title: Systematic review of screening investigations for peripheral arterial disease in patients with diabetes mellitus.
abstract: Diabetes-related foot complications are a major cause of amputation. The presence of peripheral arterial disease (PAD) identifies those at increased risk of ulceration, failure to heal an ulcer, and amputation. This systematic review assesses the ability of noninvasive screening tests to detect PAD in patients with diabetes mellitus. A database search was performed using the OVIDSP Web site, from 1946 to June 30, 2012 (MEDLINE®), and from 1974 to June 30, 2012 (EMBASE), to identify studies assessing the utility of screening tests in detecting PAD or predicting clinical outcomes in patients with diabetes mellitus. Thirteen studies were identified that reported sensitivity and specificity data on screening tests. No single screening test was reliable in identifying or excluding peripheral arterial disease in patients with diabetes. Although the evidence base is limited, transcutaneous oxygen measurements appear to be predictive of ulcer or surgical wound healing. The diagnosis of PAD (and the decision to revascularize) in patients with diabetes is unreliable using screening tests. Therefore, all patients with diabetes-related foot ulceration should be assessed by a multidisciplinary diabetes foot team that has access to a vascular specialist. A low threshold for noninvasive diagnostic imaging seems appropriate in patients with diabetes-related foot ulceration.
authors: St. George's Vascular Institute St. George's Healthcare NHS Trust London, United Kingdom.
authors: Baris A
authors: BA
authors: Ozdemir
authors: St. George's Vascular Institute St. George's Healthcare NHS Trust London, United Kingdom.
authors: Jack R
authors: JR
authors: Brownrigg
authors: St. George's Vascular Institute St. George's Healthcare NHS Trust London, United Kingdom.
authors: Keith G
authors: KG
authors: Jones
authors: St. George's Vascular Institute St. George's Healthcare NHS Trust London, United Kingdom.
authors: Matt M
authors: MM
authors: Thompson
authors: St. George's Vascular Institute St. George's Healthcare NHS Trust London, United Kingdom.
authors: Robert J
authors: RJ
authors: Hinchliffe
mesh_terms: D015897:Comorbidity; D017719:Diabetic Foot / Q000175:diagnosis* / Q000453:epidemiology*; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity