Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers

Author(s): Mutasem Ababneh*, Mousab Y. Al Ayed, Asirvatham A. Robert, Mohamed A. Al Dawish

Journal Name: Current Diabetes Reviews

Volume 16 , Issue 3 , 2020

Become EABM
Become Reviewer

Abstract:

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018.

Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test.

Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI.

Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

Keywords: Ankle-brachial index, toe brachial index, foot ulcers, peripheral arterial disease, diabetes, clinical utility.

[1]
Al Dawish MA, Robert AA, Braham R, et al. Diabetes mellitus in Saudi Arabia: A review of the recent literature. Curr Diabetes Rev 2016; 12(4): 359-68.
[http://dx.doi.org/10.2174/1573399811666150724095130] [PMID: 26206092]
[2]
Robert AA, Al Dawish MA, Braham R, Musallam MA, Al Hayek AA, Al Kahtany NH. Type 2 diabetes mellitus in saudi arabia: major challenges and possible solutions. Curr Diabetes Rev 2017; 13(1): 59-64.
[http://dx.doi.org/10.2174/1573399812666160126142605] [PMID: 26813972]
[3]
Rhee SY, Kim YS. Peripheral arterial disease in patients with type 2 diabetes mellitus. Diabetes Metab J 2015; 39(4): 283-90.
[http://dx.doi.org/10.4093/dmj.2015.39.4.283] [PMID: 26301189]
[4]
Hiramoto JS, Teraa M, de Borst GJ, Conte MS. Interventions for lower extremity peripheral artery disease. Nat Rev Cardiol 2018; 15(6): 332-50.
[http://dx.doi.org/10.1038/s41569-018-0005-0] [PMID: 29679023]
[5]
Marone EM, Cozzolino P, Ciampichini R, et al. Peripheral arterial disease in diabetic patients: a long-term population-based study on occurrence, outcomes and cost. J Cardiovasc Surg (Torino) 2018; 59(4): 572-9.
[PMID: 29745215]
[6]
Ayala MA, Rojas AG. Association between peripheral arterial disease and diabetic foot ulcers in patients with diabetes mellitus type 2. Medicina Universitaria 2017; 19: 123-6.
[http://dx.doi.org/10.1016/j.rmu.2017.07.002]
[7]
Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther 2012; 3(1): 4.
[http://dx.doi.org/10.1007/s13300-012-0004-9] [PMID: 22529027]
[8]
Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 2004; 110(6): 738-43.
[http://dx.doi.org/10.1161/01.CIR.0000137913.26087.F0] [PMID: 15262830]
[9]
Cornejo Del Río V, Mostaza J, Lahoz C, et al. Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study. PLoS One 2017; 12(10)e0186220
[http://dx.doi.org/10.1371/journal.pone.0186220] [PMID: 29073236]
[10]
Diehm C, Schuster A, Allenberg JR, et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172(1): 95-105.
[http://dx.doi.org/10.1016/S0021-9150(03)00204-1] [PMID: 14709362]
[11]
Gogalniceanu P, Lancaster RT, Patel VI. Clinical Assessment of Peripheral Arterial Disease of the Lower Limbs. N Engl J Med 2018; 378(18)e24
[http://dx.doi.org/10.1056/NEJMvcm1406358] [PMID: 29719182]
[12]
Beckman JA, Jaff MR, Creager MA. The United States preventive services task force recommendation statement on screening for peripheral arterial disease: more harm than benefit? Circulation 2006; 114(8): 861-6.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.607846] [PMID: 16923770]
[13]
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 452007;
[14]
Suominen V, Uurto I, Saarinen J, Venermo M, Salenius J. PAD as a risk factor for mortality among patients with elevated ABI--a clinical study. Eur J Vasc Endovasc Surg 2010; 39(3): 316-22.
[http://dx.doi.org/10.1016/j.ejvs.2009.12.003] [PMID: 20089422]
[15]
Moosa SR, Bakri FG, Khammash MR, et al. Peripheral arterial disease in diabetic Jordanian patients and the agreement between ankle brachial index and toe brachial index. Br J Diabetes Vasc Dis 2013; 13(1): 37-42.
[http://dx.doi.org/10.1177/1474651412475098]
[16]
Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today 2015; 50(3): 117-28.
[http://dx.doi.org/10.1097/NT.0000000000000092] [PMID: 27340299]
[17]
Frese EM, Fick A, Sadowsky HS. Blood pressure measurement guidelines for physical therapists. Cardiopulm Phys Ther J 2011; 22(2): 5-12.
[http://dx.doi.org/10.1097/01823246-201122020-00002] [PMID: 21637392]
[18]
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Press 2014; 23(1): 3-16.
[http://dx.doi.org/10.3109/08037051.2014.868629] [PMID: 24359485]
[19]
AlAyed MY, Younes N, Al-Smady M, Khader YS, Robert AA, Ajlouni K. Prevalence of foot ulcers, Foot at risk and associated risk factors among jordanian diabetics. Curr Diabetes Rev 2017; 13(2): 182-91.
[http://dx.doi.org/10.2174/1573399812666151210143140] [PMID: 26652612]
[20]
Hiatt WR, Hoag S, Hamman RF. Effect of diagnostic criteria on the prevalence of peripheral arterial disease. The San Luis Valley Diabetes Study. Circulation 1995; 91(5): 1472-9.
[http://dx.doi.org/10.1161/01.CIR.91.5.1472] [PMID: 7867189]
[21]
Hurlow JJ, Humphreys GJ, Bowling FL, McBain AJ. Diabetic foot infection: A critical complication. Int Wound J 2018; 15(5): 814-21.
[http://dx.doi.org/10.1111/iwj.12932] [PMID: 29808598]
[22]
Park SC, Choi CY, Ha YI, Yang HE. Utility of toe-brachial index for diagnosis of peripheral artery disease. Arch Plast Surg 2012; 39(3): 227-31.
[http://dx.doi.org/10.5999/aps.2012.39.3.227] [PMID: 22783531]
[23]
El-Menyar A, Amin H, Rashdan I, et al. Ankle-brachial index and extent of atherosclerosis in patients from the Middle East (the AGATHA-ME study): a cross-sectional multicenter study. Angiology 2009; 60(3): 329-34.
[http://dx.doi.org/10.1177/0003319708321585] [PMID: 18819941]
[24]
Spångéus A, Wijkman M, Lindström T, et al. Toe brachial index in middle aged patients with diabetes mellitus type 2: not just a peripheral issue. Diabetes Res Clin Pract 2013; 100(2): 195-202.
[http://dx.doi.org/10.1016/j.diabres.2013.03.004] [PMID: 23522916]
[25]
Takahara M, Fujiwara Y, Katakami N, et al. Shared and additional risk factors for decrease of toe-brachial index compared to ankle-brachial index in Japanese patients with diabetes mellitus. Atherosclerosis 2014; 235(1): 76-80.
[http://dx.doi.org/10.1016/j.atherosclerosis.2014.04.014] [PMID: 24816041]
[26]
Sahli D, Eliasson B, Svensson M, et al. Assessment of toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease. Angiology 2004; 55(6): 641-51.
[http://dx.doi.org/10.1177/00033197040550i605] [PMID: 15547650]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 3
Year: 2020
Page: [270 - 277]
Pages: 8
DOI: 10.2174/1573399815666190531093238
Price: $65

Article Metrics

PDF: 13
HTML: 4