Juma M Al-Kaabi, Fatma Al Maskari, Taoufik Zoubeidi, Abdishakur Abdulle, Syed M Shah, Paul Cragg, Bachar Afandi and Abdul-Kader Souid
Objectives: Peripheral Artery Disease (PAD) is common in patients with diabetes. Frequently, this complication is only recognized when the symptoms and signs are advanced. This study assessed its prevalence and associated risk factors in patients with type 2 diabetes mellitus who reside in the United Arab Emirates. The main purpose of the study was to identify potential disease modifiers that could be included in diabetic education programs.
Methods: This prospective, cross-sectional study assessed PAD in 394 patients with type 2 diabetes mellitus. Each patient was investigated by history, physical examination and measurements of the ankle-brachial index (ABI) by bidirectional doppler.
Results: Patients’ mean (±SD) age was 54 (±12) years and duration of diabetes 10 (±8) years. There were 264 females (67%). HbA1c was ≥7% in 247 (65%) patients, claudication present in 166 (42%) patients, reduced capillary refill time in 69 (17%) patients, retinopathy in 50 (13%) patients, and absent pulse in 20 (5%) patients. ABI was ≤1.0 in 149 (39%) patients (probable PAD) and <0.9 in 33 (9%) patients (significant PAD). Current smoking [odds ratio (OR)=3.9; confidence intervals (CI)=1.5-10.3; p-value=0.007], percent HbA1c (OR=3.4; CI=1.2-10.2; p-value=0.028) and hypertension on examination (OR=1.6; CI=1.0-2.6; p-value=0.041) were significant predictors of ABI ≤1.0. Current smoking (OR=3.7; CI=1.2-10.8; p-value=0.019) was significant predictor of ABI <0.9.
Conclusions: These results confirm the deleterious effects of smoking on diabetes-association PAD. Thus, diabetic patients should be engaged in effective smoking prevention programs. Other modifiable interventions are controlling hyperglycemia and hypertension. Patients with abnormal ABI (especially <0.9) should have stringent risk assessments and be started on an individualized risk-reduction program.