Contribution of ankle-brachial index measurement in screening for arteriopathy obliterans of the lower limbs in type 2 diabetics

Abstract

Background: Due to the silent and unpredictable nature of obliterating arteriopathy of the lower limbs (OALL) in diabetics, its screening remains essential. The objective of this study was to evaluate the diagnostic performance of the ankle-brachial index (ABI) in the detection of OALL in diabetics. Methods: This was a descriptive and comparative cross-sectional study over a period of one year. Type 2 diabetics seen in the Endocrinology Department of the Joseph Raseta Befelatanana University Hospital Center, on whom it was possible to perform arterial Doppler ultrasound of the lower limbs, were included. Results: A total of 109 cases of type 2 diabetes were included. The average value of the ABI was 1.06 ± 0.14. ABI ≤ 0.90 and > 1.40 was found in 22.4% and 14.9% of cases, respectively. The prevalence of OALL was 29.8% on arterial Doppler. It was asymptomatic in 50% of cases. The diagnostic performance of the ABI to detect OALL was as follows: for a threshold ≤ 0.90 with CI = 95%: Specificity = 100% [95–100] and 100% [94.9–100], Sensitivity = 71.4% [44.9–88.4] and 77.8% [54.1–91.3], left and right respectively; for a threshold > 1.40 with CI = 95%: Specificity = 92.4% [84.8–96.4] and 90% [81.8–94.8], Sensitivity = 0.0% [0. 0–21.1] and 0.0% [0.0–21.1]), left and right respectively. Conclusion: The ABI is a simple and non-invasive tool for early detection of OALL in diabetics. Doppler ultrasound of the lower limbs is always necessary in the event of associated mediacalcosis.