title: Non-invasive lower limb small arterial measures co-segregate strongly with foot complications in people with diabetes.
abstract: OBJECTIVE
  It is unclear how well non-invasive lower-limb vascular assessments can identify those at risk of foot complications in people with diabetes. We aimed to investigate the relationship between a history of foot complication (ulceration or amputation) and non-invasive vascular assessments in people with diabetes.
  
  
  METHODS
  Bilateral ankle-brachial index (ABI), toe brachial index (TBI) and continuous wave Doppler (CWD) were performed in 127 adults with diabetes (97% type 2; age 66.08±11.4years; 55% men; diabetes duration 8.8±7.6years; 28% on insulin therapy; 31% with foot complication history. Correlations were performed between known risk factors for, and documented history of, foot complication. Regression analysis was used to determine the effect of TBI on the likelihood of a prior foot complication.
  
  
  RESULTS
  By logistic regression, the likelihood of foot complication history was highest in those with TBI <0.6 (OR=7.74, p=0.001); then longer diabetes duration (OR=1.06, p=0.05). HbA1c did not independently predict history of foot complications (OR=1.10, p=0.356).
  
  
  CONCLUSIONS
  Likelihood of previous foot complication in this population was ~8 times higher when TBI was <0.6. Such clinical risk profiling was not shown by other non-invasive measures. Prioritizing TBI as a measure of lower-limb vascular disease may be useful to prospectively identify those at risk of diabetic foot complications.
authors.affiliation: School of Health Sciences, University of Newcastle, Australia. Electronic address: Sean.Lanting@newcastle.edu.au.
authors.forename: Sean Michael
authors.initials: SM
authors.lastname: Lanting
authors.affiliation: Charles Perkins Centre, University of Sydney, Australia. Electronic address: stephen.twigg@sydney.edu.au.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Twigg
authors.affiliation: Charles Perkins Centre, University of Sydney, Australia; Discipline of Exercise and Sport Science, University of Sydney, Australia. Electronic address: nathan.johnson@sydney.edu.au.
authors.forename: Nathan Anthony
authors.initials: NA
authors.lastname: Johnson
authors.affiliation: School of Exercise Science, Australian Catholic University, Australia. Electronic address: michael.baker@acu.edu.au.
authors.forename: Michael Kevin
authors.initials: MK
authors.lastname: Baker
authors.affiliation: Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Australia. Electronic address: ian.caterson@sydney.edu.au.
authors.forename: Ian Douglas
authors.initials: ID
authors.lastname: Caterson
authors.affiliation: School of Health Sciences, University of Newcastle, Australia; Priority Research Centre for Physical activity and Nutrition, University of Newcastle. Electronic address: vivienne.chuter@newcastle.edu.au.
authors.forename: Vivienne Helaine
authors.initials: VH
authors.lastname: Chuter
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001160:Arterioles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003131:Combined Modality Therapy; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D017078:Laser-Doppler Flowmetry; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging; D008833:Microcirculation; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D012039:Regional Blood Flow; D012044:Regression Analysis; D012307:Risk Factors; D055502:Secondary Prevention; D014034:Toes / Q000098:blood supply
keywords: Diabetes; Foot complication; Microvascular disease; Peripheral arterial disease; Toe-brachial index