Assessment of Peripheral Arterial Disease among Type 2 Diabetes Patients in Calabar, Nigeria
Main Article Content
Keywords
Peripheral Arterial Disease, Type 2 Diabetes, Ankle Brachial Index, Doppler Ultrasound
Abstract
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.
References
2. Layden J, Michaels J, Bermingham S, Higgins B; Guideline Development Group. Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance. BMJ 2012;345:e4947.
3. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997;26:517-38.
4.Yakubu PD, Khanna NN, Bakari AG, Garko SB, Abubakar AB. Assessment of Predictors and Prevalence of Peripheral Arterial Disease among Type 2 Diabetes Patients in Zaria, Northern Nigeria. Int J Clin Cardiol Res 2018; 2(1): 8-013.
5. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L, Golzarian J, Gornik HL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE; American Col- 288 Rhee SY, et al. Diabetes Metab J 2015;39:283-290 http://e-dmj.org lege of Cardiology Foundation Task Force; American Heart Association Task Force. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61: 1555-70
6. Nam SC, Han SH, Lim SH, Hong YS, Won JH, Bae JI, Jo J. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease. Angiology 2010;61: 392-6.
7. Xu D, Zou L, Xing Y, Hou L, Wei Y, Zhang J, Qiao Y, Hu D, Xu Y, Li J, Ma Y. Diagnostic value of ankle-brachial index in peripheral arterial disease: a meta-analysis. Can J Cardiol 2013;29: 492-8.
8. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45 Suppl S: S5-67.
9. Thiruvoipati T, Kielhorn CE, Armstrong EJ, Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes : Epidemiology, mechanisms, and outcomes. World J Diabetes 2015. 2015;6(7):961–9.
10. Rencüzoğulları I, Çınar T, Karabağ Y. Endothelin-1 and C Reactive Protein as Potential Biomarkers for Restenosis in Patients with Arteriosclerosis Obliterans, Endothelin-1 and C Reactive Protein as Potential Biomarkers for Restenosis in Patients with Arteriosclerosis Obliterans. J Investig Surg. 2021;34(7):771–2.
11. Hayfron-Benjamin CF, Maitland- AH, Grobusch KK, Schulze MB, Spranger J, Danquah I, et al. Association between C-reactive protein and microvascular and macrovascular Saharan Africans dysfunction in sub- with and without diabetes : the RODAM study. BMJ. 2020;8(Cvd):1–9.
12. Beckman JA, Paneni F, Cosentino F, Creager MA. Diabetes and vascular disease: Pathophysiology, clinical consequences, and medical therapy: Part II. Eur Heart J. 2013;34(31):2444–56.
13. Singh MV, Dokun AO. Diabetes mellitus in peripheral artery disease: Beyond a risk factor. Front Cardiovasc Med. 2023;10:1148040.
14. Serrano Hernando FJ, Conejero AM. Peripheral artery disease: Pathophysiology, diagnosis, and treatment. Rev Esp Cardiol. 2007;60(9):969–82.
15. Mwebaze RM, Kibirige D. Peripheral arterial disease among adult diabetic patients attending a large outpatient diabetic clinic at a national referral hospital in Uganda: a descriptive cross-sectional study. PLoS One. 2014 18;9(8):e105211.
16. T R, Divya P, P.S A, Annamalai S. Diabetes Mellitus and Peripheral Vascular Disease. Int J Contemp Med Res [IJCMR]. 2020;7(7):10–3.
17. Soyoye DO, Ikem RT, Kolawole BA, Oluwadiya KS, Bolarinwa RA, Adebayo OJ. Prevalence and Correlates of Peripheral Arterial Disease in Nigerians with Type 2 Diabetes. Adv Med. 2016;2016(1):1-6.
18. Agnelli G, Belch JJF, Baumgartner I, Giovas P, Hoffmann U. Morbidity and mortality associated with atherosclerotic peripheral artery disease: A systematic review. Atherosclerosis. 2020; 293: 94-100
19. Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease: morbidity and mortality implications. Circulation. 2006 ;114(7):688-99.
20. Obi PC, Anyanwu AC, Nwatu CB, Ekwueme C, Mbaike A, Nwako FO, Ebirim DV, Okafor C, Oputa RN. Prevalence and Predictors of Lower Extremity Peripheral Artery Disease among Adults with Type 2 Diabetes Mellitus Attending a Tertiary Hospital in Owerri, Nigeria. Cardiol and Angiol: An international J. 2019;8(3):1-11
21. Akalu Y, Birhan A. Peripheral Arterial Disease and Its Associated Factors among Type 2 Diabetes Mellitus Patients at Debre Tabor General Hospital, Northwest Ethiopia. J Diabetes Res. 2020;2020:9419413
22. Raimi T, Akintoye O, Ajayi D, Ibidapo O. Association of Peripheral Artery Disease, Peripheral Neuropathy and Insulin Resistance among Patients with Type 2 Diabetes mellitus in Ekiti, Nigeria. AJBR [Internet]. 2022;25(1):27-32.
23. Kenfack KF. Prevalence of Peripheral Artery Disease in A Group of Diabetic Patients with A High Cardiovascular Risk Using the Ankle-Brachial Index at the Bafoussam Regional Hospital. Acta Scientific Medical Sciences. 2020;1(4):111-113.
24. Okello, S., Millard, A., Owori, R. et al. Prevalence of lower extremity Peripheral artery disease among adult diabetes patients in Southwestern Uganda. BMC Cardiovasc Disord. 2014; 75(14)
25. Mwebaze RM, Kibirige D. Peripheral arterial disease among adult diabetic patients attending a large outpatient diabetic clinic at a national referral hospital in Uganda: a descriptive cross-sectional study. PLoS One. 2014 18;9(8):e105211.
26. Agboghoroma OF, Akemokwe FM, Puepet FH. Peripheral arterial disease and its correlates in patients with type 2 diabetes mellitus in a teaching hospital in northern Nigeria: A cross-sectional study. BMC Cardiovasc Disord. 2020;20(1):3–8.
27. Oyelade BO, OlaOlorun AD, Odeigah LO, Amole IO, Adediran OS. The prevalence of peripheral arterial disease in diabetic subjects in south-west Nigeria. Afr J Prim Health Care Fam Med. 2012 ;4(1):354.
28. Umuerri EM, Obasohan AO. Lower extremity peripheral artery disease: prevalence and risk factors among adult Nigerians with diabetes mellitus. West Afr J Med. 2013 Jul-Sep;32(3):200-5.
29. Ding C, Chen Y, Shi Y, Li M, Hu L, Zhou W, et al. Association between nontraditional lipid profiles and peripheral arterial disease in Chinese adults with hypertension. BMC. 2020;19(231):1–9.
30. Ogbera AO, Adeleye O, Solagberu B, Azenabor A. Screening for peripheral neuropathy and peripheral arterial disease in persons with diabetes mellitus in a Nigerian University teaching hospital. BMC Res Notes. 2015;8(1):533
31. Akpan IS, Enabulele O, Adewole AJ. An overview of peripheral artery disease in the elderly: A study in a tertiary hospital Southern Nigeria. Niger Med J 2020;61:1-5
32. Song P, Rudan D, Zhu Y, Fowkes FJI, Rahimi K, Fowkes FGR, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019;7(8):1020–30.
33. Kosiborod M, Gomes MB, Nicolucci A, Pocock S, Rathmann W, Shestakova M V, et al. Vascular complications in patients with type 2 diabetes : prevalence and associated factors in 38 countries ( the DISCOVER study program ). Cardiovasc Diabetol. 2018 Nov 28;17(1):150.
34. Rabia K, Khoo EM. Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting. Medical Journal of Malaysia. 2007;62(2):130-3.
35. Weragoda J, Seneviratne R, Weerasinghe MC, Wijeyaratne SM. Risk factors of peripheral arterial disease : a case-control study in Sri Lanka. BMC Res Notes. 2016;9(1):508.
36. Clark D 3rd, Cain LR, Blaha MJ, DeFilippis AP, Mentz RJ, Kamimura D, White WB, Butler KR, Robertson RM, Bhatnagar A, Butler J, Correa A, Benjamin EJ, Hall ME. Cigarette Smoking and Subclinical Peripheral Arterial Disease in Blacks of the Jackson Heart Study. J Am Heart Assoc. 2019;8(3):e010674.
37. Pandya H, Bhansali P. Pattern of peripheral arterial disease and serum lipid profile in patients with diabetes mellitus. Int J Med Sci Public Heal. 2015;4(8):1046.
38. Yang X, Sun K, Zhang W, Wu H, Zhang H, Hui R. Prevalence of and risk factors for peripheral arterial disease in the patients with hypertension among Han Chinese. J Vasc Surg. 2007; 46(2): 296-302.
39. Aday AW, Everett BM, Cardiovascular C. Dyslipidemia Profiles in Patients with Peripheral Artery Disease. Curr Cardiol Rep 42. 2020;21(6):42.
40. Yusuf AI, Akinlade OM, Awodun OR, Yusuf OW, Ogunmodede JA, Kolo PM. Prevalence and predictors of peripheral artery disease among hypertensive patients in a tertiary hospital in North-central Nigeria. East African Medical Journal. 2023; 100(1).
41. Khoury S, Ratchford E V. Smoking Cessation in Peripheral Artery Disease. Am Coll Cardiol. 2020;1–7.
42. Adler AI, Stevens RJ, Neil A, Stratton IM, Boulton AJ, Holman RR. UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes. Diabetes Care. 2002: (5):894-9.
43. Sartore G, Caprino R, Ragazzi E, et al. The ankle-brachial index for assessing the prevalence of peripheral artery disease and cardiovascular risk in patients with type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis. 2023; 33(3): 560-567.
44. Guan H, Li YJ, Xu ZR, Li GW, Guo XH, Liu ZM, Zou DJ et al. Prevalence and risk factors of peripheral arterial disease in diabetic patients over 50 years old in China. Chin Med Sci J. 2007 Jun;22(2):83-8
45. Al-Kaabi JM, Al Maskari F, Zoubeidi T et al. Peripheral Artery Disease in Type 2 Diabetic Patients from the United Arab Emirates. J Diabetes Metab. 2014;5(6):388
46. Oyelade BO, Olaolorun AD, Odeigah LO, Amole IO, Aderibigbe SA. The relationship between obesity and peripheral arterial disease in adult Nigerian diabetics. Niger Postgrad Med J. 2014; 21(1):57-60.
47. Anumah FE, Lawal Y, Mshelia-Reng R, Omonua SO, Odumodu K, Shuaibu R et al. Common and contrast determinants of peripheral artery disease and diabetic peripheral neuropathy in North Central Nigeria. Foot (Edinb). 2023; 55:101987
48. Ikem R, Ikem I, Adebayo O, Soyoye D. An assessment of peripheral vascular disease in patients with diabetic foot ulcer. The Foot. 2010 Dec 1;20(4):114-7.
49. Oguejiofor OC, Onwukwe CH, Ezeude CM, Okonkwo EK, Nwalozie JC, Odenigbo CU, Oguejiofor CB. Peripheral arterial disease and its predictors in type 2 diabetic patients in Nnewi, South-Eastern Nigeria. N Niger J Clin Res. 2020; 9: 20-397.
50. Hayfron-Benjamin CF, Maitland- AH, Grobusch KK, Schulze MB, Spranger J, Danquah I, et al. Association between C-reactive protein and microvascular and macrovascular Saharan Africans dysfunction in sub- with and without diabetes : the RODAM study. BMJ. 2020;8(Cvd):1–9.
51. Vainas T, Stassen FR, de Graaf R, Twiss EL, Herngreen SB, Welten RJ, van den Akker LH, van Dieijen-Visser MP, Bruggeman CA, Kitslaar PJ. C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events. J Vasc Surg. 2005; 42(2): 243-51.
52. Garofolo L, Ferreira SR, Miranda Júnior F. Association between peripheral arterial disease and C-reactive protein in the Japanese-Brazilian population. Rev Col Bras Cir. 2014;41(3):168-75.
53. Liu M, Fan F, Liu B, Jia J, Jiang Y, Sun P, et al. Joint effects of plasma homocysteine concentration and traditional cardiovascular risk factors on the risk of new-onset peripheral arterial disease. Diabetes, Metab Syndr Obes Targets Ther. 2020;13:3383–93.
54. Vainas T, Stassen FR, de Graaf R, Twiss EL, Herngreen SB, Welten RJ, van den Akker LH, van Dieijen-Visser MP, Bruggeman CA, Kitslaar PJ. C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events. J Vasc Surg. 2005; 42(2): 243-51.
55. Khandanpour N, Loke YK, Meyer FJ, Jennings B, Armon MP. Homocysteine and Peripheral Arterial Disease: Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg. 2009;38(3):316–22.
56. Indrayana Y, Harahap HS. Serum Homocysteine Level and Ankle-Brachial Index in Peripheral Arterial Disease. J Kesehat Masy. 2020;15(3):426–31.
57. Wang, X., Yang, Y., Yu, L. et al. Association between fibrinogen level and length of stay in patients with lower extremity atherosclerotic disease: a retrospective cohort study. Sci Rep. 2023; 13: 11872
58. Seki K, Sumino H, Nara M, Ishiyama N, Nishino M, Murakami M. Relationships between blood rheology and age, body mass index, blood cell count, fibrinogen, and lipids in healthy subjects. Clin Hemorheol Microcirc. 2006;34(3):401-10
59. Al-Delaimy WK, Merchant AT, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Am J Med. 2004; 116(4):236-40.
60. Minna Z, Junlan Y, Jiewei H, Kaiming Y et al. Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China. Endo Journal, 2022; 69(2):155-163
61. Eshcol J, Jebarani S, Anjana RM, Mohan V, Pradeepa R. Prevalence, incidence and progression of peripheral arterial disease in Asian Indian type 2 diabetic patients. J Diabetes Complications. 2014 Sep-Oct;28(5):627-31
62. Bosevski M, Bosevska G, Stojanovska L. Influence of fibrinogen and C-RP on progression of peripheral arterial disease in type 2 diabetes: a preliminary report. Cardiovasc Diabetol. 2013; 12: 29.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.