Peripheral arterial disease in patients with type 2 diabetes mellitus in South India: The urban vs rural divide

Abstract

Background and Aims: Peripheral arterial disease (PAD) is a marker for macrovascular disease and a risk factor for lower limb amputations, in patients with diabetes. The extent and impact of PAD in the rural population in India has not been well studied. The aim of this study was to screen for asymptomatic PAD using ankle brachial index (ABI) in order to characterize and compare risk factors associated with it and to look for the presence of ischemic heart disease (IHD) in rural and urban populations. Materials and Methods: This was an observational, cross-sectional study involving type 2 diabetic patients attending the diabetes clinic in an urban and rural hospital, in South India. Two hundred rural (R) and 400 urban (U) patients were screened for PAD over a period of1 year. An ABI ≤0.9 or >1.3 was considered abnormal. Patients with known PAD and or claudication were excluded as the aim was to look for PAD in asymptomatic patients. Anthropometric measurements and investigations were carried out. Risk factors were analyzed and P values and odds ratio (OR) were calculated. Results: 17.8% of patients had an ABI suggestive of PAD (R 20% vs U 16.8%). 63.6% were male. Known risk factors of PAD were identified and included dyslipidemia (85%; R 92.5% vs U 80.6%; OR 1.61), obesity (84.1%; R 85% vs U 83.6%; OR 0.75), hypertension (59.8%; R 47.5% vs U 67.2%; OR 1.26), and age >50 years (64.5%; R 55% vs U 70%; OR1.24). Except for smoking (22.4%; R 32.5% vs U 16.4%; OR 1.03), none of the other risk factors were different between groups. Mean duration of type 2 diabetes mellitus (T2DM) was 7.95±7.50 (R 4.66±5.22 vs U 9.61±7.93; P P =0.001). Conclusion: Our study demonstrates that one in six asymptomatic South Indians with T2DM have PAD. One in four patients with PAD had ECG changes of IHD which was statistically significant. Based on the odds ratio, the rural patients with PAD had two and a half times higher risk of IHD, even though there was no statistically significant difference in cardiovascular risk factors, age, sex, and mean hemoglobin A1c (HbA1c) in both groups. Prevalence of PAD with a lower duration of DM and higher strength of association with IHD noted in the asymptomatic rural population in our study is a cause for concern.