Jane E A Lewis1, David R Owens. 1. Department of Podiatry, Cardiff and Vale University Health Board, St. David's Hospital, Cardiff, United Kingdom CF11 9XB. jane.lewis@cardiffandvale.wales.nhs.uk
Abstract
BACKGROUND: Peripheral vascular disease is common in persons with diabetes. There is growing evidence that the vascular contribution to foot disease in diabetes is greater than has previously been realized. METHODS: A cross-sectional study of vascular status in 205 subjects with type 1 and type 2 diabetes mellitus was carried out as part of a larger diabetes assessment study. Palpation of pedal pulses, color spectral waveforms, pulse volume recording, and Doppler ankle-brachial pressure index (ABPI) were recorded bilaterally in all subjects. These modalities were evaluated descriptively, and kappa statistics were used to evaluate agreement between ABPI and pulse volume recording. In addition, visual comparisons between the color spectral waveforms (study gold standard) and pulse volume recordings were also undertaken, and clinical usefulness of pulse volume recording was evaluated. RESULTS: Results of this study identified 15.6% (n = 32) subjects having one or more pedal pulses absent on either foot, 47% (n = 98) an abnormal ABPI (<0.9/>1.30), 7.8% (n = 16) an abnormal monophasic waveform, and 7.3% (n = 15) with an abnormal pulse volume recording. The level of agreement between ABPI and pedal pulse palpation was low at 52.2%, between ABPI and spectral waveforms was low at 58%, and between ABPI and pulse volume recording was also low at 45.3%. When the pulse volume recordings were compared with the color spectral waveforms, however, the level of agreement was high at 91.7%. CONCLUSIONS: Pulse volume recording agrees well with the color spectral waveforms. It can be used with all subjects including those with edema. It is simple, quick, and valuable in a community setting to determine the need for further investigations.
BACKGROUND: Peripheral vascular disease is common in persons with diabetes. There is growing evidence that the vascular contribution to foot disease in diabetes is greater than has previously been realized. METHODS: A cross-sectional study of vascular status in 205 subjects with type 1 and type 2 diabetes mellitus was carried out as part of a larger diabetes assessment study. Palpation of pedal pulses, color spectral waveforms, pulse volume recording, and Doppler ankle-brachial pressure index (ABPI) were recorded bilaterally in all subjects. These modalities were evaluated descriptively, and kappa statistics were used to evaluate agreement between ABPI and pulse volume recording. In addition, visual comparisons between the color spectral waveforms (study gold standard) and pulse volume recordings were also undertaken, and clinical usefulness of pulse volume recording was evaluated. RESULTS: Results of this study identified 15.6% (n = 32) subjects having one or more pedal pulses absent on either foot, 47% (n = 98) an abnormal ABPI (<0.9/>1.30), 7.8% (n = 16) an abnormal monophasic waveform, and 7.3% (n = 15) with an abnormal pulse volume recording. The level of agreement between ABPI and pedal pulse palpation was low at 52.2%, between ABPI and spectral waveforms was low at 58%, and between ABPI and pulse volume recording was also low at 45.3%. When the pulse volume recordings were compared with the color spectral waveforms, however, the level of agreement was high at 91.7%. CONCLUSIONS: Pulse volume recording agrees well with the color spectral waveforms. It can be used with all subjects including those with edema. It is simple, quick, and valuable in a community setting to determine the need for further investigations.