The ABI calculation method recommended by the IWGDF doubles PAD detection and identifies a broader and slightly younger at-risk population compared with the traditional method.
The IWGDF method (using lowest foot SBP) detected nearly twice the prevalence of low ABI compared to the classical method (using highest foot SBP).
Patients newly identified as having PAD by the IWGDF method (D2) but not the classical method (D1) were slightly younger than those identified by D1.
Patients identified exclusively by the IWGDF method had a lower proportion of men compared to those identified by the classical method.
Patients identified by the IWGDF method had lower total cholesterol levels than those identified by the classical method.
Patients identified by the IWGDF method had a reduced glomerular filtration rate compared to those identified by the classical method.
Clinical signs and symptoms of PAD demonstrated limited sensitivity but generally high specificity, with absence of pedal pulses being particularly specific.
The study supports the use of the IWGDF ABI calculation as a systematic screening tool in individuals with diabetes, including those without overt symptoms.
This research compared two different methods of calculating the ankle-brachial index (ABI), a simple test that measures blood flow to the legs by comparing blood pressure at the ankle to blood pressure in the arm. One method, recommended by the International Working Group on the Diabetic Foot (IWGDF), uses the lowest blood pressure reading at the foot, while the traditional method uses the highest reading. The study followed 221 people with diabetes, examining 442 limbs total. Using the IWGDF method nearly doubled the number of people identified as having peripheral artery disease (PAD) — a dangerous condition where narrowed arteries reduce blood flow to the limbs — detecting it in 18.8% of cases compared to 9.0% with the traditional method. The additional patients caught by the newer method tended to be slightly younger, more often female, had lower cholesterol levels, and showed signs of reduced kidney function compared to those identified by the traditional method alone. This suggests the IWGDF approach captures a somewhat different population at risk for serious complications. The study also found that clinical signs like checking for foot pulses, while highly specific (good at ruling in disease when present), were not sensitive enough on their own to reliably detect PAD — meaning many cases would be missed if clinicians relied only on physical examination. This research suggests that routinely using the IWGDF method to calculate ABI in people with diabetes — even those without obvious symptoms — could identify nearly twice as many people at risk for PAD compared to the traditional approach. Early detection matters because PAD in people with diabetes increases the risk of foot ulcers, infection, and amputation. The findings also highlight an important role for nurses in systematically performing this screening, as it is a non-invasive, accessible test that could improve outcomes through earlier intervention.
Chicharro-Luna E, Zúnica-García S, Moya-Cuenca C, Gracia-Sánchez A. (2026). Role of nursing in the assessment of Peripheral Artery Disease: Comparison of two ankle to arm Index methods in patients with Diabetes.. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. https://doi.org/10.1016/j.jvn.2026.03.003