Peripheral Arterial Disease Among Diabetic Patients Admitted to Surgical Wards of a Tertiary Care Hospital: A Cross-Sectional Study

Abstract

Background: Peripheral arterial disease (PAD) is a common macrovascular complication of diabetes mellitus and an important cause of foot ulceration and amputation. Examination of the foot alone detects it poorly. The ankle-brachial index (ABI) is the most accurate noninvasive test, and it is recommended for every diabetic patient older than 50 years. Objectives: To find the frequency of PAD in diabetic patients admitted to the surgical wards of Ayub Teaching Hospital, Abbottabad, and to look at its association with age, sex, duration of diabetes, hypertension, smoking, family history of PAD and compliance with anti-diabetic medication. Materials and Methods: This cross-sectional study was carried out in the Department of Surgery, Ayub Teaching Hospital, Abbottabad, from 1 March 2025 to 28 February 2026. A total of 105 patients with type 2 diabetes were enrolled by consecutive sampling after informed consent. Trained researchers interviewed and examined each patient and measured ABI with a handheld Doppler, PAD was diagnosed when the ABI was below 0.9 in either leg. Associations were tested with the chi-square test (Fisher’s exact test where an expected count was below 5) in SPSS version 25, and p<0.05 was considered significant. Results: PAD was present in 27 of 105 patients (25.7%, 95% CI 18.3–34.8%). It increased with the duration of diabetes: 6.9% (2/29) for <10 years, 8.8% (3/34) for 10–20 years and 52.4% (22/42) for >20 years (p<0.001). It was more frequent in smokers than in non-smokers (43.3% (13/30) vs 18.7% (14/75), p = 0.009, OR 3.3, 95% CI 1.3–8.4) and in poorly compliant than in well-compliant patients (57.1% (16/28) vs 14.3% (11/77), p<0.001, OR 8.0, 95% CI 3.0–21.4). No significant association was found with age (10.0% in 18–40 years’ vs 27.4% in 41–83 years, p = 0.447), sex (28.3% in men vs 23.7% in women, p = 0.598), hypertension (26.2% vs 25.0%, p = 0.887) or family history of PAD (22.4% with vs 28.6% without, p = 0.474). Conclusion: About one in four diabetic patients admitted to our surgical wards had PAD. Longer duration of diabetes, smoking and poor compliance with anti-diabetic medication were significantly associated with it. ABI screening, especially in patients with long-standing diabetes, smokers and poor adherers, may allow earlier detection of PAD, but larger multicentre studies with multivariable analysis are needed to confirm these findings.