Risk Status of Lower Extremity Arterial Disease (LEAD) among persons with Diabetes Mellitus

 

Shilpa. S

 

ABSTRACT:

A Quantitative approach, nonexperimental descriptive exploratory research design was used for this study. 100 samples from each hospitals were selected by non probability purposive sampling technique. Socio demographic data and clinical variables were assessed using a structured interview schedule.  Risk status   assessment was done by using risk assessment scale and bio physiological methods including ABI and vibrometer. The data were analyzed and interpreted by using descriptive and inferential statistics.  Data collection tools included were structured interview schedule, risk assessment scale and bio physiological methods including ABI and vibrometer. Results and conclusion: The analysis revealed that majority of patients with diabetes mellitus were having mild risk for LEAD. There was significant association between risk status of LEAD as measured by ABI with gender, educational status, type of work, history of bad habit and presence of complication of diabetes mellitus (p< 0.05). The variables religion, type of work, prescribed medication and duration of diabetes mellitus was found to be associated with risk status of LEAD as measured by vibrometer (p< 0.05). Study also revealed there was significant association between the research variables and the selected socio demographic variables.

 

 

INTRODUCTION:

Diabetes mellitus is a chronic illness that requires continuous medical care to prevent acute and long- term complications.¹ Lower extremity arterial disease (LEAD) is one of the micro vascular complication of diabetes that  causes decreased blood flow to the legs which can injure nerves and tissues.² People with diabetes are 20 times more likely to undergo an amputation than the rest of the population.³ The unreliable nature of the symptoms and signs of lower-limb arterial insufficiency in diabetes means that non-invasive tests are essential to achieve effective screening.⁴

 

The prevalence is at least threefold higher when sensitive non-invasive tests are used to make the diagnosis of arterial insufficiency in asymptomatic and symptomatic individuals.⁵ Screening techniques like ankle-brachial index (ABI) is a measurement that is useful  in evaluating  improvement or worsening of leg circulation over time.⁶ The other problems secondary to decreased perfusion especially related to neuronal function can be assessed by vibrometer. Vibrometer is a useful non-invasive tool for the detection of subclinical neuropathy in feet occurring secondary to decreased perfusion⁷.

 

Statement of problem:

A study to assess the risk status of Lower Extremity Arterial Disease (LEAD) among persons with diabetes mellitus in selected hospitals at Malappuram.

 

 

OBJECTIVES:

·      Assess the risk status of LEAD among persons with diabetes mellitus.

·      Associate the risk status of LEAD with selected demographic variables of persons with diabetes mellitus.

 

Assumptions:

·      Persons with diabetes mellitus are at high risk of developing vascular complications.

·      The risk for developing health related complications differs from person to person.

 

Lead is a common complication of diabetes.

Eearly identification of risk factors prevent complications

 

METHODOLOGY:

A Quantitative approach, non experimental descriptive exploratory research design was chosen for this study. The study was conducted at selected hospitals at Malappuram, which include   KIMS Al-Shifa hospital and Dialife diabetic care centre, Kerala, India. The samples comprised of 100 persons with diabetes mellitus from each hospitals were selected by non probability purposive sampling technique. After getting the consent, socio demographic data were assessed by using Structured interview schedule, clinical variables by Risk assessment scale and two bio physiological methods namely ABI and vibrometer.

 

Results and discussion

Section I: Distribution of demographic characteristics of persons with diabetes mellitus

 

Table 1: Frequency and percentage distribution of persons with diabetes mellitus based on age, gender, educational status, residence, duration, type of treatment, complication of diabetes mellitus, prescribed medications, family history of diabetes mellitus and family history of vascular diseases

(n=100)

Demographic Variables	Category	Frequency (f)	Percentage (%)
Age in years	≤ 40	8	8
	41-55	53	53
	56-70	35	35
	˃ 70	4	4
Gender	Male	47	47
	Female	53	53
Educational status	No formal education	12	12
	Primary education	73	73
	Secondary education	14	14
	Graduation or above	1	1
Residence	Rural	79	79
	Urban	21	21
Duration of DM	1-5 years	38	38
	Above 5 year	62	62
Type of treatment	Diet control alone	1	1
	OHA	69	69
	Insulin therapy	30	30
Complications of DM	Yes	6	6
	No	94	94
Prescribed medications	Anti platelets	10	10
	Anti-hypertensive	14	14
	Both	8	8
	None	68	68
Family history of DM	Yes	72	72
	No	28	28
Family history of vascular disease	Yes	5	5
	No	95	95

 

 

Figure 1: Percentage distribution of persons with diabetes mellitus based on religion

 

Figure 1 depicts that 82% of the persons with diabetes mellitus are Muslims, 13% are Hindus, and 5% are Christians.

 

 

Figure 2: Percentage distribution of persons with diabetes mellitus based on type of work

 

Figure 2 shows that 87% of the study participants are doing moderate work, 11% are doing sedentary work and 2% are doing heavy work.

 

 

Figure 3: Percentage distribution of persons with diabetes mellitus based on family monthly income

 

Figure 3 shows that 52% of the persons with diabetes mellitus are having monthly family income between rupees 5001-10000 and 33% are having income between rupees 10001- 20000

 

 

Habit of regular exercise

Figure 4: Percentage distribution of persons with diabetes mellitus based on habit of regular exercise.

 

Figure 4 shows that 100% of the persons with diabetes mellitus are not having habit of regular exercise.

 

 

Figure 5: Percentage distribution of the persons with diabetes mellitus based on bad habit

 

 

Figure 5 shows that majority (92%) of diabetic patients do not have any bad habits, but 7% are using tobacco and 1% are using both tobacco and alcohol.

 

Section II: Assessment of risk status of LEAD among persons with diabetes mellitus

 

Table 2: Frequency and percentage distribution of risk status of LEAD as assessed by risk assessment scale (n=100)

Risk status	Frequency (f )	Percentage (% )
Mild	64	64
Moderate	32	32
Severe	4	4

 

Table 2 shows that 64% of the persons with diabetes mellitus are at mild risk, 32% are at moderate risk and 4% of them are at high risk for developing LEAD.

Table 3: Frequency and percentage distribution of risk status of LEAD as assessed by ABI (n=100)

Variable	Frequency(f)	Percentage (%)
Normal	61	61
Mild arterial disease	21	21
Moderate arterial disease	14	14
Severe arterial disease	0	0
Abnormal vessel hardening from PVD	4	4

 

Table 3 shows that 61% of persons with diabetes mellitus are normal,21% at mild risk and 14% are at moderate risk of developing LEAD as measured by ABI .None of the study participants were having severe arterial disease. Four percentage of the participants are at a stage of abnormal vessel hardening.

 

Table 4: Frequency and percentage distribution of risk status of LEAD as assessed by vibrometer (n=100)

Risk status	Frequency(f)	Percentage (%)
Normal	83	83
Mild	17	17
Moderate	0	0
Severe	0	0

 

Table 4 shows that 83% of the study participants are having normal findings in vibrometer study and 17% subjects are having mild deviation from normal.

 

Section III: Association between risk status of LEAD and selected socio- demographic variables

Table 5: Association of risk status of LEAD as measured by risk assessment scale with age, gender, educational status, religion and type of work, monthly family income and area of residence                                                                                                                                  (n=100)

Table 5 shows that there is no significant association of risk status of LEAD with age, gender, educational status, religion, type of work, monthly family income and area of residence (p>0.05).

 

Table 6: Association of risk status of LEAD as measured by risk assessment scale with history of bad habit, duration of diabetes mellitus, type of treatment, presence of complication, prescribed medications, family history of diabetes mellitus, family history of vascular diseases (n=100)

Variable	Category			df	Chi-square value	p value
	Mild	Mod	Severe
History of bad habits
Tobacco use	5	2	0
Alcoholism and tobacco use	0	1	0	4	2.53	0.64
None	59	29	4
Duration of diabetes mellitus
1-5 year	28	10	0	2	3.97	0.14
Above 5 year	36	22	4
Type of treatment
Diet control alone	1	0	0
OHA	49	19	1	4	7.95	0.09
Insulin therapy	14	13	3
Presence of complication
Yes	3	3	0	2	1.09	0.58
No	61	29	4
Prescribed medication
Anti platelets	8	1	1
Anti hypertensives	10	4	0	6	9.41	0.15
Both	2	5	1
None	44	22	2
Family history of diabetes mellitus
Yes	45	24	3	2	0.25	0.88
No	19	8	1
Family history of vascular diseases
Yes	2	3	0	2	1.97	0.37
No	62	29	4

 

Table 6 shows that there is no significant association between risk status of LEAD and the socio-demographic variables history of bad habits, duration and type of treatment of diabetes mellitus, presence of complications, prescribed medications, family history of diabetes and vascular diseases (p>0.05).

 

Table 7: Association between risk status of LEAD as measured by ABI with age, gender and educational status, religion and type of work

(n=100)

Variable	Category				df	Chi square value	p value
	Normal	Mild	Mod	Abn
Age
≤ 40	6	1	0	1
41-55	34	12	7	0	9	11.90	0.22
56-70	19	7	7	2
˃70	2	1	0	1
Gender
Male	32	7	4	4	3	8.72	0.03*
Female	29	14	10	0
Educational status
No formal education	8	0	2	2
Primary education	43	18	12	0
Secondary education	10	3	0	1	9	37.76	0.00*
Graduation or above	0	0	0	1
Religion
Hindu	7	3	2	1
Christian	1	2	1	1	6	6.94	0.33
Islam	53	16	11	2
Type of work
Sedentary	7	2	1	1
Moderate	54	18	13	2	6	14.54	0.02*
Heavy	0	1	0	1

^*Significant at 0.05 level

 

Table 7 shows that there is significant association of risk status of LEAD as measured by ABI with gender, educational status and type of work (p<0.05). And no association between age and religion (p>0.05).

 

Table 8: Association of risk status of LEAD as measured by ABI with area of residence, monthly family income, history of bad habit and duration of diabetes mellitus (n=100)

Variable	Category				df	Chi-square value	P value
	Normal	Mild	Mod	Abn
Area of residence
Rural	45	18	13	3	3	3.24	0.36
Urban	16	3	1	1
Monthly family income
≤5000	10	1	2	0
5001-10000	30	11	9	2	9	7.52	0.58
10001-20000	20	9	2	2
>20000	1	0	1	0
History of bad habit
Tobacco use	5	0	0	2
Both tobacco and alcoholism	0	0	1	0	6	20.19	0.00*
None	56	21	13	2
Duration of diabetes mellitus
1-5 years	28	7	2	1	3	5.43	0.14
Above 5 years	33	14	12	3

^*Significant at 0.05 level

 

Table 8 shows there is no significant association between risk status of LEAD and the socio demographic variables residence, family income and history of bad habits (p<0.05). There is no significant association between risk status of LEAD and duration of diabetes (p>0.05).

 

Table 9: Association of risk status of LEAD as measured by ABI with type of treatment, presence of complication, prescribed medications, family history of diabetes mellitus and family history of vascular diseases (n=100)

Variable	Category				df	Chi-square value	P value
	Normal	Mild	Mod	Abn
Type of treatment
Diet control alone	1	0	0	0
OHA	47	15	5	2	6	11.26	0.08
Insulin therapy	13	6	9	2
Presence of complications
Yes	2	4	0	0	3	8.29	0.04*
No	59	17	14	4
Prescribed medication
Anti platelets	8	1	1	0
Anti hypertensives	10	1	3	0	9	12.02	0.21
Both	2	3	3	0
None	41	16	7	4
Family history of diabetes mellitus
Yes	45	13	10	4	3	2.71		0.43
No	16	8	4	0
Family history of vascular diseases
Yes	1	1	2	1	3	7.36		0.06
No	60	20	12	3

^*Significant at 0.05 level

 

Table 9 shows that there is significant association between the risk status of LEAD and presence of complication of DM (p<0.05), but no association exists with type of treatment, prescribed medication, family history of diabetes and vascular disease (p>0.05).

 

Table 10: Association between risk status of LEAD as measured by vibrometer with age, gender, educational status, religion, type of work and area of residence (n=100

Variable	Category		df	Chi-square value	p value
	Normal	Mild
Age in Years
≤ 40	8	0
41 – 55	44	9	3	4.72	0.19
56 – 70	29	6
˃ 70	2	2
Gender
Male	42	5	1	2.54	0.11
Female	41	12
Educational status
No formal education	10	2
Primary education	60	13	3	0.31	0.96
Secondary education	12	2
Graduation or above	1	0
Religion
Hindu	10	3
Christian	1	4	2	15.75	0.00*
Islam	72	10
Type of work
Sedentary	9	2
Moderate	74	13	2	10.03	0.00*
Heavy	0	2
Area of residence
Rural	65	14	1	0.14	0.71
Urban	18	3

^*Significant at 0.05 level

 

Table 10 shows that there is no significant association of risk status of LEAD with age ,gender, educational status and area of residence (p>0.05 ). The demographic variables religion and type of work are significantly associated with risk status of LEAD (p<0.05).

 

Table 11: Association of risk status of LEAD as measured by vibrometer with monthly family income, history of bad habit and duration of diabetes mellitus, type of treatment, presence of complication, prescribed medications family history of diabetes mellitus and family history of vascular diseases (n=100)

Variables	Category		df	Chi square value	P value
	Normal	Mild
Monthly family income
≤ 5000	12	1
5001-10000	46	6	3	5.91	0.12
10001-20000	24	9
˃ 20000	1	1
History of bad habit
Tobacco use	6	1	2	0.25	0.88
Tobacco and alcoholism	1	0
None	76	16
Duration of diabetes mellitus
1-5 years	37	1	1	8.97	0.00*
Above 5 years	46	16
Type of treatment
Diet control alone	1	0
OHA	61	8	2	5.23	0.07
Insulin therapy	21	9
Presence of complication
Yes	5	1	1	0.00	0.98
No	78	16
Prescribed medication
Anti platelets	9	1
Anti hypertensives	13	1	3	7.52	0.04*
Both	4	4
None	57	11
Family history of DM
Yes	61	11
No	22	6	1	0.54	0 .46
Family history of vascular diseases
Yes	4	1	1	0.03	0.86
No	79	16

^*Significant at 0.05 level

 

Table 11 shows that there is significant association between risk status of LEAD and duration of diabetes mellitus and intake of medication (p<0.05) and no significant association with income, bad habit, type of treatment, presence of complication of DM, family history of diabetes and vascular disease (p>0.05).

 

CONCLUSION:

The study concluded that persons with diabetes mellitus were having mild risk for developing LEAD. There was significant association between risk status of LEAD among persons with diabetes mellitus as measured by ABI with gender, educational status, type of work, history of bad habit and presence of complication of diabetes mellitus. There was significant association between risk status of LEAD among persons with diabetes mellitus as measured by vibro meter with religion, type of work, prescribed medication and duration of diabetes mellitus.

 

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Received on 07.09.2018       Modified on 20.09.2018

Accepted on 04.10.2018       ©A&V Publications All right reserved