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The Association of Ankle-Brachial Index and Diabetic Retinopathy in Patients with Type 2 Diabetes

The difference between low and high ankle-brachial index can be indicator for diabetic retinopathy…

Patients with diabetes are at a greater risk for peripheral artery disease caused by atherosclerosis. Previous studies showed that many diabetic patients who received an amputation had peripheral artery disease. The ankle-brachial index is used as a biomarker to detect atherosclerosis. An ankle-brachial index of less than 0.9 is utilized to diagnose peripheral artery occlusive disease. Other values of ankle-brachial index are utilized to detect medial artery calcification. It remains controversial to what extent ankle-brachial index is associated with diabetic retinopathy and peripheral artery disease.

The purpose of the study was to examine the correlation of peripheral artery disease and different stages of diabetic retinopathy in patients with diabetes. Peripheral artery disease was defined by an ankle-brachial index of less than 0.9 and greater than or equal to 1.3. The study was conducted from April 2002 to November 2004. The ankle-brachial index was measured using an ankle-brachial index device, which measured blood pressure in both arms and ankle automatically and simultaneously. The Chi-square test was performed for categorical and continuous variables.

The results showed that the prevalence of ankle-brachial index of less than 0.9 and greater than or equal to 1.3 was 3.0% (odds ratio, 1.718; 95% confidence interval, 1.152 to 2.562; p-0.006). Patients with abnormal ankle-brachial index had a higher risk of coronary artery disease and cerebrovascular disease in comparison to normal ankle-brachial index. Also, results showed that lower blood pressure, higher pulse, higher BMI, higher triglyceride, and lower HDL were associated with abnormal ankle-brachial index in comparison to normal ankle-brachial index.

Practical Pearls:

  • There is an association between peripheral artery disease and diabetic retinopathy.
  • An ankle-brachial index test is recommended for patients with type 2 diabetes at high risk.
  • Patients with abnormal ankle-brachial index is associated with increased risk of cardiovascular diseases.

Chen SC, Hsiao PJ, Huang JC, et al. Abnormally Low or High Ankle-Brachial Index Is Associated with Proliferative Diabetic Retinopathy in Type 2 Diabetic Mellitus Patients. PLoS ONE. 2015;10(7):e0134718.