Significant correlation of ischemic stroke with peripheral artery disease in type 2 diabetes mellitus patients

Vishal Kumar Gupta, Ajesh Chandra Gupta, Richa Giri, Sandeep Singh Palawat


Background: Atherosclerotic disease is not only increased in incidence in type 2 diabetic patients, but its course is also accelerated. Stroke is one of the major causes of morbidity and mortality among the elderly population. The relationship between ischemic stroke and PAD (peripheral artery disease) has been poorly investigated in India. So, we studied the risk of stroke in PAD patients with type 2 diabetes. The aims and objectives of the study were to study the prevalence of PAD in patients with type 2 diabetes mellitus and to study the correlation of stroke in PAD patients with type 2 diabetes.

Methods: Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age >25 years) from December 2019 to October 2021 in the various units of department of medicine/surgery, KPS institute, GSVM medical college, Kanpur. Color Doppler of limbs and carotid artery was done in study population. Clinical sign and symptoms, history of stroke or diagnostic investigation were used for evaluate cerebrovascular events.

Results: In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009).

Conclusions: By using Doppler, we found evidence of PAD in 25% of type 2 diabetics (M>F). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009). PAD is associated with an increased risk of cerebrovascular disease morbidity and mortality. Clinician should identify a PAD patient with diabetes to elicit symptoms, complications like stroke to decrease mortality or morbidity.


PID, Ischemic stroke, Diabetes mellitus

Full Text:



International Diabetes Federation (IDF), 2020 report. "Members". Available at: Accessed on 29 April 2020.

World Health Organization: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva: World Health Organization; 1999. Available at: https://apps.who. int/iris/handle/10665/66040. Accessed on 29 April 2021.

Tehan PE, Bray A, Chuter VH. Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease. J Diabetes Complications. 2016;30(1):155-60.

2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. 34. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26:3333-41.

Kondeti K, Devi BV, Lakshmi AY, Chandra A. Role of color Doppler ultrasound and MDCT angiography in the evaluation of peripheral arterial disease. J Nut Univ Health Sci. 2020;9:86-91.

Marinelli MR, Beach KW, Glass MJ, Primozich JF, Strandness DE. Non-invasive testing vs clinical evaluation of arterial disease, a prospective study. JAMA. 1997;241(19):2031-4.

Norman PE, Davis WA, Bruce DG, Davis TM. Peripheral arterial disease and risk of cardiac death in type 2 diabetes. Diabetes Care. 2006;29(3):575-80.

Agrawal RP, Ranka M, Beniwal R. Prevalence of micro and macro vascular complications in type 2 diabetes and their risk factors. Int J Diabetes Dev. 2004;24:11-6.

Madhu SV, Kant S. Preclinical evaluation of atherosclerosis. Int J Diabetes Dev Countries. 2006;26(3):105-11.

Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai Urban Population Study (CUPS). Diabetes Care. 2000;23(9):1295-300.

Karamanou M, Protogerou A, Tsoucalas G, Androutsos G, Poulakou-Rebelakou E. Milestones in the history of diabetes mellitus: the main contributors. World J Diabetes. 2016;7(1):1-7.

Mohan V, Ravikumar R, Shanthi Rani S, Deepa R. Epidemiology of cardiovascular disease in type 2 diabetes: the Indian scenario. J Diabetes Sci Technol. 2010;4(1):158-70.

Walter DP, Gatting W, Mullee MA. The prevalence of diabetics and non-diabetic subjects in an English community. Diabetes Med. 1992;9:710-5.

Janka HU, Standl E, Mehnert H. Peripheral vascular disease in diabetes mellitus and its relation to cardiovascular risk factors screening with Doppler. Diabetes Care. 1980;3(2):207-13.

Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317-24.

Sen S, Lynch DR, Kaltsas E. Association of asymptomatic peripheral arterial disease with vascular events in patients with stroke or transient ischemic attack. Stroke. 2009;40(11):3472-7.

Hong B, Leonards CO, Endres M, Siegerink B, Liman TG. Ankle-brachial index and recurrent stroke risk: meta-analysis. Stroke. 2016;47(2):317-22.

Cang Y, Li J, Li YM. Relationship of a low ankle-brachial index with all-cause mortality and cardiovascular mortality in Chinese patients with metabolic syndrome after a 6-year follow-up: a Chinese prospective COHORT study. Intern Med. 2012;51(20):2847-56.

Ovbiagele B. Association of ankle-brachial index level with stroke. J Neurolog Sci. 2009;276(1-2):14-7.