RESUMO
Objetivo: Determinar en pacientes diabéticos tipo 2 la prevalencia de arteriopatía periférica y la validez de las manifestaciones clínicas para su diagnóstico. Métodos: Ámbito: Centro de Salud (Mariñamansa, Orense). Periodo: Enero de 2011 - enero de 2013. Criterios inclusión: Pacientes diabéticos tipo 2, con consentimiento informado. Mediciones: Edad, sexo, tiempo de evolución de diabetes, índice de masa corporal, índice de Charlson, presión arterial, índice tobillo-brazo, niveles de colesterol, hábito tabáquico. Riesgo cardiovascular (UKPDS). Cuestionario de Edimburgo. Tamaño muestral: n=323(±5,5% precisión; 95% seguridad). Análisis estadístico: Análisis multivariado de regresión logística. Estudio de sensibilidad, especificidad valores predictivos y concordancia. Aprobado por el Comité Ético de Investigación (2010/278). Resultados: La edad media fue de 71,56±12,73 años, la media de evolución de la diabetes tipo 2 fue de 12,38±9,96 años. El 26,4% referían síntomas de claudicación intermitente. El 37,2% presentaban un índice tobillo-brazo normal (ITB 0,9- 1,1), un 26,5%<0,9 y un 36,2%>1,10. La concordancia de la arteriopatía periférica según el cuestionario de Edimburgo y el ITB fue reducida (índice Kappa=0,33). El cuestionario de Edimburgo mostró una sensibilidad del 50,7% para predecir el diagnóstico de arteriopatía periférica (ITB< 0,9) una especificidad del 82,6%, un valor predictivo positivo y negativo de 48,6 y 83,8% respectivamente. Conclusiones: Una cuarta parte de los pacientes diabéticos tipo 2 presenta arteriopatía periférica. Existe una baja concordancia entre la evaluación de síntomas de claudicación intermitente y los resultados del ITB. La presencia de los síntomas de claudicación o su ausencia no permiten descartar ni confirmar la enfermedad arterial periférica (AU)
Objective: To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. Methods: Setting: Health center (Mariñamansa, Orense).Period: January 2011-January 2013. Inclusion criteria Patients with type 2 diabetes, informed consent. Measurements: Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. Sample size: n=323 (± 5.5% accuracy, 95% confidence). Statistical analysis: multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). Results: Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI <0.9) with a specificity of 82.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. Conclusions: One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/complicações , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Sensibilidade e Especificidade , Atenção Primária à Saúde , Inquéritos e Questionários , Índice de Massa Corporal , Índice Tornozelo-Braço/métodos , Análise Multivariada , Modelos LogísticosRESUMO
OBJECTIVE: To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. METHODS: Setting: Health center (Mariñamansa,Orense). PERIOD: January 2011-January 2013. INCLUSION CRITERIA: Patients with type 2 diabetes, informed consent. MEASUREMENTS: Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. SAMPLE SIZE: n=323 (± 5.5% accuracy, 95% confidence). STATISTICAL ANALYSIS: multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). RESULTS: Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI <0.9) with a specificity of 82.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. CONCLUSIONS: One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease.
