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

Abstract

BackgroundPeripheral arterial disease (PAD) is one of the recognised diabetic macro vascular complications. It is a marker of generalised systemic atherosclerosis and is closely associated with symptomatic coronary and cerebrovascular disease, hence significant morbidity and mortality. Among African adult diabetic populations, screening and diagnosis of PAD is frequently suboptimal. The aim of this study was to determine the prevalence and associated clinical factors of PAD in adult ambulatory diabetic patients attending the outpatient diabetic clinic of Mulago national referral and teaching hospital, Kampala Uganda.MethodsIn this descriptive cross sectional study, 146 ambulatory adult diabetic patients were studied. Information about their socio-demographic and clinical characteristics, fasting lipid profile status, blood pressure, glycated haemoglobin (HbA1c) levels and presence of albuminuria was collected using a pre tested questionnaire. Measurement of ankle brachial index (ABI) to assess for PAD, defined as a ratio less than 0.9 was performed using a portable 5–10 MHz Doppler device. Clinical factors associated with PAD were determined by comparing specific selected characteristics in patients with PAD and those without.ResultsThe mean age/standard deviation of the study participants was 53.9/12.4 years with a male predominance (75, 51.4%). PAD was prevalent in 57 (39%) study participants. Of these, 34 (59.6%) had symptomatic PAD. The noted clinical factors associated with PAD in this study population were presence of symptoms of intermittent claudication and microalbuminuria.ConclusionsThis study documents a high prevalence of PAD among adult ambulatory Ugandan diabetic patients. Aggressive screening for PAD using ABI measurement in adult diabetic patients should be emphasised in Uganda especially in the presence of symptoms of intermittent claudication and microalbuminuria.

Prevalence of peripheral artery disease in diabetes mellitus: research article

“…Eighty seven (59.6%) participants were ≥50 years. 12 An Indian study done by Premalatha, G et al reported mean age of the study group was 59.5±10.1 years and the mean duration of diabetes was 11.7±8.1 years which was similar to present study.…”

“…12 Majority of the study participants had symptomatic PAD (59.6%) and mild obstruction (99.3%) according to the ABI measurement. Asymptomatic PAD was noted in 41.4% of the study participants.…”

Preval�ncia e fatores associados � doen�a arterial perif�rica em indiv�duos com diabetes mellitus

“…In this study, there was no significant difference in the prevalence of PAD among men and women. Other studies also did not identify such association (1,4,13) . According to the PAD pathophysiology, men aged over 45 years and women after menopause are more susceptible to the development of that disease (2)(3) .…”

“…O sintoma mais prevalente na DAP é a claudicação intermitente, que consiste na dor em queimação ou em câimbra desencadeada pela marcha, acentuada pela continuação do esforço e que cessa com o repouso (1)(2) . A nível mundial, 202 milhões de pessoas viviam com a doença arterial periférica em 2010, 69,7% deles em paises de baixa renda ou de renda média, incluindo 54,8 milhões no sudeste da Ásia e 45,9 milhões na região do Pacífico ocidental (3) .…”

Preliminary evidence using negative pressure wound therapy to achieve limb salvage for the ischemic diabetic foot

“…[16,17] In addition, 39% of diabetic patients present with peripheral arterial occlusive disease, [18] and 46% of these patients will sustain a limb amputation. [19] Of the few studies on the benefits of NPWT in the diabetic foot over the last ten years, [1,20] the focus on the use of NPWT to achieve limb salvage in patients with DFU and peripheral arterial disease (PAD) is even rarer.…”