Vasculopathy in the diabetic foot

This paper attempts to distil some of the results of vasculopathy studies performed on Jamaican diabetic clinic attendees. Doppler measurements of ankle/brachial pressure index (A/BI) revealed that 23% of the diabetics had peripheral occlusive arterial disease (POAD) which was mostly asymptomatic. Plethysmographic blood flow studies revealed a profound reduction in the vasodilatory response to increased flow demand. Prevalence of POAD determined by Doppler testing of A/BI reported by other researchers ranged from 13% in a large community study, one-third of whom were diabetic, to 47% in patients who had been diabetic for 20 years. Isolated posterior tibial disease has been reported to carry a three-fold risk of all cause mortality and a four-fold risk of coronary heart disease mortality. This underscores the need for regular Doppler A/BI testing in order to improve the recognition, and treatment of POAD, and prevent further cardiovascular morbidity and mortality.