Determinants of peripheral artery disease among persons with diabetes mellitus in north central Nigeria

Abstract

Peripheral artery disease (PAD) is one of the leading causes of non-traumatic amputation worldwide and a major cause of depression. It is therefore imperative to identify the determinants of PAD so as to adopt strategies for its early prevention. The aim of this study therefore, is to assess the determinants of PAD among persons with diabetes mellitus (DM). This is a cross-sectional study aimed at identifying the determinants of PAD among persons with DM. One thousand and forty (1,040) participants were consecutively recruited  following consent from participants and waiver of ethical approval. Relevant medical history, anthropometric measurements, other clinical examinations including measurement of ankle-brachial index (ABI), and were undertaken. IBM SPSS version 23 was used for statistical analysis and logistic regression was used to assess for the determinants of PAD. Significance level used was p < 0.05. Following logistic regression analysis, significant determinants of PAD included age with odds ratio (OR) 1.51, Confidence Interval (CI) 1.18-2.34, p=0.033; duration of DM (OR 1.51, CI 1.23-1.85, p<0.001); positive neuropathic symptoms (OR 2.94, CI 1.94-9.23, p=0.045); central obesity (OR 9.77, CI 5.07-18.82, p<0.001); poor SBP control (OR 2.47, CI 1.26-4.87, p=0.016); poor DBP control (OR 2.45, CI 1.24-4.84, p=0.010); poor HbA1c control (OR 2.59, CI 1.50-5.71, p<0.001); and poor 2HrPP control (OR 3.43, CI 1.79-6.56, p<0.001). Significant inverse determinants of PAD included pulse pressure (OR 0.78, CI 0.67-0.99, p<0.001), statins (OR 3.01, CI 1.99-9.19, p=0.023), and antiplatelets (OR 7.14, CI 3.03-15.61, p=0.008). Significant determinants of PAD included age, duration of DM, positive neuropathic symptoms, central obesity, and poor control of, DBP, and 2HrP. Pulse pressure was however, found to be a significant inverse determinant of PAD which means that low pulse pressure may predispose to PAD. Finally, antiplatelets and statins use were significant inverse determinants of PAD, i.e., they may be protective against PAD. It is recommended therefore, that patients be placed on antiplatelets and statins as early as possible, and in line with extant guidelines.