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

 

Shilpa. S

Lecturer, Almas College of Nursing, Kottakkal

*Corresponding Author E-mail:  shilpashine9@gmail.com

 

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.

 

KEYWORDS: Risk status; Lower Extremity Arterial Disease; Persons with diabetes mellitus; Risk assessment scale; Ankle Brachial Index.

 

 


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)

Variable

Category

df

Chi square value

p value

 

Mild

Mod

Severe

Age(years)

 

 

 

 

 

 

 ≤ 40

7

1

0

 

 

 

41 – 55

34

17

2

6

3.06

0.80

56 – 70

21

12

2

 

 

 

 ˃ 70

2

2

0

 

 

 

Gender

 

 

 

 

 

 

Male

31

15

1

2

0.83

0.66

Female

33

17

3

 

 

 

Educational status

 

 

 

 

 

 

No formal education

9

2

1

 

 

 

Primary education

45

25

3

 

 

 

Secondary education

10

4

0

6

4.71

0.58

Graduate or above

0

1

0

 

 

 

Religion

 

 

 

 

 

 

Hindu

8

5

0

 

 

 

Christian

1

4

0

4

6.69

0.15

Islam

55

23

4

 

 

 

Type of work

 

 

 

 

 

 

Heavy work

7

3

1

 

 

 

Moderate work

57

27

3

4

5.16

0.27

Sedentary work

0

2

0

 

 

 

Monthly family income

 

 

 

 

 

 

 ≤ 5000

10

3

0

 

 

 

5001-10000

31

18

3

6

2.35

0.88

10001-20000

22

10

1

 

 

 

>20000

1

1

0

 

 

 

 Area of residence

 

 

 

 

 

 

 Rural

48

27

4

2

2.24

0.33

 Urban

16

5

0

 

 

 

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

Int.  J. of Advances in Nur. Management. 2019; 7(1):13-19.

DOI: 10.5958/2454-2652.2019.00004.0