Published in PLOS One on 2026-04-02, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: James Alex Sumawe, Lilian Salingwa
Source: PLOS One • DOI 10.1371/journal.pone.0328852
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Peripheral arterial disease (PAD) is more common among patients with diabetes mellitus (DM) and can lead to critical limb ischemia and amputation. Data on Doppler-diagnosed PAD are scarce in Tanzania. This study aimed to determine the prevalence of PAD and associated risk factors among DM patients referred for lower limb Doppler assessment at a tertiary hospital. Patients with ≥Grade III stenosis according to Jager’s criteria were classified as having peripheral arterial disease.
Analytical cross-sectional design was conducted among 80 adult DM patients suspected of PAD at Muhimbili National Hospital between April 3, 2023, and March 30, 2024. Demographic, clinical, and sonographic data were collected. PAD was defined as ≥Grade III stenosis by Jager’s criteria. Associations between risk factors and PAD were analyzed using Firth penalized logistic regression to account for small event numbers.
Mean participant age was 61.2 ± 11.2 years; 55% were male. 18% had PAD, and 63.7% had hypertension. The dorsalis pedis artery was the most commonly affected segment (32.5%). Only DM duration was significantly associated with PAD (AOR = 1.19; 95% CI: 1.00–1.41; p = 0.044).
PAD is present in a notable proportion of DM patients referred for Doppler evaluation. Longer DM duration is an exploratory predictor. Findings are limited by small sample size, few PAD events, and missing HbA1c data. Larger, multicenter studies are needed to confirm risk factors and improve generalizability.
Introduction
Peripheral arterial disease (PAD) is the partial or complete obstruction of limb arteries, leading to reduced blood flow, tissue ischemia, and, in severe cases, ulceration or amputation [1]. Globally, PAD affects over 200 million people, and in sub-Saharan Africa (SSA) prevalence ranges from 1.7% to 52.5%, with higher rates reported when using Doppler-based diagnostics compared to clinical assessment alone [1,2].
Diabetes mellitus (DM) significantly increases PAD risk due to hyperglycemia, insulin resistance, hypertension, and Older age, smoking, obesity, and family history of cardiovascular disease further elevate risk [3–6]. PAD in DM can lead to serious complications, including non-healing ulcers, gangrene, and amputation [7,8].
While the ankle-brachial index (ABI < 0.9) is widely used internationally, it may underestimate PAD in DM due to arterial calcification [9,10]. Duplex ultrasonography provides non-invasive, accurate assessment of arterial stenosis and hemodynamic significance [7,11–13]. In this study, PAD was defined as ≥Grade III stenosis by Jager’s criteria (≥50% narrowing with hemodynamic compromise), allowing objective detection of clinically meaningful disease.
Despite increasing DM prevalence in Tanzania, local data on Doppler-diagnosed PAD are lacking. This study aimed to determine the prevalence, arterial distribution, and risk factors of PAD among adults with DM referred for lower limb Doppler sonography at a tertiary hospital. The findings will guide targeted screening and interventions to reduce PAD-related complications.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 James Alex Sumawe, Lilian Salingwa. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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