Screening of hospitalised diabetic patients for lower limb ischaemia: is it necessary?

Diabetes mellitus is a major risk factor for atherosclerosis and consequently lower limb ischaemia. This study aimed at screening hospitalised diabetic patients for lower limb ischaemia by measuring their ankle brachial pressure index (ABI).

ABI was measured, utilising handheld Doppler ultrasound, for 100 patients with type 2 diabetes mellitus, who were admitted to the surgical ward, King Abdullah University Hospital, Irbid, Jordan, for non lower-limb related problems. The presence of hypertension, angina and intermittent claudication was examined. Findings were compared with those of another 100 non-diabetic patients as a control group.

The results revealed a significant increase in the incidence of hypertension, angina, and claudication in the diabetic patients. Foot pulses were palpable in 96 patients of the control group and in 84 patients of the diabetes mellitus group. The mean ABIs in the diabetes mellitus and control groups were 0.99 and 1.1, respectively. It was less than 0.9 in 34 and 25 patients of the diabetes mellitus and control groups, respectively. ABI was significantly lower in the hypertension and angina patients, while it was not significantly low in the claudication patients.

We recommend the routine measurement of ABI for hospitalised diabetic patients, especially those with hypertension and angina, as comorbid problems of atherosclerosis. Those with a reading of less than 0.9 should be directed for further vascular evaluation.