Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados

Background Peripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied. Methods Multistage probability sampling was used to select a representative population sample of people ≥25 years of age with known diabetes or fasting blood glucose ≥7 mmol/L or HbA1c ≥6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤0.90 or >0.4; normal 1.00 to 1.40 in both legs; and non-compressible >1.40 in one leg and the other not ≤0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD. Results Of 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤0.90) had normal waveforms in both arteries (Kappa = 0.43). Conclusion Asymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.

[1]  Aditya M. Sharma,et al.  Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound , 2020, Vascular medicine.

[2]  K. Rahimi,et al.  Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. , 2019, The Lancet. Global health.

[3]  C. Howitt,et al.  The prevalence of peripheral neuropathy severe enough to cause a loss of protective sensation in a population‐based sample of people with known and newly detected diabetes in Barbados: a cross‐sectional study , 2019, Diabetic medicine : a journal of the British Diabetic Association.

[4]  I. Hambleton,et al.  Prevalence and phenotype of diabetes and prediabetes using fasting glucose vs HbA1c in a Caribbean population , 2017, Journal of global health.

[5]  I. Hambleton,et al.  Social distribution of diabetes, hypertension and related risk factors in Barbados: a cross-sectional study , 2015, BMJ Open.

[6]  V. Aboyans,et al.  Epidemiology of peripheral artery disease. , 2015, Circulation research.

[7]  Charles G. Taylor,et al.  The extensive inpatient burden of diabetes and diabetes-related foot disease in Barbados. , 2014, Clinical medicine.

[8]  Igor Rudan,et al.  Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis , 2013, The Lancet.

[9]  A. Gomes,et al.  A call to action: women and peripheral artery disease: a scientific statement from the American Heart Association. , 2012, Circulation.

[10]  O. P. Adams,et al.  Knowledge, attitudes, practices, and barriers reported by patients receiving diabetes and hypertension primary health care in Barbados: a focus group study , 2011, BMC family practice.

[11]  O. P. Adams,et al.  Are primary care practitioners in Barbados following diabetes guidelines? - a chart audit with comparison between public and private care sectors , 2011, BMC Research Notes.

[12]  O. P. Adams,et al.  Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study , 2010, BMC family practice.

[13]  O. P. Adams,et al.  Are primary care practitioners in Barbados following hypertension guidelines? - a chart audit , 2010, BMC Research Notes.

[14]  R. Scissons.  Characterizing Triphasic, Biphasic, and Monophasic Doppler Waveforms , 2008 .

[15]  L. Norgren,et al.  Inter-society consensus for the management of peripheral arterial disease. , 2007, International angiology : a journal of the International Union of Angiology.

[16]  N. Shammas,et al.  Epidemiology, classification, and modifiable risk factors of peripheral arterial disease , 2007, Vascular health and risk management.

[17]  P. Norman,et al.  Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. , 2006, Diabetes Care.

[18]  A. Panju,et al.  Does the clinical examination predict lower extremity peripheral arterial disease? , 2006, JAMA.

[19]  R. Langer,et al.  Ethnicity and Peripheral Arterial Disease: The San Diego Population Study , 2005, Circulation.

[20]  K. Harding,et al.  An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. , 2005, Diabetes care.

[21]  N. Chaturvedi,et al.  Explanations for the high risk of diabetes-related amputation in a Caribbean population of black african descent and potential for prevention. , 2004, Diabetes care.

[22]  Elizabeth Selvin,et al.  Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999–2000 , 2004, Circulation.

[23]  R. Donnelly,et al.  ABC of arterial and venous disease: Non-invasive methods of arterial and venous assessment , 2000, BMJ.

[24]  R. Donnelly,et al.  Non-invasive methods of arterial and venous assessment , 2000, BMJ : British Medical Journal.

[25]  F. Fowkes,et al.  The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. , 1992, Journal of clinical epidemiology.

[26]  J. Beckman,et al.  Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. , 2013, European heart journal.

[27]  Richard Hellman,et al.  Comprehensive foot examination and risk assessment. A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. , 2008, Physical therapy.

[28]  L. Norgren,et al.  Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). , 2007, Journal of vascular surgery.

[29]  L. Bouter,et al.  Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study , 2006, Diabetologia.

[30]  Y. Jang,et al.  Standards of Medical Care in Diabetes-2010 by the American Diabetes Association: Prevention and Management of Cardiovascular Disease , 2010 .

[31]  Peripheral Arterial Disease in People With Diabetes , 2003 .

[32]  M. Criqui,et al.  Peripheral arterial disease detection, awareness, and treatment in primary care. , 2001, JAMA.