Dataset Information

The use of ankle brachial pressure indices in a cohort of black African diabetic patients.

ABSTRACT:

Background

Peripheral arterial disease is very common in patients with diabetes, but it remains grossly under-recognized in this type of patients. Ankle brachial index (ABI) is a simple, non-invasive and reproducible method for detection and improving risk stratification. However, the sensitivity appears to be lower in diabetic patients and, false 'high' readings occur because of the arterial calcification of the vessel media which render the vessels incompressible.

Materials and methods

The study evaluated the prevalence of a low ABI <0.9 in diabetic patients in a hospital-based cross sectional observational study. The study has been registered.

Results

The prevalence of peripheral arterial disease in diabetics with ABI< 0.9 was 18%. The majority (77%) of responders were asymptomatic with mild PAD (ABI 0.7-0.9). Age >60 years, hypertension (systolic BP?>?140?mmHg) and presence of foot ulcer were identified as independent risk factors. 22 participants (4.4%) of the 500 had ABI greater than 1.3 but were excluded in the analysis.

Conclusion

The prevalence of PAD in diabetics measured by the ABI index was low and the majority in our setting had mild PAD and were asymptomatic. ABI could be used in patients with diabetes, but values should be interpreted with precision, according to the clinical situation as higher values are common.

SUBMITTER: Weledji EP

PROVIDER: S-EPMC6156742 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

The use of ankle brachial pressure indices in a cohort of black African diabetic patients.

Weledji Elroy Patrick EP Alemnju Neville Telelen NT Nouediou Christophe C

Annals of medicine and surgery (2012) 20180919

<h4>Background</h4>Peripheral arterial disease is very common in patients with diabetes, but it remains grossly under-recognized in this type of patients. Ankle brachial index (ABI) is a simple, non-invasive and reproducible method for detection and improving risk stratification. However, the sensitivity appears to be lower in diabetic patients and, false 'high' readings occur because of the arterial calcification of the vessel media which render the vessels incompressible.<h4>Materials and meth ...[more]

PMID: 30263113

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Project description:ImportanceThe prevalence and morbidity of peripheral artery disease (PAD) are high, with limb outcomes including revascularization and amputation. In community-dwelling patients with PAD, the role of noninvasive evaluation for risk assessment and rates of limb outcomes have not been established to date.ObjectiveTo evaluate whether ankle-brachial indices are associated with limb outcomes in community-dwelling patients with PAD.Design, setting, and participantsA population-based, observational, test-based cohort study of patients was performed from January 1, 1998, to December 31, 2014. Data analysis was conducted from July 15 to December 15, 2017. Participants included a community-based cohort of 1413 patients with PAD from Olmsted County, Minnesota, identified by validated algorithms deployed to electronic health records. Automated algorithms identified limb outcomes used to build Cox proportional hazards regression models. Ankle-brachial indices and presence of poorly compressible arteries were electronically identified from digital data sets. Guideline-recommended management strategies within 6 months of diagnosis were also electronically retrieved, including therapy with statins, antiplatelet agents, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and smoking abstention.Main outcomes and measuresAnkle-brachial index (index ?0.9 indicates PAD; <.05, severe PAD; and ?1.40, poorly compressible arteries) and limb revascularization or amputation.ResultsOf 1413 patients, 633 (44.8%) were women; mean (SD) age was 70.8 (13.3) years. A total of 283 patients (20.0%) had severe PAD (ankle-brachial indices <0.5) and 350 (24.8%) had poorly compressible arteries (ankle-brachial indices ?1.4); 780 (55.2%) individuals with less than severe disease formed the reference group. Only 32 of 283 patients (11.3%) with severe disease and 68 of 350 patients (19.4%) with poorly compressible arteries were receiving 4 guideline-recommended management strategies. In the severe disease subgroup, the 1-year event rate for revascularization was 32.4% (90 events); in individuals with poorly compressible arteries, the 1-year amputation rate was 13.9% (47 events). In models adjusted for age, sex, and critical limb ischemia, poorly compressible arteries were associated with amputation (hazard ratio [HR], 3.12; 95% CI, 2.16-4.50; P?<?.001) but not revascularization (HR, 0.91; 95% CI, 0.69-1.20; P?=?.49). In contrast, severe disease was associated with revascularization (HR, 2.69; 95% CI, 2.15-3.37; P?<?.001) but not amputation (HR, 1.30; 95% CI, 0.82-2.07; P?=?.27).Conclusions and relevanceCommunity-dwelling patients with severe PAD or poorly compressible arteries have high rates of revascularization or limb loss, respectively. Guideline-recommended management strategies for secondary risk prevention are underused in the community.

Project description:BackgroundCurrently, no international diagnostic criteria for diabetic neuropathy (DN) have been established. Recently, a novel point-of-care sural nerve conduction device has been developed. We aimed to investigate associations between DN and clinical parameters related to the development and progression of DN by using this novel device.MethodsWe conducted a retrospective observational study in patients with diabetes whose sural nerve functions were measured using DPN Check between January 2015 and October 2016. Multiple and logistic regression analyses were conducted to assess the associations of sural nerve conduction velocity (SNCV) and amplitude (SNAP) with clinical parameters related to DN.ResultsA total of 740 patients were enrolled in this study. At baseline, 211 patients were diagnosed with DN by using DPN Check. The sensitivity, specificity, and positive likelihood ratio of DPN Check compared with ankle reflex as reference were 81%, 46%, and 1.5, respectively. Of these, 182 patients were followed up for approximately 1 year to measure changes in SNCV and SNAP. Both SNCV and SNAP were inversely associated with duration of diabetes, plasma glucose levels, and hemoglobin A1c levels at baseline, whereas these were positively associated with ankle-brachial index. Logistic regression analysis revealed that poor glycemic control was associated with increased risk of reduction in both SNCV [odds ratio = 1.570; 95% confidence interval (CI) = 1.298-1.898; p < 0.001] and SNAP (odds ratio = 1.408; 95% CI = 1.143-1.735; p = 0.001), and longer duration of diabetes was also significantly associated with an increased risk of reduction in both SNCV (odds ratio = 1.058; 95% CI = 1.032-1.084; p < 0.001) and SNAP (odds ratio = 1.049; 95% CI = 1.019-1.079; p = 0.001).ConclusionSural nerve functions were significantly associated with glycemic control and arteriosclerosis in patients with diabetes. DPN Check may be useful as a screening tool to identify DN in clinical practice.

Project description:Brachial-ankle pulse wave velocity (baPWV), as a marker of arterial stiffness, has been demonstrated to be associated with blood pressure (BP) and onset of hypertension. However, little information is available on the associations between baPWV and BP indices [systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), mean arterial pressure (MAP)] in treated hypertensive patients. We aimed to assess the associations between BP indices and baPWV. In this cross-sectional study, 14,598 hypertensive patients from China Stroke Primary Prevention Trial (CSPPT) at the exit visit of the trial were analyzed. Elevated baPWV was defined as ≥18.3 m/s. Multivariate linear and logistic regression analyses were performed to evaluate the associations of BP indices with baPWV and elevated baPWV. Moreover, the smooth curve fitting (penalized spline method) was conducted. Multivariate linear regression analyses showed that continuous SBP, DBP, PP and MAP were independently and positively associated with baPWV (β = 0.081, 0.084, 0.078 and 0.115, respectively, all P < 0.001). Compared with controlled SBP group (<140 mm Hg), uncontrolled SBP (≥140 mm Hg) was significantly associated with higher baPWV [β = 2.234, 95% confidence interval (CI): 2.137-2.332]. Similarly, compared with controlled DBP group (<90 mm Hg), uncontrolled DBP (≥90 mm Hg) was significantly associated with higher baPWV (β = 1.466, 95%CI: 1.341-1.590). Multiple logistic analyses also showed that SBP, DBP, PP and MAP were significantly and positively associated with elevated baPWV (OR = 1.056, 1.049, 1.052, and 1.075, respectively, all P < 0.001). The fully-adjusted smooth curve fitting presented a linear association between BP indices with baPWV. In conclusion, among treated hypertensive patients, SBP, DBP, PP and MAP levels were independently and positively associated with baPWV and elevated baPWV, suggesting that baPWV might be a way to predict uncontrolled BP.

Dataset Information

The use of ankle brachial pressure indices in a cohort of black African diabetic patients.

Background

Materials and methods

Results

Conclusion

Publications

The use of ankle brachial pressure indices in a cohort of black African diabetic patients.

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