A study on diabetic foot and its association with peripheral artery disease
DOI:
https://doi.org/10.18203/2349-2902.isj20170937Keywords:
Diabetic foot, Peripheral arterial diseaseAbstract
Background: Diabetes mellitus is characterized by high blood sugar levels over a prolonged period due to alteration in either the insulin secretion, insulin action, or both. Worldwide, as of the recent 2016 data collected from the World Health Organization (WHO) around 422 million adults have diabetes mellitus which is estimated to almost double by 2030 which is composed of mainly type 2 diabetes (85-90% of all cases). The early detection of peripheral artery disease in asymptomatic patients goes a long way in reduction of major lower limb amputations and mortality. Hence, there is a need for evaluation of peripheral vascular disease in all diabetics, especially those with diabetic foot by formulating effective management protocols, thereby limiting the morbidity, mortality and social costs associated with the disease.
Methods: Patients admitted and seen in out-patient department for diabetic foot ulcers between January 2013 and October 2013 in Department of general surgery, vascular surgery and diabetology, Kilpauk Medical College Hospital, Chennai, India were taken for study.
Results: 150 cases satisfying the inclusion criteria were taken up for the study from January 2013 to October 2013. Out of 150 patients, 76 patients presented with ulcer in foot, 34 presented with gangrene of toe or foot. After clinical examination it was found that 52 patients had associated neuropathy, 17 patients had ABI less than 0.3 and 39 patients had ABI in between 0.4 and 0.9. Patients with ulcer and gangrene in foot and with ABI less than 0.9 were admitted and evaluated with doppler study of lower limbs. After getting consent, appropriate procedure was done for each patient. Wound debridement was done in 21 cases, toe disarticulation in 12, fore foot amputations in 4, Below knee amputation in 9, above knee amputation in 3. 11 patients were referred to vascular surgery and underwent revascularization procedures (BYPASS).
Conclusions: The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. Males have a higher predilection for developing peripheral vascular disease than females. The average age of presentation of PAD in diabetics is 40 -60 years. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment.
References
World Health Organization, Global Report on Diabetes. Geneva; 2016.
Murabito JM, Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication: a risk profile from the Framingham heart study. Circulation. 1997;96:44-9.
Kannel WB, Mcgee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care. 1979;2:120-6.
Weitz JI, Byrne J, Clagett GP, Farkouh ME, Porter JM, Sackett DL, et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation. 1996;94:3026-49.
Norgren L, Hiatt WR, Dormandy JA. Inter- society onsensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(1):1-75.
Daniel M, Cronenwett JL. Basic data related to natural history of intermittent claudication. Ann Vasc Surg. 1989;3:273-7.
Marinelli MR, Beach KW, Glass MJ. Non-invasive testing vs clinical evaluation of arterial disease, a prospective study. JAMA. 1997;241:2031-4.
Diabetes can be controlled in 80 percent of cases in India. Available at news.biharprabha.com. Accessed on 6 February 2016.
Janka HU, Stand IE, Mehnert H. Peripheral vascular disease in diabetes mellitus and its relation to cardiovascular risk factor: screening with doppler ultrasonic technique. Diabetes Care. 1980;3:207.
Palumbo PJ, Melton LJ. Peripheral vascular disease and diabetes In Harris MI, Hamman RF. Diabetes in America, Washington: US Government Printing Office. 1985;1468.
Orchard TJ, Dorman JS, Maser RE. Prevalence of complications in IDMM by sex and duration. pittsburg epidemiology of diabetes complications. Diabetes. 1990;39:1116-24.
Singh S, Armstrong EJ, Sherif W, Alvandi B, Westin GG, Singh GD, Amsterdam EA, et al. Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty. Vasc Med. 2014;19:307-14.
