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OBJECTIVE: Although the total prevalence of peripheral artery disease (PAD) in the general population is estimated to be 3%-10%, patients with diabetes mellitus (DM) are known to have a significantly greater risk of developing PAD. However, the extent to which DM can contribute to the development of PAD in patients with other known risk factors remains unclear. We initiated a prospective screening protocol for diabetic patients to determine the prevalence and outcome of clinical and sub-clinical PAD.
METHODS: We performed lower extremity vascular screenings on 366 adult participants from a partnering endocrinology diabetes clinic whom were undergoing diabetes education. Patients were screened by a single vascular physician via a focused vascular history, physical examination, ankle brachial index, and duplex ultrasound imaging of the superficial femoral artery. A positive screening was defined as 1) symptomatic for PAD (history of intermittent claudication, lower extremity ulcers, revascularizations, and/or amputations), 2) an ankle-brachial index <0.90 or >1.30, or 3) signs of SFA disease on duplex ultrasound examination or 4) lower extremity pain that might represent arterial insufficiency. Statistical analysis was performed with SPSS software (IBM). Groups were compared using chi-square for non-parametric values and t-test for parametric values.
RESULTS: Of the 387 patients screened, 366 completed a focused vascular evaluation. 112 patients (30.6%) screened positive. Of the positives, 12 (10.7%) were symptomatic for PAD; 52 (46.4%) had abnormal ABI’s; 64 (57.1%) had abnormal SFA duplex exams; 48 (42.9%) presented with pain. Of the positive patients, 65 (58.0%) presented with only one symptom, 34 (30.4%) with two symptoms, 9 (8.0%) with three symptoms, and 4 (3.6%) with four symptoms. Table 1 shows demographic factors that demonstrated significance (P < 0.05) and each factor’s contribution to the positive screening groups.

Demographic Factor		PAD positive		Odds Ratio
		(n=112)
Male		68 (60.7%)		1.99
CAD		33 (29.5%)		2.45
Smoking		59 (52.7%)		1.86
Insulin use		80 (71.4%)		1.76
Obesity		57 (50.9%)		0.44

CONCLUSIONS: These DM patients had a similar risk profile but higher prevalence than that found in the general population. This data suggest that DM potentiates other PAD risk factors rather than being the overwhelming contributor to the development of PAD.