title: Predictors of decrease in ankle-brachial index among patients with diabetes mellitus.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Hoe
authors.forename: W-P
authors.initials: WP
authors.lastname: Koh
authors.forename: A
authors.initials: A
authors.lastname: Jin
authors.forename: C-F
authors.initials: CF
authors.lastname: Sum
authors.forename: S-C
authors.initials: SC
authors.lastname: Lim
authors.forename: S
authors.initials: S
authors.lastname: Tavintharan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D003404:Creatinine; D006442:Glycated Hemoglobin