title: Role of an intermittent claudication questionnaire for the diagnosis of PAD in ambulatory patients with type 2 diabetes.
abstract: OBJECTIVE
  In epidemiological studies, peripheral arterial disease is assessed by the measurement of the ankle/brachial index (ABI), thus enabling detection of asymptomatic disease. Our aim was to evaluate the diagnostic accuracy of a validated questionnaire on intermittent claudication for peripheral arterial disease in a clinical setting.
  
  
  METHODS
  We administered the Edinburgh questionnaire on intermittent claudication and measured ABI using a portable Doppler in 456 outpatients with type 2 diabetes. Subjects with intermittent claudication and an ABI above 0.9 were examined with color Doppler ultrasound imaging. Peripheral arterial disease was considered to be present when the ABI was <0.9 or the color Doppler arterial waveform was monophasic.
  
  
  RESULTS
  Thirty-five (7.6%) of the 456 patients had intermittent claudication. Of these, 22 (63%) had an ABI <0.9 and the remaining 13 (37%) had an ABI >0.9. Of these latter, 12 were reexamined and 3 (25%) were found to have monophasic waveforms in color Doppler, thus being diagnosed with peripheral arterial disease. The overall accuracy of intermittent claudication for peripheral arterial disease was 75% (95% CI, 71-79).
  
  
  CONCLUSIONS
  Among patients with type 2 diabetes, a normal ABI does not rule out peripheral arterial disease; the use of an intermittent claudication questionnaire is able to identify correctly the disease in 3 out of 4 patients with diabetes. Our results suggest incorporating the intermittent claudication questionnaire into the general consultation instead of the general screening of the ABI.
authors.affiliation: Centro de Salud Ciudad Jardín, Servicio Andaluz de Salud, Málaga, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Mancera-Romero
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Morata
authors.forename: M
authors.initials: M
authors.lastname: Angel Sánchez-Chaparro
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Pérez
authors.forename: F
authors.initials: F
authors.lastname: Paniagua-Gómez
authors.forename: A
authors.initials: A
authors.lastname: Hidalgo-Conde
authors.forename: P
authors.initials: P
authors.lastname: Valdivielso
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D018615:Ultrasonography, Doppler, Color