Diabetes Metab J.  2018 Feb;42(1):63-73. 10.4093/dmj.2018.42.1.63.

Color Doppler Ultrasonography Is a Useful Tool for Diagnosis of Peripheral Artery Disease in Type 2 Diabetes Mellitus Patients with Ankle-Brachial Index 0.91 to 1.40

• Hur KY
• Jun JE
• Choi YJ
• Lee YH
• Kim DJ
• Park SW
• Huh BW
• Lee EJ
• Jee SH
• Huh KB
• Choi SH

• KMID: 2409187
• DOI: http://doi.org/10.4093/dmj.2018.42.1.63

Abstract

BACKGROUND
The clinical utility of ankle-brachial index (ABI) is not clear in subjects with less severe or calcified vessel. Therefore, we investigated the usefulness of color Doppler ultrasonography for diagnosing peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) subjects.
METHODS
We analyzed 324 T2DM patients who concurrently underwent ABI and carotid intima-media thickness (CIMT) measurements and color Doppler ultrasonography from 2003 to 2006. The degree of stenosis in patients with PAD was determined according to Jager's criteria, and PAD was defined as grade III (50% to 99% stenosis) or IV stenosis (100% stenosis) by color Doppler ultrasonography. Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the risk factors for PAD in patients with ABI 0.91 to 1.40.
RESULTS
Among the 324 patients, 77 (23.8%) had ABI 0.91 to 1.40 but were diagnosed with PAD. Color Doppler ultrasonography demonstrated that suprapopliteal arterial stenosis, bilateral lesions, and multivessel involvement were less common in PAD patients with ABI 0.91 to 1.40 than in those with ABI ≤0.90. A multivariate logistic regression analysis demonstrated that older age, current smoking status, presence of leg symptoms, and high CIMT were significantly associated with the presence of PAD in patients with ABI 0.91 to 1.40 after adjusting for conventional risk factors. CIMT showed significant power in predicting the presence of PAD in patients with ABI 0.91 to 1.40.
CONCLUSION
Color Doppler ultrasonography is a useful tool for the detection of PAD in T2DM patients with ABI 0.91 to 1.40 but a high CIMT.

Keyword

Ankle brachial index; Diabetes mellitus, type 2; Peripheral arterial disease; Ultrasonography, Doppler, color

MeSH Terms

Ankle Brachial Index*
Carotid Intima-Media Thickness
Constriction, Pathologic
Diabetes Mellitus, Type 2*
Diagnosis*
Humans
Leg
Logistic Models
Peripheral Arterial Disease*
Risk Factors
ROC Curve
Smoke
Smoking
Ultrasonography, Doppler, Color*
Smoke

Figure

• 

  Fig. 1 Flow chart presenting the study subjects. ABI, ankle-brachial index; PAD, peripheral artery disease.

• 

  Fig. 2 Degree of stenosis on color Doppler ultrasonography in patients with ankle-brachial index 0.91 to 1.40 (n=306). Grade III and IV stenoses were defined as peripheral artery disease and expressed with gray bars.

• 

  Fig. 3 Receiver operating characteristic curves for carotid intima-media thickness (CIMT) for predicting peripheral artery disease (PAD) in 306 patients with ankle-brachial index 0.91 to 1.40. (A) The area under the curve for CIMT for predicting PAD in symptomatic type 2 diabetes mellitus (T2DM) patients (n=62). (B) The area under the curve (AUC) for CIMT for predicting PAD in asymptomatic T2DM patients (n=244).

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