Endocrine Abstracts

Aim: In diabetes, non-invasive lower-limb assessments including continuous wave Doppler (CWD), ankle-brachial index (ABI) and toe-brachial index (TBI) are recommended to assess vascular status due to increased risk of ulceration and amputation associated vascular pathology. How well these measurements can identify those at risk of these complications is unknown. The aim of this study was to investigate the relationship between a history of foot complication and non-invasive vascular assessments in people with diabetes.

Methods: Bilateral ABIs, TBIs and CWD were performed in 100 consenting adults with diabetes (94% type 2; age 64.9±11.3 years; 55% men; diabetes duration 8.8±7.9 years; 21% on insulin therapy; 15% with a foot complication history including ulceration or amputation). Correlations were performed between known risk factors for, and documented history of, foot complications. Regression analysis was used to determine the effect of each vascular measurement on the likelihood of a previous foot complication.

Results: By logistic regression, the likelihood of foot complications history was highest in those with TBI 0.6 (OR=10.17, P=0.020); longer diabetes duration (OR=1.08, P=0.012) and higher HbA1c (OR=1.05, P=0.045). ABI (OR=3.31, P=0.783) and CWD (OR=1.299, P=0.264) did not independently predict a history of foot complications.

Conclusions: Likelihood of foot complication presence in this population was ten times higher when the TBI was 0.6, whereas such clinical risk profiling was not shown by other non-invasive measures. Prioritising TBI as a measure of lower limb microvascular disease may be useful to prospectively identify those at risk of diabetic foot complications.