matched healthy participants as controls from three centres in Calabar, making a total of 224 participants. Socio-demographic information was collected. After physical examination and anthropometric measurements, the ABI was performed using a Doppler ultrasound device. Descriptive statistics were used to summarize clinical and demographic characteristics, and comparative analysis was done using chi-square for categorical variables and t-test for continuous variables. Logistic regression was used for independent risk factors associated with PAD.Results:The median ages for the Type 2 DM patients and the controls were 58 years (IQR 10) and 58 years (IQR 11), respectively. The prevalence of PAD using ABI<0.9 in this study was 37.5% in people living with type 2 diabetes and 14.3% in controls. The prevalence of PAD for Type 2 DM patients and controls using symptoms of palpation of pedal pulsations and intermittent claudication was 17.0% vs 3.6% and 11.6% vs 2.7% respectively. There was a statistically significant relationship between advanced age, hypertension, duration of diabetes, glycaemic control, fibrinogen, as well as CRP, and PAD among people living with Type 2 diabetes. After multiple regression analysis, the predictors of PAD in this study were age, duration of Diabetes, and elevated serum CRP. There was no correlation between smoking, obesity, and lipid profiles with PAD.Conclusion:There is a high prevalence of peripheral artery disease among people with T2DM in Calabar. The use of ABI is of great value in the detection of PAD, as evidenced by a more objective assessment of PAD compared to intermittent claudication and reduced/absent pedal pulses. Routine screening of PLWDM for PAD using ABI would enhance early diagnosis and intervention.

BackgroundThe clinical utility of ankle-brachial index (ABI) is not clear in subjects with less severe or calcified vessel. Therefore, we investigated the usefulness of color Doppler ultrasonography for diagnosing peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) subjects.MethodsWe analyzed 324 T2DM patients who concurrently underwent ABI and carotid intima-media thickness (CIMT) measurements and color Doppler ultrasonography from 2003 to 2006. The degree of stenosis in patients with PAD was determined according to Jager's criteria, and PAD was defined as grade III (50% to 99% stenosis) or IV stenosis (100% stenosis) by color Doppler ultrasonography. Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the risk factors for PAD in patients with ABI 0.91 to 1.40.ResultsAmong the 324 patients, 77 (23.8%) had ABI 0.91 to 1.40 but were diagnosed with PAD. Color Doppler ultrasonography demonstrated that suprapopliteal arterial stenosis, bilateral lesions, and multivessel involvement were less common in PAD patients with ABI 0.91 to 1.40 than in those with ABI ≤0.90. A multivariate logistic regression analysis demonstrated that older age, current smoking status, presence of leg symptoms, and high CIMT were significantly associated with the presence of PAD in patients with ABI 0.91 to 1.40 after adjusting for conventional risk factors. CIMT showed significant power in predicting the presence of PAD in patients with ABI 0.91 to 1.40.ConclusionColor Doppler ultrasonography is a useful tool for the detection of PAD in T2DM patients with ABI 0.91 to 1.40 but a high CIMT.

OBJECTIVEThe aim of this article was to define risk factors for incidence of peripheral arterial disease (PAD) in a large cohort of patients with type 2 diabetes mellitus (T2DM), overall and within the context of differing glycemic control strategies.RESEARCH DESIGN AND METHODSThe Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) randomized controlled trial assigned participants to insulin-sensitizing (IS) therapy versus insulin-providing (IP) therapy. A total of 1,479 participants with normal ankle-brachial index (ABI) at study entry were eligible for analysis. PAD outcomes included new ABI ≤0.9 with decrease at least 0.1 from baseline, lower extremity revascularization, or lower extremity amputation. Baseline risk factors within the overall cohort and time-varying risk factors within each assigned glycemic control arm were assessed using Cox proportional hazards models.RESULTSDuring an average 4.6 years of follow-up, 303 participants (20.5%) experienced an incident case of PAD. Age, sex, race, and baseline smoking status were all significantly associated with incident PAD in the BARI 2D cohort. Additional baseline risk factors included pulse pressure, HbA1c, and albumin-to-creatinine ratio (P < 0.05 for each). In stratified analyses of time-varying covariates, changes in BMI, LDL, HDL, systolic blood pressure, and pulse pressure were most predictive among IS patients, while change in HbA1c was most predictive among IP patients.CONCLUSIONSAmong patients with T2DM, traditional cardiovascular risk factors were the main predictors of incident PAD cases. Stratified analyses showed different risk factors were predictive for patients treated with IS medications versus those treated with IP medications.

Introduction and Aim:Atherosclerotic cardiovascular disease (ASCVD)and Framingham score (FRS) are two important scores used for the prediction of coronary events in an individual.Both of these scores do not account for certain known predisposing factors such as BMI, duration of diabetes, LDL cholesterol and glycemic index levels among type 2 diabetes mellitus (T2DM) subjects. So, this study aims to assess whether addition of any of these important risk factors might help in improving these scoring systems in T2DM patients.&#x0D; Methodology: Our study is a cross-sectional study which included 320 T2DM patients without CAD and 120 T2DM patients with CAD. Duration of T2DM, BMI, glycated hemoglobin and fasting lipid profile values of the T2DM patients were recorded from the Laboratory information system.&#x0D; Results: IBM Statistical Package for the Social Sciences (SPSS) 16 version was used for statistical analysis. T2DM patients with CAD had more years of duration of T2DM than the patients without CAD and a significant association was found (p=.045*). A strong significant positive correlation was observed between FRS score and duration of T2DM in diabetic patients with CAD (r=.331, p=&lt;.0001*).&#x0D; Conclusion:Our observations imply that inclusion of important parameter such as duration of T2DM might improve in better calculation of these risk scores in T2DM patients. Future studies are needed to assess the performance of existing risk scores by including important parameter such as duration of diabetes which might help in improving these scoring systems in T2DM patients.

Background: Peripheral arterial disease (PAD) is one of the major macrovascular complications of diabetes mellitus (DM) which is largely neglected by clinicians. DM-associated atherosclerosis can lead to complications in all major of vascular beds, including the coronary arteries, carotid vessels, and lower extremity arteries. Aims and objective were to study the prevalence of PAD in patients with type 2 DM and to study the correlation with carotid artery intima-media thicknessMethods: Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age &gt;25 year) from Dec 2019 to Oct 2021 in the various units of department of medicine or surgery, KPS institute, GSVM medical college Kanpur. Color doppler of limbs and carotid artery was done in study population.Results: In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The mean Carotid IMT (mm) (Average) was 0.82±0.16 in all diabetics. Patients with PAD have more increase in CIMT (0.95±0.12) as compare to non-PAD (0.77±0.15) p&lt;0.001.Conclusions: By using doppler, we found evidence of PAD in 25% of type 2 diabetics (M&gt;&gt;F). Patients with PAD have more increase in CIMT as compare to non-PAD.

Serum cystatin C levels are associated with asymptomatic peripheral arterial disease in type 2 diabetes mellitus patients without overt nephropathy

Background: Plasma calprotectin is a persistent biomarker of insulin resistance (IR), gastroenteritis, and cardiovascular disease (CVD). We assessed the role of plasma and urinary calprotectin in type 2 diabetes patients with peripheral arterial disease (PAD), to assess whether calprotectin is a risk factor for developing PAD in type 2 diabetes patients. Aim of the work: To study the association of plasma and urinary calprotectin levels with peripheral arterial disease in type 2 diabetic patients Methods: The current study was conducted on 90 subjects. They were subdivided into 3 groups. Group I: 30 type 2 diabetics with PAD, group II: 30 type 2 diabetics without PAD and group III: 30 healthy control subjects of comparable age and sex. They were subjected to history taking, full clinical examination, anthropometric measurement, plasma and urinary calprotectin levels that were measured by ELISA and ankle brachial index. In addition, HbA1c, fasting serum lipid profile, highly sensitive CRP and CBC were measured. Results: plasma calprotectin level was significantly higher in patients with T2DM with lower extremity peripheral arterial disease (LEPAD) compared to the other 2 groups, urinary calprotectin was significantly higher in all type 2 diabetic subjects compared to healthy control group. Age, current smoking status, duration of diabetes, glycated hemoglobin and plasma calprotectin were independent determinant of peripheral arterial disease in T2DM patients Conclusion: Elevated plasma and urinary calprotectin levels in diabetic patients compared to healthy control suggest the possible role of calprotectin in development of atherosclerosis and peripheral arterial disease and the possibility of its use as a biomarker for diabetic vasculopathy.

Peripheral vascular disease is a major macrovascular complication of diabetes mellitus. This study was done to determine the prevalence of peripheral arterial disease in type 2 diabetes mellitus using the ankle brachial pressure index. An 12 MHz doppler probe was used in the arms and legs to assess the ankle brachial index (ABI) in 200 type 2 diabetes mellitus patients aged more than 40 years. Thorough history of patients including age, smoking history, history of symptoms of peripheral arterial disease, complete physical examination and routine investigations were collected at the time of enrolment for all subjects. A ratio of the highest blood pressure from the posterior tibial or pedal arteries of each leg to the highest blood pressure from the brachial arteries &amp;lt; 0.9 was considered abnormal. Abnormal ABIs were found in 33% (66/200) patients with type 2 diabetes mellitus. 45.5% patients had ABI 0.80-0.89, 33.3% patients had ABI 0.50-0.79 and 21.2% patients had ABI &amp;lt;0.5 Prevalence of peripheral vascular disease in type 2 diabetes mellitus is on rise in northern India so there is need to educate the patients regarding risk factor modification and importance of early intervention to prevent future progression of peripheral vascular disease.

BackgroundLower extremity peripheral arterial disease (PAD) is a marker of widespread atherosclerosis. Individuals with PAD, most of whom do not show typical PAD symptoms ('asymptomatic' patients), are at increased risk of cardiovascular ischaemic events. American College of Cardiology/American Heart Association guidelines recommend that individuals with asymptomatic lower extremity PAD should be identified by measurement of ankle-brachial index (ABI). However, despite its associated risk, PAD remains under-recognised by clinicians and the general population and office-based ABI detection is still poorly-known and under-used in clinical practice. The Prevalence of peripheral Arterial disease in patients with a non-high cardiovascular disease risk, with No overt vascular Diseases nOR diAbetes mellitus (PANDORA) study has a primary aim of assessing the prevalence of lower extremity PAD through ABI measurement, in patients at non-high cardiovascular risk, with no overt cardiovascular diseases (including symptomatic PAD), or diabetes mellitus. Secondary objectives include documenting the prevalence and treatment of cardiovascular risk factors and the characteristics of both patients and physicians as possible determinants for PAD under-diagnosis.Methods/DesignPANDORA is a non-interventional, cross-sectional, pan-European study. It includes approximately 1,000 primary care participating sites, across six European countries (Belgium, France, Greece, Italy, The Netherlands, Switzerland). Investigator and patient questionnaires will be used to collect both right and left ABI values at rest, presence of cardiovascular disease risk factors, current pharmacological treatment, and determinants for PAD under-diagnosis.DiscussionThe PANDORA study will provide important data to estimate the prevalence of asymptomatic PAD in a population otherwise classified at low or intermediate risk on the basis of current risk scores in a primary care setting.Trial registration numberClinical Trials.gov Identifier: NCT00689377.

To investigate the prevalence and risk factors of peripheral arterial disease (PAD) in male Chinese octogenarians and nonagenarians with hypertension. Ankle-brachial index (ABI) was measured in the noninvasive vascular laboratory for hypertensive male octogenarians and nonagenarians enrolled from outpatient and inpatient departments. The baseline conditions were investigated using standard questionnaire and by routine physical examinations. PAD was diagnosed when an ABI≤0.9 in either lower extremity. Totally 290 male Chinese octogenarians and nonagenarians [age: (84.61±4.20) years] with hypertension who were receiving antihypertensive therapy were enrolled in this study, among whom 9 men with missing data except age and ABI measurements. The ABI was 0.948±0.258, with the range of highest frequency of 0.91-1.30, and 106 patients were diagnosed as PAD, 182 as non-PAD, and 2 had ABI>1.3. ABI in hypertensive men with PAD were significantly lower than in those without PAD (P<0.05). On the contrary, age, blood urea nitrogen, white blood cell counts, platelets and aspartic transaminase were significantly higher in PAD patients than in non-PAD patients (all P<0.05). The prevalence of PAD in this study population were 36.5%; more specifically, it significantly differed between different subgroups when stratified by age (28.6% vs. 46.3%, below and above 85 years), with and without hypertension (27.5% vs. 40.1%), stroke (44.7% vs. 27.5%), dyslipidemia (41.4% vs. 33.3%), coronary artery disease (44.1% vs. 13.9%), and diabetes mellitus (53.7% vs. 21.8%) (all P<0.05). The prevalences of PAD in hypertensive patients treated with diuretics, calcium antagonists, beta-blocker, or angiotensin receptor antagonist were 41.4%, 36.1%, 22.4%, and 26.8%, respectively. No association was observed between the prevalence of PAD and smoking/alcohol drinking in these subjects. Multivariate analysis showed that age (OR 1.12, 95%CI 1.014-1.238), blood urea nitrogen (OR 1.15, 95%CI 1.025-1.301), aspartic transaminase (OR 1.05, 95%CI 1.005-1.089), diabetes mellitus (OR 4.02, 95%CI 1.797-9.009), coronary artery disease (OR 6.34, 95%CI 1.734-23.214) were strong risk factors of PAD. PAD is highly prevalent among aged Chinese hypertensive men, in which age, blood urea nitrogen, aspartic transaminase, diabetes mellitus, coronary artery disease may be involved in the development of this condition.

Atherosclerosis has been assessed in human immunodeficiency virus (HIV)-infected persons by using various methods. Peripheral arterial disease (PAD) has not been evaluated, however. We studied the cross-sectional prevalence of lower limb PAD in an HIV-infected population. PAD was assessed using the Edinburgh Claudication Questionnaire and by measuring the systolic ankle-brachial blood pressure index (ABI) at rest and after exercise. Patients with PAD were further evaluated by duplex scan of lower limb arteries. Ninety-two consecutive HIV-infected patients were evaluated (23.9% women; mean age, 49.5 years; 61.9% current smokers). Claudication was reported by 15.2% of the patients. PAD was found in 20.7% of the patients: 9.8% had an abnormal ABI (<0.90) at rest, and 10.9% had normal ABI at rest but a >25% decrease after exercise. Of the patients with PAD, 84.2% were investigated with duplex scan, all of whom had atherosclerotic occlusions or stenoses of the iliac or femoral arteries. Age, diabetes, smoking, and low CD4+ T lymphocyte counts were identified as independent predictors of PAD. The prevalence of symptomatic and asymptomatic PAD is high in the HIV-infected population and is much higher than expected (prevalence in the general population, approximately 3% at 60 years). This study suggests the presence of an epidemic of PAD approximately 20 years earlier in the HIV-infected than in the general population. Larger epidemiological studies are needed to better define risk factors and to evaluate whether PAD is associated with increased mortality, as it is in the general population.