Prevalence of peripheral arterial disease and prognostic factors for amputation among type 2 diabetic patients in Mbujimayi

Background: Peripheral arterial disease (PAD) is an atheromatous disease affecting one or more arteries of the lower limbs. It is frequently associated with type 2 diabetes mellitus, which is a strong risk factor and increases the incidence of lower limb amputations. This study aimed to determine the prevalence of PAD in type 2 diabetic patients as well as the prognostic factors for limb amputations in Mbujimayi. Methods: This was a multicenter cross-sectional study conducted in Mbujimayi (DR Congo) from September 2020 to December 2023. The study involved patients of both sexes, aged at least 18 years, who were diagnosed with type 2 diabetes mellitus. Results: A total of 237 type 2 diabetic patients were included in the study. The prevalence of PAD in these patients was 39.7%. The mean age was 59.8 ± 8.2 years. The mean duration of diabetes mellitus was 15.8 ± 8.8 years at the time of consultation. Intermittent claudication was found in 28.7% of the patients, and palpation revealed distal pulse abnormalities in 34.2% of the patients. The mean ABI was 0.88 ± 0.18. Compared with clinical assessment alone, ABI measurement was effective in detecting PAD in diabetic patients, including asymptomatic patients, with a sensitivity of 83.3% and a specificity of 84.3%. The frequency of amputations was 21.9%,with a 3-month postamputation mortality rate of 36.5%. Diabetes mellitus duration ≥ 20 years (p 0.009; OR 3.9), glycemic imbalance (p 0.033; OR 3.4), renal failure (p < 0.001; OR 9.0), ulcerations of the lower limbs (p 0.013; OR 3.7) and persistent leukocytosis (p < 0.001; OR 10.5) were found to be factors associated with the risk of amputation in diabetic patients in Mbujimayi. Conclusion: PAD is very common among type 2 diabetic patients in Mbujimayi, where it is responsible for a high rate of amputationand short-term mortality. ABI is a simple, inexpensive, and highly recommendable method for the early detection of PAD in underprivileged areas such as Mbujimayi.