Prevalence, Grade and Associated Factors of Peripheral Arterial Disease Among Adult Patients Attending Diabetic Clinic at Bugando Medical Centre.
- Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2019
- xiii; 74 Pages Includes References and Appendices
Abstract:
Background: Peripheral arterial disease is a disease of public health significance, ranging from asymptomatic to gangrene. Culminates is major limb amputation with social and economic impact. This study was done to determine the prevalence, grade and associated factors of PAD among adult patients attending diabetic clinic at Bugando Medical Centre (BMC).
Method: Ankle brachial index was measured in adult diabetic patients attending clinic in May and June 2019, using 8.0MHz hand held vascular Doppler and sphygmomanometer. PAD was defined as ABI≤0.09. Demographic data, associated factors of PAD were inquired by pretested and coded questionnaire. Univariate and multivariate logistic regression were used to determine association between dependent and independent variables. PAD was graded by using Fontaine classification system.
Results: Total of 386 patients were studied, 165 males and 221 females, M: F ratio 1:1.3, age ranged from 18-95 years, with mean age 60.0 years [Std.Dev±12.3]. Prevalence of PAD was 36.3%, males and females were affected by 40% and 33.5% respectively, p=0.188. PAD Prevalence increased by increasing age 12.5%, 27.6% and 45.6% for age group ≤40 years, 41-60 years and >60 years respectively, p=0.005. PAD Prevalence increased with higher BMI, 32.7% for normal BMI and 38.2% for overweight and obese, p=0.179. PAD was common among hypertensive (40.8%) compared to normotensive (24%), p=0.003. Those with family history of vascular diseases and those without had PAD by 43% and 32% respectively, p=0.027. Those with history of cigarette smoking and those without history of cigarette smoking had PAD by 74.1% and 33.4% respectively, p=0.000. Patients with typical, atypical and no claudications had PAD by 76%, 58.3% and 22% respectively, p=0.000. Patients whose HbAIc was ≥7 and <7% had PAD by 60.5% and 35.1% respectively, p=0.006. Grading PAD using Fontaine classification system, patients who were in grade I, IIA, IIB, III and IV had PAD by 23.1%, 46.5%, 72.7%, 74.4% and 100% respectively.
Conclusion: Peripheral arterial disease is common among diabetic patients attending outpatient clinic at Bugando Medical Centre, Majority present with claudications. PAD is associated with increasing age, hypertension, family history of vascular diseases, and history of cigarette smoking and higher levels of glycated hemoglobin ≥7%. Grading PAD using Fontaine grading system, patients in grade I, IIA, IIB, III and IV had PAD by 23.1%, 46.5%, 72.7%, 74.4% and 100% respectively.
= OPERATIONAL DEFINITIONS - For the purpose of this study, I have used the following as operational definitions: Peripheral arterial disease is defined as ankle brachial index ≤ 0.90 OPERATIONAL DEFINITIONS Poorly controlled diabetes Patient whose glycated haemoglobin is ≥ 7% OPERATIONAL DEFINITIONS Controlled diabetes Patient whose glycated haemoglobin is < 7%
= LIST OF ABBREVIATIONS ABI Ankle brachial index ACC American College of cardiology ACEI Angiotensin converting enzyme inhibitor ARBs Angiotensin receptor blockers BMC Bugando medical centre BMI Body mass index CAD Coronary artery disease CLI Critical limb ischemia CHD Coronary heart disease CKD Chronic kidney disease CV Cardiovascular DSA Digital subtraction angiography ECQ Edinburgh claudication questionnaire PAD Peripheral arterial disease HDL High density lipoprotein HF Heart failure IC Intermittent claudication LEAD Lower extremity artery disease LDL Low density lipoprotein LMIC Low and middle income countries PI Principle investigator PTFE Polytetrafluoroethylene RA Research assistant TBI Toe brachial index
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz