title: Prevalence of lower extremity peripheral artery disease among adult diabetes patients in southwestern Uganda.
abstract: BACKGROUND
  Peripheral artery disease (PAD) is a major complication of atherosclerosis. PAD can be diagnosed with low-cost diagnostic techniques and is associated with significant morbidity and mortality. While the major epidemiologic risk factors for PAD have been established in the western world, data from resource-poor countries are limited. We performed a cross-sectional study to determine the prevalence and correlates of PAD among patients with diabetes at Mbarara Referral Hospital in southwestern Uganda.
  
  
  METHODS
  We consecutively enrolled diabetes patients aged 50 years or greater presenting to the outpatient clinic. We collected blood for fasting lipid profile, HIV serology, and glycosylated hemoglobin, measured blood pressure and ankle brachial index, and administered the Edinburgh Claudication Questionnaire (ECQ). We also surveyed patients for other PAD risk factors. We used logistic regression to determine correlates of PAD.
  
  
  RESULTS
  We enrolled 229 diabetes patients. The median age of 60 years (IQR 55-66), and 146 (63.7%) were female. Fifty five patients (24%) had PAD (ABI of ≤ 0.9). Of these, 48 /55 (87.27%) had mild PAD (ABI 0.71-0.9) while 7/55 (12.73%) had moderate to severe PAD (ABI < 0.7). Amongst those with PAD, 24/55 (43.64%) reported claudication by the ECQ. Correlates of PAD included female sex (AOR 2.25, 95% CI 1.06 - 4.77, p = 0.034), current high blood pressure (AOR 2.59, 95% CI 1.25-5.33, p = 0.01), and being on a sulfonylurea-glibenclamide (AOR 3.47, 95% CI 1.55 - 7.76, p = 0.002).
  
  
  CONCLUSIONS
  PAD was common in diabetic patients in southwestern Uganda. Given its low cost and ease of measurement, ABI deserves further assessment as a screening tool for both PAD and long term cardiovascular risk amongst diabetics in this region.
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, P,O Box 1410, Mbarara, Uganda. okello.samson@must.ac.ug.
authors.forename: Samson
authors.initials: S
authors.lastname: Okello
authors.forename: Alexander
authors.initials: A
authors.lastname: Millard
authors.forename: Rogers
authors.initials: R
authors.lastname: Owori
authors.forename: Stephen Bambeiha
authors.initials: SB
authors.lastname: Asiimwe
authors.forename: Mark Jacob
authors.initials: MJ
authors.lastname: Siedner
authors.forename: Joselyn
authors.initials: J
authors.lastname: Rwebembera
authors.forename: Laurence Anthony
authors.initials: LA
authors.lastname: Wilson
authors.forename: Christopher Charles
authors.initials: CC
authors.lastname: Moore
authors.forename: Brian Herb
authors.initials: BH
authors.lastname: Annex
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human