Vasculopathy in the diabetic foot

This paper attempts to distil some of the results of vasculopathy studies performed on Jamaican diabetic clinic attendees. Doppler measurements of ankle/brachial pressure index (A/BI) revealed that 23of the diabetics had peripheral occlusive arterial disease (POAD) which was mostly asymptomatic. Plethysmographic blood flow studies revealed a profound reduction in the vasodilatory response to increased flow demand. Prevalence of POAD determined by Doppler testing of A/BI reported by other researchers ranged from 13in a large community study, one-third of whom were diabetic, to 47in patients who had been diabetic for 20 years. Isolated posterior tibial disease has been reported to carry a three-fold risk of all cause mortality and a four-fold risk of coronary heart disease mortality. This underscores the need for regular Doppler A/BI testing in order to improve the recognition, and treatment of POAD, and prevent further cardiovascular morbidity and mortality.

Peripheral occlusive arterial disease in diabetic clinic attendees

Peripheral occlusive arterial disease occurs with a greater frequency in the diabetic population than in the general population. It can have debilitating effects and so early detection and intervention are important. The aim of this study was to investigate the prevalence of peripheral occlusive arterial disease (POAD) among a sample of diabetic patients attending the out-patient clinic at the University Hospital of the West Indies (UHWI), Mona. A sphygmomanometer was used to measure arm and ankle blood pressures in 80 diabetic patients, and the ankle-brachial systolic pressure index (ABI) was determined. The presence or absence of peripheral pulses was detected with the Multi-dopplex (model 1). POAD was defined by the absence of one or more peripheral pulses and/or an ABI < 0.9. Of the 80 diabetic patients examined, 18 (22.5) were found to have POAD. Seventy-eight per cent of diabetics with POAD had the disease in both legs. Intermittent claudication was diagnosed in 27.7of patients with POAD. A significantly larger proportion of diabetics with POAD were hypertensive and/or neuropathic (p < 0.05). The results suggest that serious attention should be given to the quantitative screening for POAD in the diabetic patients attending the clinic at the UHWI.