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2. INTRODUCTION
 DIABETES MELLITUS is an endocrine disorder in which
high blood glucose either due to deficiency of insulin or its
resistance which is the leading causes of mortality and
morbidity .
 According to international diabetic federation ,the current
diabetic capital of the world , our India will be having 101.2
million diabetic patients by 2030 .
 In these patients peripheral arterial disease is one of the
high risk condition .
 Ankle brachial index is an available straight forward
reproducible method for detection of PAD , for improving
risk satisfaction in the population .

4. Peripheral Vascular Disease
PAD is characterized by narrowing
and blocking of peripheral arteries
 It is an undiagnosed ,untreated
,poorly understood , and much
more common than previously
thought.
The risk of PAD in the patients with
diabetes mellitus is four fold
higher compared to non diabetic
population .
Patients with DM and PAD have a
high risk of cardiovascular
morbidity and mortality .

5.  Ankle brachial index or ankle brachial pressure index gives
the assessment of peripheral arterial disease.
 ABPI =systolic blood pressure at the ankle./systolic blood
pressure in the arm.
 SBP at the ankle is usually higher compared to SBP at the
arm.
 Therefore contrary to this condition indicates the
condition of PAD .
 This test is non-invasive and inexpensive and co-effective
assessment and therefore ABPI is widely used by variety of
health care professionals, nurses, physicians, podiatrists
working in primary and secondary care settings to access
the signs and symptoms of PAD .

6.  Heavy vehicle drivers are more
prone to the high risk factors
like hypertension, peripheral
disease, high cholesterol i.e
obesity etc.
 They may suffer from back,
legs, arms and hand pains
caused by uncomfortable
seating for long time and the
vehicle vibrations .
 It may predispose to stasis of
blood and lead to occlusive
disorders of vessels of lower
limbs .

7. OBJECTIVES
 1) To access ankle brachial index in heavy vehicles
drives with type 2 diabetes .
 2) To find out if there is any variation in ABPI when
compared to non diabetic heavy vehicle drivers .

8. METHODOLOGY
 60 heavy vehicle drivers of age group 40-60 who are
volunteered for this study were taken as subjects. An
informed consent was taken from each subject after
explaining in detail about the procedure in their local
language.
 Prior approval from the INSTITUTIONAL ETHICAL
COMMITTEE is also taken before starting this study .
The participant has a right to withdraw from the study
at any time during the period of the study if they are
not willing to continue.

9.  STUDY TOOL : 1) Ankle brachial pressure index.
2) Random blood sugar.
3)An appropriately sized blood pressure cuff for
the upper and lower extremities with a working
sphygmomanometer.
4) A Doppler device for detecting flow.
5) Ultrasound transmission gel.
6) An examination table.
 STUDY DESIGN :
Cross-Sectional study
 STUDY POPULATION :
A study of 60 drives of a age group 40-60 years of
which 30 drivers have un complicated diabetes and 30 normal
diabetic individuals.

10.  INCLUSION CRITERIA :
1) Drivers with an experience of more than 5 years who are
working around 12 hours per day of age group 40-60 years.
2) Community- dwelling , generally asymptomatic adults
(may include population with atypical symptoms or minor
symptom not recognized as PAD).
 EXCLUSION CRITERIA :
1) Symptomatic adult, population exclusively of persons
with known CVD, severe chronic kidney disease (stage 4-5).
2) Patients who are unable to remain supine for the
duration of examination are not candidates for an adequate ABI.
3) It is also contraindicated in a patient in whom the use of
an occlusive sphygmomanometer cuff may worsen the extremity
injury.

11.  PROCEDURE : ABPI derived from systolic BP’s measured
in the arms and legs after 10 minutes of rest in a supine
position with arms and legs straight and at rest.
 Manual cuff were used for all BP measurements and arm
circumference was determined during screening to select
the appropriate cuff size consisted with JNC7
recommendation.
 One measurement of BP was made at each of the 6 sites in
the following order: Left arm ,Left ankle(dorsalis pedis ,
posterior tibialis),Right arm, Right ankle.

13.  Right ABPI = Higher of the Right ankle pressures
/Higher arm pressure.
 Left ABPI = Higher of the Left ankle pressure / Higher
arm pressure.
 The lower ratio of either side is considered the patients
overall ABPI.
 INTERPRETATIONS:
The interpretation can be done as below
provided that there are no other significant conditions
affecting the arteries of the leg the following ABPI
ratios can be used to predict the severity of PAD

14. ANKLE BRACHIAL
PRSSERE INDEX
INTERPRETATION ACTION
Above 1.2 Abnormal vessel
hardening from
peripheral arterial disease
Refer routinely
1.0-1.2 Normal range None
0.90-0.99 Acceptable None
0.80-0.89 Some arterial disease Manage risk factors
0.50-0.79 Moderate arterial disease Routine specialist referral
Under 0.50 Severe arterial disease Urgent specialist referral

15.  Elderly and diabetic individuals have calcification in
their arteries that prevent occlusion of flow by
pressure cuff.
 This will cause an abnormally high reading.
 Typically reading greater than 1.50 is considered
abnormal such patients must be referred for further
testing in vascular laboratory.

16. IMPLICATIONS:
This test is non-invasive and inexpensive and co-
effective assessment and therefore Ankle brachial index
measurement has a lot of importance in clinical practice
but it is often incorrectly performed procedure in surveyed
general practices due to lack of time and inadequate
training have been identified as factors associated with it.
Therefore before potential adoption of ABPI as
formalized screening tool for peripheral vascular disease
and other diseases like cardiovascular disease, there is a
need for robust training program to be conducted to
medical students and also to be included in academic
curriculum with standardized methodology in order to
optimize accuracy and consistency to detect peripheral
arterial disease.

17.  REFERENCES:
1)^Aboyans V , Ho E, Denenberg JO, Ho LA, Natarajan L,
Criqui MH(November 2008). “The association between elevated
ankle systolic pressures and peripheral occlusive arterial disease
in diabetic and nondiabetic subjects”. J Vas Surg. 48(5): 1197-203.
doi:10.1016/j.jvs.2008.06.005.PMID 18692981.
2)Jude EB, Eleftheriadou I, Tentolouris N.Peripheral arterial
disease in diabetes-a review. Diabet Med. 2010 Jan;27():4-14
3) Prime , Inc. Announces driver body composition study
results to promote Healthy Lifestyles Among the Trucking
Industry – Press Release Rocket says:
04.2.15 at 10:14

18.  […] to a 2014 NIOSH study , truck drivers are more likely to
have risk factors – like hypertension , high cholesterol […]
 4)cDermott MM, Guralnik JM, Tian L, Liu K,
Ferrucci L , Liao Y , Sharma L, Criqui MH. Associations of
borderlines and low normal ankle-brachial index values
with functional decline at 5 year follow-up: the WALCS
 5)Lange SF, Trampisch HJ, Pittrow D, Darius H,
Mahn M, Allenberg JR, Tepohl G, Haberl RL, Diehm C; get
ABI Study Group. Profound influence of different methods
for determination of the ankle brachial index on the
prevalence estimate of peripheral arterial disease . BMC
Public Health. 2007: 147.

19. THANK YOU