Correlation between type 2 diabetes mellitus and ankle-brachial index in a geographically specific Greek population without peripheral arterial disease

Abstract

Background. Diabetes mellitus (DM) remains one of the fastest growing and most challenging medical diseases today. The Ankle-Brachial Index (ABI) is the ratio of ankle systolic blood pressure divided by brachial systolic pressure. Generally, ABI has a high specificity and sensitivity for the diagnosis of peripheral arterial disease (PAD). In DM, ABI measurement is recommended by the American Diabetes Association for all subjects > 50 years old. The prevalence of an abnormal ABI is high in type 2 DM. An ABI ≥ 1.3 is associated with increased risk of cardiovascular disease and mortality in the general population, as well as with all-cause mortality in DM. The purpose of the study was to assess the potential association of a high ankle-brachial index with diabetes mellitus in a specific Greek population free from peripheral arterial disease. Materials and methods. Between July 2017 and August 2018, people over 30 years old with and without type 2 DM were examined. We included 240 subjects (118 men) with mean age 64.5 ± 14.6 years from Naxos island in Greece who did not have peripheral arterial disease (PAD). Of these, 144 had DM and 96 did not. DM duration was 10.6 ± 7.4 years. ABI was measured in all subjects. ABI was measured in the supine position after 5–10 minutes of rest, in normal room temperature (25 °C) after patients had taken off their shoes and socks. Results. We grouped ABI measurements into 4 groups: ABI 0.90–1.29; ABI 1.30–1.39; ABI 1.40–1.49; ABI > 1.50. ABI > 1.30 was seen in 44 % of participants with DM vs. 3.1 % of those without DM. There was a significant correlation (p < 0.001) between diabetes duration and ABI. Among participants with DM, those with ABI > 1.30 had DM duration of 14.2 ± 8.2 years, while those with ABI < 1.30 had DM duration of 8 ± 5 years. ABI was 0.21 (19 %) higher in DM vs. non-DM subjects (1.28 ± 0.20 vs. 1.07 ± 0.11, p < 0.001). Conclusions. A high ABI is more frequent in DM, PAD-free, Greek participants, especially among subjects with long-standing DM.