THE USE OF PLETHYSMOGRAPHY AS A SCREENING EXAM FOR ARTERIOPATHY IN PEOPLE WITH TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.66104/47k82n53Keywords:
Pletismografia; Doença Arterial Periférica; Diabetes Mellitus Tipo 2; Triagem.Abstract
INTRODUCTION: Type 2 Diabetes Mellitus (T2DM) is a highly prevalent chronic metabolic disease associated with macro- and microvascular complications driven by endothelial dysfunction, oxidative stress, and persistent inflammation. Chronic hyperglycemia reduces nitric oxide bioavailability, promoting a pro-thrombotic state that contributes to arteriopathies such as peripheral arterial disease (PAD). The asymptomatic nature of early vascular changes and the lack of effective screening strategies often result in delayed diagnosis, increasing the risk of ulcers, amputations, and mortality. In this context, plethysmography has emerged as a non-invasive, low-cost method with potential utility for early vascular assessment. OBJECTIVE: To evaluate and synthesize the available scientific evidence on the role of plethysmography in vascular assessment in patients with T2DM, considering its diagnostic performance and clinical applicability. METHODS: A systematic review with qualitative synthesis was conducted following PRISMA 2020 guidelines and structured using the PICO framework. Searches were performed in VHL, LILACS, Embase, PubMed, and Web of Science using controlled descriptors and free terms related to plethysmography, PAD, T2DM, and screening. Studies published between 2014 and 2024 were included. Seminal studies outside this period were considered for contextual purposes. Study selection was performed by two independent reviewers, with disagreements resolved by a third evaluator. Methodological quality was assessed using Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and QUADAS-2. RESULTS: Ten studies were included. Evidence consistently demonstrates an association between T2DM and vascular dysfunction mediated by endothelial impairment and oxidative stress. Plethysmography showed potential for vascular function assessment due to its non-invasive nature and outpatient applicability. However, evidence on diagnostic performance remains limited. A key study reported low sensitivity (20%) of the ankle-brachial index measured by plethysmography for PAD detection, compared to pulse volume waveform analysis (81.8%) and Doppler ABI (72.7%), despite high specificity. CONCLUSION: Plethysmography appears to have complementary value in vascular assessment, particularly in functional evaluation. However, current evidence does not support its use as a standalone screening tool for PAD in T2DM. Further robust studies are required to define its clinical role.
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