Profile of Peripheral Arterial Disease in Type 2 Diabetes Mellitus - A Hospital-based observational study in Coastal Karnataka

Introduction: Ankle Brachial Index (ABI) is one of the common non-invasive diagnostic tools available for diagnosing Peripheral Arterial Disease (PAD). However, it has been observed that for an individual diagnosed with both PAD and Type 2 Diabetes Mellitus (T2DM), ABI tends to give false diagnostic value because of the calcification of the major lower limb arteries. Therefore, the health care professionals are at times misled for the diagnosis of PAD. To overcome this another diagnostic tool Toe Brachial Index (TBI) was suggested to perform. However, there is limited literature on performing both ABI and TBI in the given population in a single study.Aim: The main focus of this study is to report the profile of ABI and TBI along with classical symptoms like claudication pain, palpation of pulse and history of T2DM for the screening and diagnosis of PAD in T2DM.Materials And Methods: In this cross-sectional observational study, a total of 121 participants diagnosed with T2DM were recruited for the study as per the inclusion criteria. Detailed demographic details of the participants were noted. Diagnostic tool including both ABI and TBI were performed for all the participants and the data was analysed.Results: Among 121 participants, only 3 participants had both ABI and TBI positive indicating positive diagnostic test for PAD and 106 participants had both ABI and TBI negative. However, in the remaining 12 participants, 10 showed TBI positive but ABI negative and 2 had ABI positive but TBI negative.Conclusions: Based on our study we have reported the profile of PAD in T2DM individuals, which is found to be 10.75.%. Therefore, it can be concluded that ABI and TBI both should be performed to rule out any complication. This will be beneficial in early screening and detection of neuro ischemic changes in foot and subsequently to prevent amputation

Photobiomodulation With Customized Insoles on Maximum Plantar Pressure in Diabetic Foot Syndrome by the Biomechanical Model: A Case Report

A 49-year-old male patient with type 2 diabetes mellitus and Diabetic Foot Syndrome (DFS) was evaluated by comprehensive diabetic foot assessment. A 10-session photobiomodulation therapy (low-level laser therapy) was prescribed for neuropathic pain and symptoms applying the scanning and probe method. Customized insoles were recommended for redistributing the plantar pressures and reducing stress on the diabetic foot’s plantar surface for 4 weeks. Dynamic plantar pressure distribution, lower limb kinematics, and postural sway were evaluated using WinTrack dynamic pressure platform. Photobiomodulation therapy with customized insoles is useful in the redistribution and treatment of plantar pressure and gait kinematics. This approach should be extensively used in DFS as preventive and treatment measures