Prevalence and Predictors of Lower Extremity Peripheral Artery Disease among Adults with Type 2 Diabetes Mellitus Attending a Tertiary Hospital in Owerri, Nigeria

Abstract

Background: Lower extremity peripheral artery disease [LEAD] is common among patients with Diabetes mellitus (DM) and is under-diagnosed and under-treated.  Early diagnosis and treatment will prevent associated cardiovascular events, minimize long term disability and improve quality of life. There is paucity of data on LEAD in Owerri and Southeastern Nigeria in general. Study Objectives: To determine the prevalence and predictors of LEAD among adults with type 2 diabetes mellitus (T2DM). Study Design: Cross-sectional analytical. Study Site: Endocrinology Clinic, Federal Medical Centre, Owerri, Nigeria. Methodology: Two hundred and seventy (270) T2DM patients and 135 non-diabetic controls were recruited consecutively between January and June, 2016. Questionnaires  were  used  to  collect  relevant  information,  followed  by  focused  physical examination and anthropometry. A portable Ankle Brachial Index (ABI) kit was used for measurement of ABI and participants with values < 0.9 were diagnosed as having LEAD. For participants with ABI ≥ 1.3, a toe pressure kit was used to measure their toe systolic pressure and those with toe brachial index (TBI) ≤ 0.7 were diagnosed as having LEAD. Fasting blood samples were also collected for assessment of glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and lipid profile. Data analysis was performed with SPSS version 22 and p-value < 0.05 was considered significant. Results: The mean ages of the T2DM and control participants were 59.8 ± 10.7 and 59.6 ± 12.3 years respectively (P = 0.89) while their mean ABIs were 0.97 ± 0.18 and 0.99 ± 0.16 respectively    (P = 0.26). The  prevalence  of  LEAD  was  31.1%  and  27.4%  among T2DM  and  control  participants respectively (P = 0.44) while among the T2DM participants that had LEAD, 57 (67.8%), 26 (31.0%) and 1 (1.2%) had mild, moderate and severe LEAD respectively. The only predictor of LEAD among T2DM participants was absent/reduced dorsalis pedis artery pulsation (AOR = 3.57, CI = 1.13 – 11.29, P = 0.03). Conclusions and Recommendations: There is a high prevalence of LEAD among adults with T2DM but this is not significantly higher than the prevalence among non-diabetic individuals. Regular screening of T2DM patients for LEAD should be encouraged. There is also need for regular palpation of dorsalis pedis artery among adults with T2DM to identify those with absent or reduced pulsation which may be an indication of the presence of LEAD.