Evaluation of the Critical Peripheral Arterial Blood Flow of the Lower Limbs of Patients with Diabetic Foot Ulcers
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetics have a 15% lifetime risk of developing foot ulcers. Ankle-brachial index (ABI) is a noninvasive vascular screening test to identify large-vessel peripheral arterial disease and can be measured using the hand Doppler. As a component of a multimodal approach to vascular assessment, the pocket Doppler has been used routinely by foot surgeons. It also has results comparable to those measured in vascular laboratories and is thus important in patients with diabetic foot ulcers (DFUs). AIMS AND OBJECTIVES: The study aimed to evaluate the critical peripheral arterial blood flow of the lower limb of patients with DFUs while determining the effect of ankle-brachial pressure index on DFU grade. PATIENTS AND METHODS: This was a case-control study of 49 diabetic patients with features of DFUs presenting at UBTH over a period of 1 year between March 2016 and February 2017. Forty-nine diabetic patients without ulcers were used as controls. Sociodemographic characteristics (age, gender, weight, height, educational level, occupation, religion, address, smoking status, and alcohol intake) and clinical history (age at initial diagnosis of DM, duration of DM, current medical therapy, and history of hypertension) were recorded using guided questionnaires. The color of the foot lesion, the peripheral pulses, the sensation, the ulcer grading, and the findings of the foot on radiographs, as outlined in the Diabetic Foot Severity Score (DFSS) were assessed. Data were analyzed using the Statistical Package for the Social Sciences version 20.0 software. Chi-squared test of association was used to test for statistical association between Ankle-Brachial Pressure Index grading variable and DFU status. A scatter plot was drawn to determine the linear relationship between DFSS and the Ankle-Brachial Pressure Index. The level of significance was set at P < 0.05. RESULTS: The DFSS ranged from 7 to 20 with a mean of 11.9. The mean Ankle-Brachial Pressure Index for diabetics without foot ulcers was 1.169 ± 0.225. The mean ABI for diabetics with foot ulcers was 0.944 ± 0.238. There was a statistically significant difference between the mean Ankle-Brachial Pressure Index for diabetics with and without foot ulcers ( t = 4.807, P < 0.0001). A receiver operating characteristic curve was drawn to analyze the accuracy of Ankle-Brachial Pressure (AB) Index in diagnosing diabetics with foot ulcer. At a cutoff value of 1.135, the Ankle-Brachial Pressure Index produced a sensitivity of 75.5% and a specificity of 63.3%. A Spearman's correlation between DFSS and the Ankle-Brachial Pressure Index showed a moderate, positive correlation between DFSS and the Ankle-Brachial Pressure Index. CONCLUSION: The study has shown a statistically significant positive relationship between DFSS and ABI. The study also showed that there is a statistically significant difference between the ABI of diabetic patients with and without ulcers. This study also infers that diabetics with ABI values < 1.135 are at risk of foot ulceration.
Source: Annals of African Medicine
Author: Efe Uwadiae
Institution: University of Benin Teaching Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7117132050