Abstract
Background The global rise in type 2 diabetes mellitus (T2DM) has led to an epidemic of lower extremity arterial disease (LEAD), primarily caused by atherosclerosis and compounded by late detection and high treatment costs. Early detection is key for managing LEAD effectively. Color doppler ultrasound (DUS), a non-invasive and cost-effective technique, enhances early diagnosis through high-resolution imaging. Integrating DUS with proprietary MATLAB-based software for quantitative wall shear stress (WSS) analysis offers a non-invasive method to assess WSS. This approach targets the popliteal artery, using WSS as a reliable marker for early LEAD detection in T2DM patients.Methods This study included 202 patients clinically diagnosed with T2DM from March 2019 to November 2023 at Shanghai East Hospital, along with 69 healthy volunteers recruited during the same period. The T2DM group was further divided into three subgroups based on the intima-media thickness (IMT) of the popliteal artery: T2DM IMT normal group (IMT < 0.9 mm), T2DM IMT thickening group (1.0 ≤ IMT < 1.2 mm), and T2DM plaque formation group (IMT ≥ 1.2 mm). Using WSS quantitative analysis software, we calculated the average WSS of the popliteal artery and created two-dimensional WSS distribution maps, three-dimensional WSS spatial distribution maps, and WSS fusion images. Subsequently, we analyzed the WSS and its variation patterns among the control group, the T2DM group, and its various subgroups.Results In a study comparing T2DM patients to controls, T2DM groups showed significantly altered blood pressure, blood lipids, and blood viscosity, along with reduced WSS values, indicating advanced arterial damage. Specifically, WSS was lower in T2DM groups with normal and thickening IMT and those with plaque formation compared to controls. The optimal WSS cutoff for predicting LEAD was 1.82 dyne/cm², with a sensitivity of 68% and specificity of 83%. WSS negatively correlated with factors like age and disease duration, and positively with peak systolic velocity (PSV).Conclusions Non-invasive WSS measurement using DUS provides a valuable diagnostic tool for early LEAD detection in T2DM patients. Reduced WSS in the popliteal artery is a predictive marker of disease onset, offering potential for earlier intervention and better management of LEAD, ultimately improving patient outcomes.