Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09; 95% CI: 1.05 - 4.17; p = 0.035) and LDL cholesterol (OR = 2.75; 95% CI: 1.10 - 6.85; p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]
References
[1]
Weitz, J.I., Byrne, J., Clagett, G.P., Farkouh, M.E., Porter, J.M., Sackett, D.L., Strandness Jr., D.E. and Taylor, L.M. (1996) Diagnosis and Treatment of Chronic Arterial Insufficiency of the Lower Extremities: A Critical Review. Circulation, 94, 3026-3049. https://doi.org/10.1161/01.CIR.94.11.3026
[2]
Criqui, M.H. and Aboyans, V. (2015) Epidemiology of Peripheral Artery Disease. Circulation Research, 116, 1509-1526. https://doi.org/10.1161/CIRCRESAHA.116.303849
[3]
Marso, S.P. and Hiatt, W.R. (2006) Peripheral Arterial Disease in Patients with Diabetes. Journal of the American College of Cardiology, 47, 921-929. https://doi.org/10.1016/j.jacc.2005.09.065
[4]
Forbang, N.I., Dermott, M.M., Liao, Y., J.H., Allison, M.A., Liu, K., Tian, L., Evans, N. and Criqui, M.H. (2014) Associations of Diabetes Mellitus and Other Cardiovascular Disease Risk Factors with Decline in the Ankle Brachial Index. Vascular Medicine, 19, 465-472. https://doi.org/10.1177/1358863X14554033
[5]
Munger, M.A. and Hawkins, D.W. (2004) Atherothrombosis: Epidemiology, Pathophysiology, and Prevention. Journal of the American Pharmacists Association, 44, S5-S13. https://doi.org/10.1331/154434504322904569
[6]
Ness, J. and Aronow, W.S. (1999) Prevalence of Coexistence of Coronary Artery Disease, Ischemic Stroke, and Peripheral Arterial Disease in Older Persons, Mean Age 80 Years, in an Academic Hospital-Based Geriatrics Practice. Journal of the American Geriatrics Society, 47, 1255-1256. https://doi.org/10.1111/j.1532-5415.1999.tb05208.x
[7]
Thiruvoipati, T., Kielhorn, C.E. and Armstrong, E.J. (2015) Peripheral Artery Disease in Patients with Diabetes: Epidemiology, Mechanisms, and Outcomes. World Journal of Diabetes, 6, 961-969. https://doi.org/10.4239/wjd.v6.i7.961
[8]
Selvin, E. and Erlinger, T.P. (2004) 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, 110, 738-743. https://doi.org/10.1161/01.CIR.0000137913.26087.F0
[9]
Rubba, P., Leccia, G., Faccenda, F., De Simone, B., Carbone, L., Pauciullo, P., Vaccaro, O. and Mancini, M. (1991) Diabetes Mellitus and Localizations of Obliterating Arterial Disease of the Lower Limbs. Angiology, 42, 296-301. https://doi.org/10.1177/000331979104200406
[10]
Selvin, E., Marinopoulos, S., Berkenblit, G., Rami, T., Brancati, F.L., Powe, N.R. and Golden, S.H. (2004) Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus. Annals of Internal Medicine, 141, 421-431. https://doi.org/10.7326/0003-4819-141-6-200409210-00007
[11]
Jude, E.B., Oyibo, S.O., Chalmers, N. and Boulton, A.J. (2001) Peripheral Arterial Disease in Diabetic and Non-Diabetic Patients: A Comparison of Severity and Outcome. Diabetes Care, 24, 1433-1437. https://doi.org/10.2337/diacare.24.8.1433
[12]
American Diabetes Association (2003) Peripheral Arterial Disease in People with Diabetes. Diabetes Care, 26, 3333-3341. https://doi.org/10.2337/diacare.26.12.3333
[13]
Dick, F., Diehm, N., Galimanis, A., Husmann, M., Schmidli, J. and Baumgartner, I. (2007) Surgical or Endovascular Revascularization in Patients with Critical Limb Ischemia: Influence of Diabetes Mellitus on Clinical Outcome. Journal of Vascular Surgery, 45, 751-761. https://doi.org/10.1016/j.jvs.2006.12.022
[14]
Dormandy, J.A. and Rutherford, R.B. (2000) Management of Peripheral Arterial Disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). Journal of Vascular Surgery, 31, S1-S296.
[15]
Aboyans, V., Ricco, J.B., Bartelink, M.E.L., Björck, M., Brodmann, M., Cohnert, T., Collet, J.P., Czerny, M., De Carlo, M., Debus, S., Espinola-Klein, C., Kahan, T., Kownator, S., Mazzolai, L., Naylor, A.R., Roffi, M., Röther, J., Sprynger, M., Tendera, M., Tepe, G., Venermo, M., Vlachopoulos, C., Desormais, I. and ESC Scientific Document Group (2018) 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in Collaboration with the European Society for Vascular Surgery (ESVS): Document Covering Atherosclerotic Disease of Extracranial Carotid and Vertebral, Mesenteric, Renal, Upper and Lower Extremity Arteries Endorsed by: The European Stroke Organization (ESO) the Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European Heart Journal, 39, 763-816. https://doi.org/10.1093/eurheartj/ehx095
[16]
Prompers, L., Huijberts, M., Apelqvist, J., Jude, E., Piaggesi, A., Bakker, K., Edmonds, M., Holstein, P., Jirkovska, A., Mauricio, D., et al. (2007) High Prevalence of Ischaemia, Infection and Serious Comorbidity in Patients with Diabetic Foot Disease in Europe. Baseline Results from the Eurodiale Study. Diabetologia, 50, 18-25. https://doi.org/10.1007/s00125-006-0491-1
[17]
Nativel, M., Potier, L., Alexandre, L., Baillet-Blanco, L., Ducasse, E., Velho, G., Marre, M., Roussel, R., Rigalleau, V. and Mohammedi, K. (2018) Lower Extremity Arterial Disease in Patients with Diabetes: A Contemporary Narrative Review. Cardiovascular Diabetology, 17, Article No. 138. https://doi.org/10.1186/s12933-018-0781-1
[18]
HANDLES. (2016) Update of the PNNS Benchmarks-Revision of Benchmarks Relating to Physical Activity and Sedentary Lifestyle.
[19]
Williams, B., Mancia, G., Spiering, W., et al. (2018) 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Giornale Italiano di Cardiologia, 19, 3S-73S.
[20]
Carter, S.A. and Lezack, J.D. (1971) Digital Systolic Pressures in the Lower Limb in Arterial Disease. Circulation, 43, 905-914. https://doi.org/10.1161/01.CIR.43.6.905
[21]
American Diabetes Association (2018) Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41, S105-S118. https://doi.org/10.2337/dc18-S010
[22]
Semporé, W.Y., Kyélem, G.C., Ilboudo, A., Ouédraogo, N., Ilboudo, E.K., Yaméogo, T.M. and Abraham, P. (2019) Screening for Obliterating Arteriopathy of the Lower Limbs in Diabetics Followed at the Bobo Dioulasso University Hospital by Measuring the Ankle Systolic Pressure Index. RAFMI, 6, 13-18.
[23]
Codjo, H.L., Adoukonou, T.A., Wanvoegbe, A., Dohou, H., Bankolé, C., Alassani, A., Dovonou, C.A. and Houénassi, D.M. (2016) Prevalence of Peripheral Artery Disease Among Diabetics in Parakou in 2013. Annales de Cardiologie et d’Angéiologie, 65, 260-264. https://doi.org/10.1016/j.ancard.2016.04.026
[24]
Wanvoegbe, F.A., Gninkoun, C.J., Houehanou, C., Agbodande, K.A., Akotegnon, F., Dedjan, H., Quenum, R., Alalade, M., Alassani, A., Dovonou, A. and Azon-Kouanou, A. (2023) Lower Limb Arteriopathy in Diabetics at the Oueme-Plateau Provincial Hospital in Porto-Novo: Frequency and Associated Factors. Open Journal of Internal Medicine, 13, 295-303. https://doi.org/10.4236/ojim.2023.134027
[25]
Mariko, M., Sow, D.S., Traoré, B., Togo, A., Nguele, O., Traoré, D., Konaté, M., Koné, A. and Sidibé, A.T. (2021) Screening of Peripheral Arterial Disease of Diabetic Patients with Ankle-Brachial Index in Daily Practice at Bamako. Health Sciences and Diseases, 22, 15-21.
[26]
Tseng, C.H. (2003) Prevalence and Risk Factors of Peripheral Arterial Obstructive Disease in Taiwanese Type 2 Diabetic Patients. Angiology, 54, 331-338. https://doi.org/10.1177/000331970305400309
[27]
Ben Nacef, I., Ben Ahmed, H., Kahena, B., Belhadj Hassen, H., Allouche, E., Rojbi, I., Mchirgui, N., Khiari, K. and Bezdah, L. (2019) Screening for Obliterating Arteriopathy of the Lower Limbs by Measuring the Systolic Pressure Index in Type 2 Diabetics. Tunisted, 97, 1-16.
[28]
Rada, C., Oummou, S., Merzouk, F., Amarir, B., Boussabnia, G., Bougrini, H., Benzaroual, D., Elkarimi, S. and Elhattaoui, M. (2016) Screening for Obliterating Arteriopathy of the Lower Limbs Using the Systolic Pressure Index in Patients at High Cardiovascular Risk. Prospective Observational Study on 370 Asymptomatic Patients at High Cardiovascular Risk. Journal des Maladies Vasculaires, 41, 353-357. https://doi.org/10.1016/j.jmv.2016.10.003
[29]
Raharinavalona, S.A., Raherison, R.E., Razanamparany, T., Rasoaniana, D., Andrianasolo, R.L. and Rakotomalala, A.D.P. (2022) Contribution of Ankle-Brachial Index Measurement in Screening for Arteriopathy Obliterans of the Lower Limbs in Type 2 Diabetics, Journal of Endocrinology, Metabolism and Diabetes of South Africa, 27, 117-123. https://doi.org/10.1080/16089677.2022.2074123
[30]
Konin, C., Essam N’loo, A.S., Adoubi, A., Coulibaly, I., N’guetta, R., Boka, B., N’djessan, J.J., Koffi, J., Yao, H., Angoran, I. and Adoh, M. (2014) Peripheral Arterial Disease of the Lower Limbs in African Diabetic Patients: Ultrasonography and Determining Factors. Journal des Maladies Vasculaires, 39, 373-381. https://doi.org/10.1016/j.jmv.2014.08.001
[31]
Adler, A.I., Stevens, R.J., Neil, A., Stratton, I.M., Boulton, A.J. and Holman, R.R. (2002) UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes. Diabetes Care, 25, 894-899. https://doi.org/10.2337/diacare.25.5.894
[32]
Guan, H., Liu, Z.M., Li, G.W., Guo, X.H., Xu, Z.R., Zou, D.J., Xing, H.L., Liu, W., Sheng, Z.Y., Tian, H.M., Zhu, D.L., Yu, D.M., Zhuang, W.T., Chen, L.L. and Weng, J.P. (2007) [Analysis of Peripheral Arterial Obstructive Disease Related Factors among Diabetic Population Aged > or = 50]. Chinese Medical Journal, 87, 23-27.
[33]
Tseng, C.H. (2007) Sex Difference in the Distribution of Atherosclerotic Risk Factors and Their Association with Peripheral Arterial Disease in Taiwanese Type 2 Diabetic Patients. Circulation Journal, 71, 1131-1136. https://doi.org/10.1253/circj.71.1131
[34]
Chen, T., Xiao, S., Chen, Z., Yang, Y., Yang, B. and Liu, N. (2024) Risk Factors for Peripheral Artery Disease and Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes. Diabetes Research and Clinical Practice, 207, Article ID: 111079. https://doi.org/10.1016/j.diabres.2023.111079
[35]
Sartore, G., Ragazzi, E., Caprino, R. and Lapolla, A. (2023) Long-Term HbA1c Variability and Macro-/Micro-Vascular Complications in Type 2 Diabetes Mellitus: A Meta-Analysis Update. Acta Diabetologica, 60, 721-738. https://doi.org/10.1007/s00592-023-02037-8
[36]
Aboyans, V., Sevestre, M.A., Désormais, I., Lacroix, P., Fowkes, G. and Criqui, M.H. (2018) Epidemiology of Lower Extremity Artery Disease. La Presse Médicale, 47, 38-46. https://doi.org/10.1016/j.lpm.2018.01.012
[37]
Taniwaki, H., Shoji, T., Emoto, M., Kawagishi, T., Ishimura, E., Inaba, M., Okuno, Y. and Nishizawa, Y. (2001) Femoral Artery Wall Thickness and Stiffness in Evaluation of Peripheral Vascular Disease in Type 2 Diabetes Mellitus. Atherosclerosis, 158, 207-214. https://doi.org/10.1016/S0021-9150(01)00414-2
[38]
Suzuki, E., Kashiwagi, A., Nishio, Y., Egawa, K., Shimizu, S., Maegawa, H., Haneda, M., Yasuda, H., Morikawa, S., Inubushi, T., et al. (2001) Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients. Diabetes Care, 24, 2107-2114. https://doi.org/10.2337/diacare.24.12.2107
[39]
Mohammedi, K., Woodward, M., Hirakawa, Y., Zoungas, S., Williams, B., Lisheng, L., Rodgers, A., Mancia, G., Neal, B., Harrap, S., et al. (2016) Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients with Type 2 Diabetes. Diabetes Care, 39, 1796-1803. https://doi.org/10.2337/dc16-0588
[40]
Adler, A.I., Stratton, I.M., Neil, H.A., Yudkin, J.S., Matthews, D.R., Cull, C.A., Wright, A.D., Turner, R.C. and Holman, R.R. (2000) Association of Systolic Blood Pressure with Macrovascular and Microvascular Complications of Type 2 Diabetes (UKPDS 36): Prospective Observational Study. BMJ, 321, 412-419. https://doi.org/10.1136/bmj.321.7258.412
[41]
Riandini, T., Pang, D., Toh, M.P.H.S., Tan, C.S., Liu, D.Y.K., Choong, A.M.T.L., Chandrasekar, S., Tai, E.S., Tan, K.B. and Venkataraman, K. (2021) Diabetes-Related Lower Extremity Complications in a Multi-Ethnic Asian Population: A 10 Years Observational Study in Singapore. Diabetologia, 64, 1538-1549. https://doi.org/10.1007/s00125-021-05441-3
[42]
Sartore, G., Caprino, R., Ragazzi, E., Bianchi, L., Lapolla, A. and Piarulli, F. (2023) The Ankle-Brachial Index for Assessing the Prevalence of Peripheral Artery Disease and Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus. Nutrition, Metabolism and Cardiovascular Diseases, 33, 560-567. https://doi.org/10.1016/j.numecd.2022.11.019
[43]
Newman, J.D., Navas-Acien, A., Kuo, C.C., Guallar, E., Howard, B.V., Fabsitz, R.R., Devereux, R.B., Umans, J.G., Francesconi, K.A., Goessler, W., Best, L.T. and Tellez-Plaza, M. (2016) Peripheral Arterial Disease and Its Association with Arsenic Exposure and Metabolism in the Strong Heart Study. American Journal of Epidemiology, 184, 806-817. https://doi.org/10.1093/aje/kww002
[44]
Frisbie, S.H. and Mitchell, E.J. (2022) Arsenic in Drinking Water: An Analysis of Global Drinking Water Regulations and Recommendations for Updates to Protect Public Health. PLOS ONE, 17, e0263505. https://doi.org/10.1371/journal.pone.0263505