Diagnostic accuracy of bedside tests for peripheral arterial disease in people with diabetes

Michel Oria Saavedra, Oria850929@gmail.com, Carolina Ortiz Martínez and Cecilia Capriles Lemus

SAP Podiatry, 2026

Abstract: Introduction: Bedside tests are recommended to detect peripheral arterial disease in people with diabetes, but medial arterial calcification can produce falsely normal results and their accuracy remains uncertain. Methods: Systematic review following PRISMA 2020. Scopus, PubMed, OpenAlex and Crossref were searched from 2018 to 2026 for diagnostic accuracy studies of the ankle-brachial index, the toe-brachial index and Doppler waveform analysis against a reference standard. Risk of bias was assessed with QUADAS-2 and results were synthesized narratively. Results: Fifteen studies were included (60 to 604 participants). Ankle-brachial index sensitivity ranged from 35% to 95% and specificity from 62% to 98%; in the largest prospective comparison sensitivity was 41% (95% CI 32-50) and specificity 84% (95% CI 79-89). Toe-brachial index sensitivity ranged from 55% to 100% and specificity from 57% to 92%. Doppler waveform analysis detected additional cases, with sensitivity between 63% and 100% in most studies. Conclusions: Bedside tests show high specificity but limited sensitivity for peripheral arterial disease in diabetes. The toe-brachial index and waveform analysis outperform the ankle-brachial index and should complement it when calcification is suspected.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:cwf:podart:pod2026278

DOI: 10.62486/pod2026278

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