الفهرس 
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Abstract
Our present study amied to evaluate patients of type 2 diabetes carrying some risk factors of PVD even in absence of symptoms and manage them early in hope to reduce the rate of limb loss.
This study included 200 diabetic patient (96 male and 104 female) with age ranged from 5o -80 years old with mean age ± SD (61. 10±6.5) diagnosed as type 2 diabetes mellitus attending the diabetic Out -Patient Clinic at Assiut University Hospital during the study period from January 2012 to December 2013. Those patient were classified according to there age group in to 3 groups 89 patient <60 years old (44.5%), 82 patient from 60-70 years old (41%), 29 patient >70 years old (14.5%). Beside 100 healthy individuals age and sex matched with the patients as control group.
To all patient and control groups ankle brachial index were done and then the diabetic group subdivided in two category. Group I diabetic patient who had abnormal ABI according to recently published practice guidelines for PAD management from the American College of Cardiology and the American Heart Association (ACC/AHA), ABI ratios are interpreted as follows:
• 1.00 to 1.29: normal
• 0.91 to 0.99: borderline (equivocal)
• 0.41 to 0.90: mild to moderate PAD
• 0.00 to 0.40: severe PAD (Hirsch et al., 2006), group II diabetic patient who had normal ABI to evaluate risk factors for development peripheral arterial disease among diabetic patient type 2.
Inclusion criteria
• Type 2 diabetic patients according to WHO 1999.
Exclusion criteria
• Type 1 diabetic patients.
• Other causes of claudication which interfere with ABI measurement as:-
o Hip arthiritis.
o Nerve root compression.
o Spinal canal stenosis.
o Venous claudication.
o Patient with previous history of amputation.
All the studied groups were subjected to the following:
Detailed history was obtained from each patient including age, sex, smoking, diabetes duration and type of treatment (oral or insulin), hypertension duration, symptoms of coronary artery disease or cerebrovascular stroke, treatment for dyslipidemia. Also we stress on symptoms of diabetic neuropathy (numbness, tingling, burning sensation), and symptoms of peripheral arterial disease (claudication, rest pain, cold sensation)
Thoraugh clinical examination including:
• Blood pressure measurement.
• Anthropometric measurement including Weight, height, waist circumference, BMI.
• ECG
• Foot examination include:
- Inspection of foot regarding dependent rubor, pallor on elevation, absence of hair growth, dystrophic toe nails, and cool, dry, fissured skin interdigital spaces for fissures, ulcerations, and infections
- Neuropathy assessment by 128 Hz tuning fork for vibration testing and Semmes-Weinstein 5. 07/10 gm monofilament for protective sensation
- Vascular assessment by palpation of dorsalis pedis artery and posteriol tibial artery, skin temperature and ankle brachial index (ABI) by Doppler ultrasound.
Ankle–brachial pressure index (ABI):
The ABI was measured with a blood pressure cuff and a Doppler ultrasound sensor. The cuff was applied to both arms and ankles. The Doppler probe was used to determine systolic blood pressure in both brachial arteries in the antecubital fossa, and in the right and left posterior tibial arteries, and the right and left dorsalis pedis arteries. The ABI for each leg was calculated as the ratio of the higher of the two systolic pressures (posterior tibial or dorsalis pedis) in the leg and the higher systolic pressure of either the left or right arm (Ashok et al., 2013). An ABI =< 0. 9 in either leg was considered abnormal, suggesting peripheral arterial disease; progressively lower ABI values indicate more severe obstruction (Ashok et al., 2013).
The following investigations will be performed for all the studied patients and control:
- Random blood sugar.
- HbA1c
- Complete blood count (CBC).
- Lipid Profile
Statistical analysis:
Analysis of the data was performed and statistical analysis using the SPSS software (version 16).
Descriptive statistics: Mean, standard deviation and percentages were calculated. Test of significances: Student t-test was used to compare the mean difference between the two groups and Chi-square test and was used to compare the difference in proportion between the two groups. A significant P value was considered when it is < 0. 05.
Ethical Consideration:
Verbal or written consent form before starting the study. Confidentiality was assured for all patients
The results of this study showed that:
Diabetic patient classified according to risk score as following:
- 27 (13. 5%) patient had no risk of diabetic foot (need follow up annually by generalist and or specialist)
- 88(44%) patient had diabetic neuropathy (need follow up every 3-6 month by generalist or rspecialist)
- 71 (35. 5%) patient had peripheral vascular disease (need follow up every 2-3month by specialist).
- 14 (7%) patient had foot ulcer and need interference need follow up every 1-2month by specialist).
This study showed that 69.7% patient less than 60 years old had normal ABI while 30.3% had abnormal ABI , 68.3% patient with age ranged from 60-70 years old had normal ABI while 31.7% had abnormal ABI and 37.9% patient more than 70 years old had normal ABI while 62.1% had abnormal ABI .There was a statistical significant increase of the age of patient with abnormal ABI when compared to the patient with normal ABI with p valu =0.002 .
There was no statistical significant difference as regarding sex between patient with normal and abnormal ABI
There was a statistical significant increase of number of diabetic patient who known to be smoker (43.7%) with abnormal ABI when compared to number of smoker patient (15.5%)with normal ABI while 20.9% ex-smoker diabetic patient had normal ABI when compared to 4.2% ex-smoker had abnormal ABI and 63.6% of non smoker diabetic patient had normal ABI when compared to 52.1% non smoker had abnormal ABI .
There was no significant difference as regarding weight, height, waist circumference and BMI in patient with abnormal ABI when compared to patient with normal ABI with p value =(0.268), (0.188), (0.225), (0.103) respectively .
There was significant increase in mean systolic blood pressure for patient with abnormal ABI when compared to patient with normal ABI with p value = 0.049.While there was no significant difference as regarding mean diastolic blood pressure for patient with abnormal ABI when compared to patient with normal ABI with p value =0.185
There was a statistical significant increase in number of patient with abnormal ABI (44.8%) who presented with diabetic neuropathy when compared to (16.7%) had abnormal ABI without neuropathy with p value =0.001.
There was no significant statistical difference in prevalence of foot ulcer in diabetic patient with abnormal ABI 8.5% when compared to patient with normal ABI 6.2% with p value =0.551.
There was a statistical significant increase in RBG and HbA1c of patient with abnormal ABI when compared to patient with normal ABI with p value =0.024 ,0.038 respectively .
There was no statistical significant differance in mean of cholesterol, TGs, HDL of patient with abnormal ABI when compared with patient with normal ABI with p value=(0.117), (0.317), (0.093) respectively.
While there was a statistical significant incerase in mean LDL of patient with abnormal ABI when compared to Patient with normal ABI with p value =0.010.
There was a statistical significant increase in WBC count of patient with abnormal ABI when compared with patient with normal ABI with p value =0.004.
While there was no significant difference in mean HGB and PLT of patient with abnormal ABI when compared to patient with normal ABI with p value =(0.459) ,( 0.062) respectively.
- There was significant statistical positive correlation between age of diabetics and abnormal ABI (r= 0.487; p< 0.001)
- There was significant statistical positive correlation between duration Of HTN and abnormal ABI (r= 0.482; p< 0.001)
- There was significant statistical positive correlation between duration Of diabetes and abnormal ABI (r= 0.190; p< 0.007)
- There was significant statistical positive correlation between systolic BP and abnormal ABI (r= 0.307; p< 0.001)
- There was significant statistical positive correlation between RBG and abnormal ABI (r= 0.279; p< 0.001)
- There was significant statistical positive correlation between HbA1c and abnormal ABI (r= 0.454; p< 0.001)
- There was significant statistical positive correlation between LDL and abnormal ABI (r= 0.443; p< 0.001)