Title : Systolic blood pressure index in elderly diabetics
Abstract:
Introduction: The risk of developing peripheral artery disease (PAD) increases significantly in diabetic patients, who are also more exposed to ischemic events than the general population. This risk is independent of other risk factors, particularly smoking, which is considered a major risk factor for the development of lower limb PAD in elderly diabetics.
Materials and Methods: This descriptive study included 330 patients with type 2 diabetes over the age of 65 (149 men, 181 women). In our study, we performed an ankle-brachial index (ABI) measurement in all patients to screen for diabetic PAD (ABI < 0.9). However, when medial calcification is present in advanced diabetes, the leg arteries become incompressible, and the ABI is invalid (high ABI > 1.30). The ADA consensus recommends ABI measurement in all diabetics over the age of 50. If the measurement is normal, a repeat measurement is recommended 5 years later. If the ABI cannot be measured due to incompressible arteries, it is advisable to measure the pressure at the big toe.
Results: The mean age of the paents was 70.42 years. The mean duraon of diabetes was 15.6 years.
The mean ankle-brachial index (ABI) was 1.02. The prevalence of peripheral artery disease (PAD) was 26.06%, reaching 36.6% when medial calcificaon (ABI > 1.3) is included. In our study, one in five paents had compensated PAD, and among diabec paents with a normal ABI (63.33%), the prevalence of PAD is esmated to be undiagnosed at 19%, or one in five, and 5.15% had already undergone amputaon. The prevalence of PAD was significantly twice as high in men. Our prevalence figure is consistent with some comparable internaonal studies, which primarily focused on older individuals and used the same measurement methods. In parcular, the GERODIAB cohort found a 26.1% prevalence of PAD, and the PARTNERS study, where the ABI performed on 6,979 subjects over 70 years of age found a prevalence of 29%. In Algeria, in a doctoral thesis by Zekri on 500 type 2 diabecs with a mean age of 63.9 years and a mean diabetes duraon of 12 years, the prevalence of PAD detected by ABI was 24.4% [278].
Conclusion: PAD is asymptomac in more than 50% of cases. Symptoms oen remain silent for a long me in the elderly and frequently only become apparent at the stage of permanent ischemia. Individual screening for PAD should be systemac in all situaons at risk of pressure ulcers. It relies firstly on clinical examinaon of the foot, systemacally supplemented by measurement of the ABI.
