Predictors of decrease in ankle–brachial index among patients with diabetes mellitus

Diabet. Med. 29, e304–e307 (2012) Abstract Aim  Screening for peripheral arterial disease, a complication among patients with diabetes, is performed by periodic assessment of ankle–brachial index. We aimed to study the degree of ankle–brachial index change over time and factors associated with significant change. Method  We assessed difference between two ankle–brachial index measurements over time in a consecutive series of 82 patients with Type 2 diabetes. All patients had ankle–brachial index > 0.9 but ≤ 1.3 for the first measurement, and significant ankle–brachial index decrease was defined as a decrease of > 0.1 in the follow‐up measurement compared with the baseline. Results  The mean follow‐up duration was 27.6 (median 30.0) months. Significant ankle–brachial index decrease was seen in 20.7% of patients, including 5% with follow‐up ankle–brachial index of ≤ 0.9, consistent with the diagnosis of peripheral arterial disease. After adjusting for age and gender, higher baseline HbA 1c and serum creatinine levels, increase in follow‐up serum LDL cholesterol levels compared with baseline and history of retinopathy were predictors of significant ankle–brachial index decrease. Conclusions  Our study suggests that, within two years, one in five patients with diabetes and a normal ankle–brachial index may have significant progression of peripheral arterial disease. Annual ankle–brachial index assessment and better control of hyperlipidaemia may thus be required for at‐risk patients with poor glycaemic control, renal impairment and retinopathy.