Ashu Rastogi, MD, and his team at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, have delivered an essential message in the most comprehensive prospective study of its kind: arterial stiffness kills—even when the ABI looks normal.
In a paper just published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews , Gupta A, Singh R, Bhadada SK, Jude EB, and Rastogi A followed over 2,100 individuals with type 2 diabetes and a first-time diabetic foot ulcer (DFU) over nearly a decade. Their aim: to assess whether brachial-ankle pulse wave velocity (BaPWV) could improve mortality prediction beyond the traditional ankle-brachial index (ABI).
🔍 What They Found:
- ABI alone can mislead: Nearly 1,500 patients had “normal” ABIs (0.9–1.2), yet a striking proportion still died during follow-up.
- BaPWV fills the gap: A BaPWV > 1882 cm/s was independently associated with higher all-cause mortality—even in those with normal ABI.
- Worse yet: BaPWV above 2210 cm/s predicted a 1.7-fold increase in mortality. Those with BaPWV <1642 cm/salso faced excess risk—suggesting a U-shaped curve of harm.
- Quarter of cohort died: Over 25% experienced all-cause mortality, with most deaths due to cardiovascular events.
🦶 Why It Matters:
In the era of GLP-1s, SGLT2is, and advanced imaging, it’s easy to forget that non-invasive vascular metrics can still save lives. By combining ABI and BaPWV, clinicians may better stratify risk in people with diabetic foot complications—and potentially intervene earlier.
As Dr. Rastogi and colleagues note, both indices can be measured quickly and simultaneously using oscillometric devices. This makes widespread clinical adoption highly feasible.
🧠Final Thought:
This study doesn’t just support routine BaPWV measurement in diabetic foot care—it redefines it as a potential standard of care.
đź”— Read the full article on ScienceDirect
Citation:
Gupta A, Singh R, Bhadada SK, Jude EB, Rastogi A. “Ankle brachial index and brachial-ankle pulse wave velocity as predictor for major adverse limb events and all-cause mortality in diabetes,” Diabetes Metab Syndr, 2025. https://doi.org/10.1016/j.dsx.2025.103239
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