Comparison of Ultrasound Blood Flow Characteristics of the Lower Limb in Diabetics with Early-Stage Peripheral Artery Disease and Non-Diabetic Controls
The aim of this study was to compare lower limb blood flow in asymptomatic diabetic patients with early-stage peripheral artery disease (PAD) and non-diabetic controls using duplex ultrasound parameters. This was a comparative cohort study of lower limb blood flow in 35 Black-African diabetic patients (25 females and 10 males with early-stage PAD median age 54 [IQR, 47 - 61] years; median HbA1c 6.3 [IQR, 5.7 - 8.0]%; BMI 29.2 ± 6.7; ABI 1.1 ± 0.1) and 36 non-diabetic controls (28 females and 8 males; median age 54 [IQR, 47 - 61] years; median HbA1c 6.3 [IQR, 5.7 - 8.0] %, BMI 29.2 ± 6.7; ABI 1.1 ± 0.1). Peak systolic velocity (PSV), pulsatility index (PI) and resistive index (RI), were utilised to compare blood flow in the popliteal arteries (PA), anterior tibial arteries (ATA) and posterior tibial arteries (PTA) in addition to ankle brachial index. All the ultrasound parameters showed good (ICC ≥ 0.7; 0.50 - 0.85, 95% CI) to excellent (ICC = 1.0; 1.0 - 1.0, 95% CI) reliability within groups as well as acceptable variability (<10% CV) other than pulsatility index of the anterior tibial artery within diabetic patients (11.1% CV). PSV, RI and PI were significantly and meaningfully higher (P < 0.001; d ≥ 0.33), in diabetic patients compared to non-diabetic controls except for PI - PTA (P = 0.72; d = 0.11). Differences in PSV and RI highlighted the effects of early-stage PAD on lower limb blood flow of diabetic patients. In contrast, the effects of early-stage PAD on blood flow were not demonstrated in the PTA and ATA of diabetic patients by PI.
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