All diabetic patients over 50 years of age should be screened for peripheral arterial disease using the ankle-brachial index, the American Diabetes Association has recommended.
If normal, the test should be repeated every 5 years. A screening anklebrachial index (ABI) also may be considered in younger diabetics who have other risk factors for peripheral arterial disease (PAD), while a diagnostic ABI should be performed in any patient with symptoms, the ADA said in a consensus statement.
Management of PAD in diabetics should include primary and secondary cardiovascular risk factor modification as well as treatment of PAD symptoms such as claudication or critical limb ischemia, according to the statement (Diabetes Care 26:3333-3341, 2003).
The guidelines, the first ever to specifically address screening and management of PAD in patients with diabetes, were drawn up from an earlier consensus conference that was sponsored in part by educational grants from 11 major pharmaceutical companies. The six-member consensus panel was chaired by Dr. Peter Sheehan, director of the Diabetes Foot & Ankle Center, Hospital for Joint Diseases, New York.
Peripheral arterial disease affects about 12 million Americans. It is uncertain exactly how many of them have diabetes, but data from the Framingham Heart Study suggest that about 20% of people with symptomatic PAD are diabetic. But the total number of individuals with both PAD and diabetes is certainly far more than 2.4 million, because the vast majority are not symptomatic.
Diabetics often lack pain perception as a result of neuropathy, so they may be more likely than nondiabetics to present with an ischemic ulcer or gangrene before PAD is diagnosed. Detection of PAD in diabetics also is hampered by the use of insensitive screening methods such as merely documenting the absence of peripheral pulses or the presence of claudication Rather, diabetics typically elicit more subtle symptoms, such as leg fatigue or slow walking.
The ankle-brachial index, on the other hand, is both validated and reproducible. It involves measuring the systolic blood pressure in the ankles (dorsalis pedis and posterial tibial arteries) and arms (brachial artery), using a handheld Doppler and then calculating a ratio. …