Concordance and overlap between peripheral artery disease and peripheral sensory neuropathy in diabetes

Background Peripheral artery disease (PAD) and peripheral sensory neuropathy (PSN) are major contributors to diabetic foot complications. Although they have distinct underlying mechanisms, they are often assumed to coexist in clinical practice. However, the degree of overlap and their respective risk factor profiles remain poorly defined. We assessed the concordance and overlap of PAD and PSN and their associated risk factors in West Africans with diabetes. Methods This was a cross-sectional study among 706 Ghanaian adults with diabetes. PAD was defined as an ankle-brachial pressure index ≤ 0.90 and/or intermittent claudication. PSN was defined as vibration perception threshold ≥25 volts and/or diabetic-neuropathy-symptoms score ≥1. Participants were classified into four groups: PAD only, PSN only, both PAD and PSN, or neither condition. Concordance between PAD and PSN was assessed using cross-tabulation and Cohen’s kappa statistic. Multivariable multinomial logistic regression models were fitted to examine factors independently associated with isolated PAD, isolated PSN, and co-existing PAD and PSN. Results Mean (SD) age, diabetes duration, BMI, HbA1c, and total cholesterol were 59.7(±9.95) years, 13.8(±8.24) years, 29.5(±6.01) kg/m², 8.47(±1.99) %, and 4.89(±1.32) mmol/L, respectively; 77.2% were female. In the study population, concordance was fair (κ=0.20, p < 0.001). Age [adjusted odds ratio 1.04, 95% confidence interval 1.01–1.07,p-value=0.011], diabetes duration [1.04(1.00–1.07), 0.028], hypertension [2.14(1.07–4.29),0.032], HbA1c [1.16(1.03–1.32), 0.018], and obesity[1.72(1.02–2.91),0.044] were independently associated with co-existing PAD and PSN. Smoking [3.36(1.21–9.31), 0.020] and diabetes duration [1.04(1.01–1.07), 0.005] were associated with isolated PSN. Conclusion PAD and PSN frequently occur independently among Ghanaians. This highlights the need to establish dual screening protocols for them. Future studies may better characterize the phenotype in which PAD and PSN coexist.