There is currently no agreement as to which bedside test is the most useful for the diagnosis of PAD in diabetes. The aim of this systematic review and meta-analysis was to evaluate the performance of bedside tests for the detection of PAD in individuals with diabetes.
MEDLINE and EMBASE databases were systematically searched for studies providing data on diagnostic performance of bedside tests used for the detection of PAD in people with diabetes. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for the diagnosis of PAD.
A total of 18 studies, reporting on a total of 3016 limbs of diabetic patients, were included in our qualitative review. Of these, eleven studies (1543 limbs) were included in the meta-analysis of diagnostic accuracy: ankle-brachial pressure index (ABPI, 9 studies, 1368 limbs, sensitivity 63.5% [95% CI 51.7-73.9%], specificity 89.3% [95% CI 81.1-94.2%]); toe-brachial pressure index (TBPI, 3 studies, 221 limbs, sensitivity 83.0% [95% CI 59.1-94.3%], specificity 66.3% [95% CI 41.3-84.6%]); and tibial waveform assessment (4 studies, 397 limbs, sensitivity 82.8% [95% CI 73.3-89.4%], specificity 86.8% [95% CI 75.5-93.3%]). Overall, there was a high risk of bias across studies, most frequently relating to patient selection and lack of blinding.
TBPI, pulse oximetry and tibial arterial waveform assessment have demonstrated some promise, warranting further investigation.

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