Peripheral Arterial Disease in People Living with Type 2 Diabetes Mellitus

Background: Diabetes mellitus (DM) is characterized by chronic hyperglycaemia due to absolute or relative deficiency of insulin affecting carbohydrate, fats and protein metabolism. It results in chronic vascular complications including macrovascular complications such as peripheral arterial disease (PAD), coronary artery disease and stroke. PAD results from narrowing of blood vessels with reduction in blood flow to the arms and legs (mostly). This results in ischaemic changes in the lower limbs and may ultimately cause ischaemic foot ulcers. PAD is a common macrovascular complication of type 2 DM and is usually asymptomatic. Palpation of peripheral pulses may not correlate with the degree of PAD. The ankle-brachial index (ABI) assessment using a handheld doppler is an objective and sensitive method of diagnosing PAD in people with type 2 diabetes mellitus (PLWDM). The aim of this study was to determine the prevalence of PAD and relationship between hypertension, dyslipidaemia and smoking in PLWDM.

Methods: Venous blood samples were collected for fasting plasma glucose, glycated haemoglobin (HbA1/c) and fasting lipid profile. PAD was obtained by determining the ABI using a handheld doppler. Data analysis was done using SPSS version 28.

Results: There was a total of 226 participants (126 cases, 100 controls). Mean age of cases was 52.4 years. The mean BMI for cases was 27.6kg/m2. Mean HbA1c of cases was 7.6± 1.5%. HDL in the controls was significantly higher than in the cases, p=0.0002, (<0.05). The prevalence of hypertension among cases with PAD was significantly higher (52.9% vs 7.6% in cases without PAD (p=0.0001). Prevalence of PAD was 27% with the ABI range of 0.62 – 0.89. Cases with hypertension had a significantly lower ABI (0.87 for both feet) than normotensive cases (0.94 for both feet), p=0.0001. Most of the diabetic smokers (71.4%) had PAD. About 76.5% of PLWDM who had PAD were asymptomatic. PAD was diagnosed in only 5 of the 18 subjects who had non-palpable foot pulses.

Conclusion: The frequency of PAD amongst people with type 2 DM was 27%. High density lipoprotein was markedly reduced among cases with PAD. The number of smokers in this study was low (5.6%) but 71.4% of diabetic smokers had PAD. Age did not influence the presence of PAD.