Infradiagnóstico de enfermedad arterial periférica en pacientes con diabetes mellitus atendidos en consultas de segundo nivel

Abstract

Objective

To determine the prevalence of undiagnosed peripheral arterial disease in patients with diabetes mellitus.

Method

We conducted a cross-sectional study on 360 patients > 50 years of age with diabetes mellitus, who were able to walk and be treated at our Department of Medicine. We excluded patients with severe oedema or swelling in the lower limbs, amputation or revascularization procedures, and those who were hemodynamically unstable or previously diagnosed with peripheral arterial disease. We evaluated the diagnostic performance of the Edinburgh questionnaire, and the absence of dorsalis pedis pulses. Peripheral arterial disease was defined by an ankle-brachial index measured by Doppler of less than 0.90.

Results

The prevalence of peripheral arterial disease was 27% (95% CI: 22%-32%), distributed into 16% symptomatic peripheral arterial disease and 11% asymptomatic peripheral arterial disease. The prevalence of peripheral arterial disease in the three age strata, 50-60 years, 61-70 years, and over 70 years was 18%, 24% and 36%, respectively (P < .001). There was no difference in the prevalence of peripheral arterial disease between men and women (28% vs. 25%, P = .083). The overall diagnostic yield of the Edinburgh questionnaire and the dorsalis pedis pulses examination had a sensitivity of 77% (95% CI: 68%-84%) and a specificity of 62% (95% CI: 59%-65%)

Conclusions

Patients with diabetes mellitus treated at the hospital showed a high prevalence of undiagnosed peripheral arterial disease. The low diagnostic performance of the Edinburgh questionnaire and dorsalis pedis pulse examination justifies the implementation of the ankle-brachial index routinely.