Peripheral arterial disease in patients with diabetes in primary care: an observational study

Abstract

Peripheral arterial disease (PAD) puts patients at risk for skin ulceration and limb amputation. Measurement of the ankle-brachial index (ABI) along with clinical evaluation to detect PAD is recommended for selected diabetic patients. Objectives: To determine the prevalence of PAD signs in diabetic patients managed in primary care. Setting: Centro de Saúde de São Martinho do Bispo. Participants: Diabetic patients managed in primary care in this clinic. Study type: Observational study, using data obtained from the «Venha Pelo Seu Pé project». Methods: A convenience sample of diabetic patients was selected, aged 50 years of age or over, attending a diabetic foot care consultation. Data were collected by experienced healthcare professionals working in this clinic. Data were obtained in an interview, by physical examination, and from clinic records. These included age, sex, body mass index (BMI), waist circumference, blood pressure, past medical history of tobacco use, dyslipidemia, hypertension, macrovascular disease, duration of diabetes, last noted value of glycosylated haemoglobin (HbA1c), diabetes medication, arterial claudication and resting pain, palpation of pedal pulses, and ABI values. The chi-square and Fisher tests were used to test associations between variables. Results: There were 418 patients in the study sample comprising 48.4% of the diabetic patients in this clinic. The mean age was 68.85±8.64 years and 52.9% were females. In the sample, 2.9% were smokers, 87.1% had hypertension and 84.0% had dyslipidemia (or medication for those problems). In 19.1% there was known macrovascular disease. Diabetes had been known for a mean duration of 10.72±8.48 years and the mean HbA1c was 6.86±1.16% of. The foot ulcer, or amputation, was found in 0.5%. Arterial claudication was present in 9.8% (CI95%: 7.1-13.1) and a non-palpable pulse in 14.6% (CI95%: 11.3-18.3). The ABI was less than or equal to 0.9 in 11.5% (CI95%: 6.6-14.9), with a prevalence of clinical findings of PAD of 28.5% (CI95%: 24.2-33.1). An association was found between ABI = < 0.9 and a non-palpable pulse (p=0.009) or arterial claudication (p < 0.001). Conclusions: We cannot compare the prevalence of PAD in this study with findings from other Portuguese studies, because ABI was measured in few studies. The findings in other studies suggest that there might be a lower prevalence or under-diagnosis of PAD. A combination of different diagnostic methods may contribute to increase in the detection of PAD in clinical practice.