Asymptomatic Peripheral Arterial Disease Among Jordanian Patients With Diabetic Foot Ulcer

Abstract

Background and objective Peripheral arterial disease (PAD) is a common disorder that is usually associated with leg symptoms such as intermittent claudication (IC), which could be masked by peripheral neuropathy in diabetic patients. In this study, we aimed to assess the prevalence and associated risk factors of asymptomatic PAD among Jordanian patients with diabetic foot ulcers. Methods A cross-sectional study involving diabetic foot patients attending the diabetic foot clinic at the Medical City in Royal Medical Services in Amman, Jordan, was conducted from January 2023 to March 2024. The criteria for the diagnosis of asymptomatic PAD were as follows: patients with toe brachial index (TBI) <0.7 and no leg symptoms as determined by the San Diego Claudication Questionnaire (SDCQ). Results PAD was observed in 38 out of 133 patients (28.6%). Of these, 26 patients (68.4%) had asymptomatic PAD. Statistically significant associations were observed between PAD and male gender, former smoking, cerebrovascular disease (CVD), age, duration of diabetes, and high-density lipoprotein (HDL). Multiple binary logistic regression showed that ex-smoking and age had a significant impact on developing PAD; ex-smoker patients were 4.75 times [95% confidence interval (CI): 1.26-17.90, p=0.021] more likely to have PAD than non-smokers, and the odds ratio (OR) of having PAD increased by 1.05 times for each additional year of patient age (95% CI: 1.004-1.095, p=0.032). In investigating factors associated with asymptomatic PAD, only hypertension showed significant results. Conclusions The prevalence of asymptomatic PAD is relatively high in diabetic foot patients. PAD may delay wound healing and lead to limp loss and poorer quality of life.

Keywords: asymptomatic; claudication; diabetes mellitus; peripheral arterial disease; toe brachial index.