Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

Abstract

Peripheral vascular disease is 2 -3 times more likely to develop in people with diabetes mellitus (DM) than in the general population.1 It can occur in 8% of people at the time of diagnosis of DM and may reach 45% by 20 years' duration. 2There are no published data on the prevalence of peripheral artery disease (PAD) or medial arterial calcification in an unselected group of black South African patients with DM. Traditionally it is thought that South African blacks have a lower incidence of vascular disease than their white counterparts. In the studies 3,4 examining PAD as seen in a vascular unit in Durban the pattern of atherosclerotic disease varied between the different ethnic groups reviewed, with black patients suffering more from peripheral aneurysms than aortic aneurysm and generally having more limb-threatening peripheral vascular disease than exercise-limiting claudication. The black population generally had a higher concentration of high-density lipoproteins than the white or Indian populations. The black patients presented much later in the process than the other population groups. PAD is therefore well established in blacks but the incidence is still lower compared with that of other ethnic groups. The reason for these differences still needs careful investigation.The screening evaluation of the foot of a person with DM should include palpation of pedal pulses and if pulses are absent or decreased a more specific vascular evaluation is indicated (particularly if the tibialis posterior pulse is absent). 2In general, this means a Doppler evaluation of ankle and brachial systolic pressures defined as an ankle brachial index (ABI) with ratio less than 0.9 indicating peripheral vascular disease. Because medial arterial calcification can cause falsely elevated pressures some advocate the use of toe systolic blood pressure indices in subjects with DM.2 At least one study has shown that in the absence of overt calcification (ABI ≥ 1.3) the toe systolic blood pressure indices convey no advantage over ABI in determining perfusion pressure of the lower limbs. 5No data are available on this topic in African black diabetic patients, where the prevalence would probably be lower and the value of the ABI in these patients is still regarded as questionable. Therefore, the aim of our study was to determine the concordance between ankle Doppler indices and toe systolic blood pressure indices as well as to determine the value of pedal pulse palpation in the assessment of PAD. MethodsThe setting for this cross-sectional study was Mamelodi Hospital, a community hospital serving mainly as a primary health care facility for the urban black community of Objectives. To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM).Design. Cross-sectional study.Subjects. A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a c...

Peripheral Arterial Disease among Adult Diabetic Patients Attending a Large Outpatient Diabetic Clinic at a National Referral Hospital in Uganda: A Descriptive Cross Sectional Study

“…This can be explained by the varied study diagnostic approaches of PAD with higher prevalence noted in studies using ABI measurement [7], [8], [9], [10] compared to clinical palpation of lower limb pulses [11], [12], [13].…”

“…Studies from Tanzania by Gulam-Abbas Z et al [9] and South Africa by Paul A et al [8] and Rheeder P [10] et al reported prevalence of 20.7%, 29.3% and 4.7% respectively. A prevalence of 52.5% was noted in the Nigerian study [7].…”

“…In Sub Saharan Africa (SSA), the prevalence of PAD varies from 1.7–52.5% [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] with higher prevalence noted in studies that use Doppler based means of diagnosis as opposed to clinical evaluation (inspection for foot colour/skin changes and palpation for absent/diminished foot pulses). Despite this varied prevalence, screening of PAD among adult diabetic patients in SSA is infrequent [11] , [13] .…”

Macrovascular disease in type 2 diabetes

“…7 The article by Professor Paul Rheeder and colleagues (p. 79) takes a step toward addressing the large hiatus in knowledge of macrovascular disease in the black population of South Africa with type 2 diabetes. 8 Rheeder and co-workers (including medical students) focus on the clinical assessment of peripheral vascular disease in black women in a primary health care facility and argue that simple palpation of peripheral pulses by competent clinical examination, augmented with relatively inexpensive arterial Doppler measurements, is crucial to the evaluation of this particular macrovascular complication in this setting. Against the backdrop of increasingly expensive technology-driven methods of assessment of other vascular regions, this is refreshing and sound advice that will require dedicated translation into widespread practice at all levels of diabetes care.…”

The Prevalence of Lower Extremity Peripheral Artery Disease among Adults with Type 2 Diabetes Mellitus Attending a Teaching Hospital in Ghana

“…In Ghana, the prevalence rate of diabetes mellitus in adults is 3.3 per cent 3 and the prevalence of PAD worldwide has been estimated at between 4.5% and 29% 4 , and in Sub Saharan Africa, the prevalence of PAD varies from 1.7-52.5% [5][6][7][8] . A study in Nigeria reported evidence of PAD in 54% of diabetic patients with foot complications 9 , whilst another study from Tanzania found PAD in 21% of diabetic patients 10 .…”