Edinburgh questionnaire in the screeningfor peripheral artery disease intype 2 diabetic patients
Keywords:
type 2 diabetes ; peripheralarterydisease ; intermittent claudication ; Edinburgh questionnaire.Abstract
Aim: to analyze Edinburgh questionnaire (EQ) screening performance for peripheral artery disease (PAD) in type 2 diabetic patients.
Methods: Cross sectional study including 150 type 2 diabetic patients without PAD history. All patients responded to EQ and had peripheral pulse checkup and measurement of the ankle/brachial index (ABI). PAD was considered to be present when the ABI was ≤ 0.9
Results: Participants mean age was 57.46 ± 8.04 years and sex-ratio (men/women) was 1.3. EQ has revealed intermittent claudication in 18 patients (12%).
On examination, 42 patients (28%) had at least one weakened or abolished pulse in upper limbs. ABI has revealed the presence of PAD in 16% of patients. The EQ sensibility specificity, positive and negative predictivevalueswere 29, 91,39 and 87%, respectively. Among patients with false negative results (n=17), nine had peripheral neuropathy.
Conclusion:In diabetic patients, EQ had a very low sensibility for the PAD screening. In fact, the important false negative rate, due to the coexisting of peripheral neuropathy, had limited the use of this questionnaire.
Downloads
References
American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26: 3333-3341
Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes 2015;6(7):961-9.
Wattanakit K, Folsom AR, Selvin E, Weatherley BD, Pankawa JS, Brancatib FL, et al. Risk factors for peripheral arterial disease incidence in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis 2005; 180: 389-97.
Rhee SL, Guan H, Liu ZM, Cheng S, Wapadji S, Palmes P, et al. Multi-country stydy on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis. Diabetes Res ClinPract 2007; 76:82-92.
Grimaldi A, Heurtier A. [Epidemiology of cardio-vascular complications of diabetes]. Diabetes Metab 1999; 25 (3):12-20.
Hiatt WR. Preventing atherothrombotic events in peripheral arterial disease: the use of antiplatelet therapy. J Intern Med2002; 251: 193-206.
Adler AI, BoykoEJ, AhroniJH, Smith DG. Lower-extremity amputation in diabetes Diabetes Care 1999;22:1029-1035
Marso SP, Hiatt WR. Peripheral Arterial Disease in Patients With Diabetes. J Am CollCardiol. 2006;47(5):921-9.
Edinburgh Claudication Questionnaire.Occas Pap R Coll Gen Pract2002; 82: 44.
Rose GA. The diagnosis of ischemic heart pain and intermittent claudication in field surveys. Bull WHO 1962; 27:645-58.
Criqui MH, Denenberg JO, Bird CE, Fronek A, Klauber MR, Langer RD. The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med 1996;1(1):65-71.
Leng GC, Fowkes FG. The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys.J ClinEpidemiol1992;45(10):1101-9.
Davies JH, Richards J, Conway K, Kenkre JE, Lewis JE, Mark Williams. Primary care screening for peripheral arterial disease: a cross-sectional observational study.Br J Gen Pract2017;67(655):e103-e110.
Okello S, Millard A, Owori R, Asiimwe SB, Siedner MJ, Rwebembera J et al.Prevalence of lower extremity peripheral artery disease among adult diabetes patients in southwestern Uganda.BMC CardiovascDisord2014;14:75.
Hirsch AT, Hartman L, Town RJ et al. National health care costs of peripheral arterial disease in the Medicare population. Vasc Med 2008; 13: 209-15.
Codjo HL, Adoukonou TA, Wanvoegbe A, Dohou H, Bankolé C, Alassani A2, Dovonou CA2, Houénassi DM[Prevalence of peripheralarterydisease among diabetics in Parakou in 2013]. Ann CardiolAngeiol2016;65(4):260-4.
Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, et al. Prevalence of lower-extremity disease in the US adult population > 40 years of age with and without diabetes. Diabetes Care 2004; 27:1591e7.
Millan-Guerrero RO, Vasquez C, Isais-Millan S, Trujillo-Hermandez B, Caballero-Hoyos R.[Association between neuropathy and peripheral vascular insufficiency in patients with diabetes mellitus type 2]. Rev Invest Clin2011;63(6):621-9.
Fowkes FG, Housley E, Cawood EH, Macintyre CC, Ruckley CV, Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol1991;20:384-392.
ValdivielsoP,Ramirez-Bollero J, Pérez-LópezC. Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?World J Diabetes2014; 5(5): 577-585.
Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. J Vasc Surg. 2011;54:e32-e58.
Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC).Eur Heart J 2011;32:2851-2906.
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).J VascSurg2007;45:S5-67.
Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and Utility of Ankle Brachial Index in Patients with Diabetes. Eur J VascEndovascSurg 2011; 41 (1):110-6.
Natsuaki C, Inoguchi T, Maeda Y, Yamada T, Sasaki S, Sonoda N et al.Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients. Atherosclerosis 2014;234(2):360-5.
