Factors Influencing the Presence of Peripheral Arterial Disease among Patients with Type-2 Diabetes Kessiri Wongkongkam a Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy (nursing) Faculty of Graduate Studies

Peripheral arterial disease (PAD) commonly results from the narrowing of peripheral arteries due to atherosclerosis. It is increasing in type 2 diabetes mellitus (DM) patients worldwide; including in Thai type 2 DM patients. This case-control study aims to compare the differences in factors influencing the presence of PAD between type 2 DM patients with and those without PAD and to examine three groups of factors to determine which one is the best predictor of PAD development in type 2 DM patients. The pathophysiology of PAD development in type 2 DM provided the conceptual framework of this study. 437 type 2 DM patients were recruited from eight medical and surgical clinics of four tertiary hospitals in Bangkok and nearby. However, 7.32% of them were excluded according to the exclusion criteria. Thus, 405 eligible patients were enrolled in the study. The ankle-brachial index (ABI) was used for PAD diagnosis. An ABI < 0.9 was diagnosed as PAD development (the case group) while an ABI between 0.91 and 1.30 was defined as without PAD (the control group). Thus, 135 subjects were included into the case study and 270 subjects participated as controls. Personal information, the Self-Care Diabetic Activities (SCDA) and chief complaint were determined and peripheral pulse palpation and ABI measurements were done. Data were analyzed by using descriptive statistics, T-test, Chi-square test, univariate and multiple logistic regression analysis. The univariate analysis indicated that age, BMI, comorbidity (i.e., hypertension (HT), heart disease (HD), chronic kidney disease, HT duration, HD duration and CKD duration), HDL-Cholesterol, educational level, occupation, DM duration and HbA1C level were significantly related to PAD development in type 2 DM patients (p < 0.05). The multivariate model also determined that age (> 70 years of age), having HD, and BMI were significantly associated with PAD progression (all p < 0.05). These three variables can explain 12.3% of the variance in the presence of PAD among patients with type 2 DM. The demographic and physiological-related factors were the best predictors for the presence of PAD among patients with type 2 DM. These findings indicate factors associated with PAD progression and predictive factors for PAD development among type 2 DM patients. Therefore, screening for PAD in type 2 DM patients is recommended. ABI and peripheral pulse palpation should be measured, and an interview conducted to determine the patient’s chief complaint. In addition, health care providers should check for the presence of PAD in higher risk patients (i.e., the elderly, those having HD, and lower BMI) to decrease PAD progression and prevent lower-extremity amputations.