Prevalence of peripheral arterial disease and arterial calcification based on three ankle-brachial index calculation methods (highest, average, and lowest systolic ankle pressure): A cross-sectional study in Type 2 diabetes mellitus patients in Peru

Among patients with T2DM, PAD prevalence varied substantially (7.8% - 28.2%) depending on the ABI calculation method, while AC was present in up to 18.2%. The lowest ankle pressure method increased sensitivity and may be preferred in high-risk populations where avoiding missed diagnoses is critical. The highest ankle pressure method, which maximizes specificity, may be more suitable for general screening and comparability with existing literature, whereas the average pressure approach could be useful in research or prognostic modeling. The hierarchical classification strategy allowed PAD and AC to coexist in the same individual, although this was rare. Given the variability in prevalence across methods, local validation studies are needed to determine which approach optimally balances sensitivity, specificity, and clinical applicability in Peruvian diabetic populations.