Different Methods of Ankle-Brachial Index Calculation on the Prevalence of Peripheral Arterial Disease and Arterial Calcification in Subjects with Type 2 Diabetes Mellitus from a Public Hospital in Peru

Abstract

Objective: To determine the frequency of peripheral arterial disease (PAD) and arterial calcification (AC) using three methods of ankle-brachial index (ABI) in patients with type 2 diabetes mellitus. Methodology: A descriptive cross-sectional study using data from the Foot at Risk Program of the Endocrinology Department at Hospital María Auxiliadora from 2015 to 2020. We calculated the ABI for each lower limb using the lowest, highest, or average systolic pressure from the dorsalis pedis or posterior tibial artery in the ipsilateral leg. We defined PAD if any ABI from either leg was <0.9; AC if ABI was >1.3; and the rest were classified as normal. We calculated the prevalence of PAD and AC for each ABI method and assessed differences between ABI categories based on clinical variables using the chi-square or Fisher's exact test. Results: We included 643 subjects with a mean age of 61.4 years, 69.8% female. The prevalence of PAD was 7.8%, 15.4%, and 28.2% using the highest, average, or lowest systolic pressure as the numerator in the ABI, respectively. The highest prevalence of PAD occurred with the lowest pressure and the lowest with the highest pressure. AC was observed in 18.2%, 11%, and 16.2%, and normal values were 74%, 73.6%, and 55.7%. In all three methods, PAD was associated with older age and AC was associated with longer duration of diabetes. Conclusions: Using different ABI methods, we observed a prevalence of PAD ranging from 7.8% to 28%, and a prevalence of CA between 11% and 18% among patients with type 2 diabetes mellitus at a public hospital in Peru. Further research is necessary to verify if the new ABI calculation methods provide improved accuracy in predicting complications.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Approval was obtained from the Institutional Ethics and Research Committee of Hospital María Auxiliadora under code HMA/CIEI/015/2024. The data did not contain any personally identifiable information.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

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