{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:43Z","timestamp":1792789663274,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research at King Abdulaziz University","award":["IPP: 138-142-2025"],"award-info":[{"award-number":["IPP: 138-142-2025"]}],"id":[{"id":"https:\/\/ror.org\/02ma4wv74","id-type":"ROR","asserted-by":"crossref"}]},{"award":["IPP: 138-142-2025"],"award-info":[{"award-number":["IPP: 138-142-2025"]}],"id":[{"id":"https:\/\/ror.org\/02ma4wv74","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Vascular ultrasound enables non-invasive assessment of lower-limb arterial morphology and hemodynamics and may identify vascular abnormalities associated with type 2 diabetes mellitus (T2DM). This study aimed to determine whether ultrasound-derived morphological and hemodynamic parameters differ between patients with T2DM and non-diabetic controls. Methods: PubMed, Web of Science, EMBASE, and the Cochrane Library were systematically searched for studies published within the preceding 10 years up to June 2026. Eligible studies were original publications that quantitatively compared lower-limb arterial morphology and\/or hemodynamics between adults with T2DM and non-diabetic controls using ultrasound imaging. Four studies comprising 708 participants and 2069 artery-level assessments were included. Ultrasound parameters were meta-analyzed using random-effects models, and between-group differences were evaluated using standardized mean differences (SMDs). Results: The pooled analyses demonstrated no statistically significant differences between patients with T2DM and non-diabetic controls in either morphological (SMD 0.23, 95% CI \u22120.14 to 0.61; p = 0.227) or hemodynamic parameters (SMD \u22120.14, 95% CI \u22120.36 to 0.09; p = 0.227). Heterogeneity was observed in both the morphological and hemodynamic analyses (I2 = 93% and 83%, respectively). Conclusions: Based on the available evidence, the pooled analyses identified no statistically significant overall differences in lower-limb arterial morphological or hemodynamic parameters between patients with T2DM and non-diabetic controls. The available evidence is limited by heterogeneous imaging methods and correlated artery-level measurements. Prospective multicentre studies using standardized imaging protocols and segment-specific analyses are required to clarify the clinical value of ultrasound for detecting early lower-limb vascular dysfunction in T2DM.<\/jats:p>","DOI":"10.3390\/jcm15197580","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:33:12Z","timestamp":1790699592000},"page":"7580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound Evaluation of Lower-Limb Arterial Morphology and Hemodynamics in Type 2 Diabetes Mellitus Versus Non-Diabetic Controls: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9981-6138","authenticated-orcid":false,"given":"Salahaden R.","family":"Sultan","sequence":"first","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Department of Radiology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2697-1394","authenticated-orcid":false,"given":"Faisal","family":"Albin Hajji","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3973-9012","authenticated-orcid":false,"given":"Muyaser","family":"Fatani","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"174","DOI":"10.4103\/ajm.ajm_53_20","article-title":"Pathophysiology of diabetes: An overview","volume":"10","author":"Banday","year":"2020","journal-title":"Avicenna J. Med."},{"key":"ref_2","unstructured":"(2020). GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396, 1204\u20131222."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(20)32374-6","article-title":"The Lancet Commission on diabetes: Using data to transform diabetes care and patient lives","volume":"396","author":"Chan","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12933-022-01516-6","article-title":"Cardiovascular disease in type 2 diabetes mellitus: Progress toward personalized management","volume":"21","author":"Ma","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_6","first-page":"102502","article-title":"Cardiovascular Event Prevalence in Type 1 Versus Type 2 Diabetes: Veradigm Metabolic Registry Insights","volume":"4","author":"Goldsweig","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1161\/CIRCULATIONAHA.116.022194","article-title":"Clinical Update: Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus\u2014Mechanisms, Management, and Clinical Considerations","volume":"133","author":"Hess","year":"2016","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jain, N., Agarwal, M.A., Jalal, D., and Dokun, A.O. (2020). Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092809"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1161\/CIR.0000000000001040","article-title":"Comprehensive Management of Cardiovascular Risk Factors for Adults with Type 2 Diabetes: A Scientific Statement from the American Heart Association","volume":"145","author":"Joseph","year":"2022","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1136\/heartjnl-2015-309076","article-title":"Contemporary evaluation and management of lower extremity peripheral artery disease","volume":"102","author":"Foley","year":"2016","journal-title":"Heart"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.300.2.197","article-title":"Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: A meta-analysis","volume":"300","author":"Fowkes","year":"2008","journal-title":"JAMA"},{"key":"ref_12","first-page":"e726","article-title":"2016 AHA\/ACC guideline on the management of patients with lower extremity peripheral artery disease: A report of the American college of cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"135","author":"Gornik","year":"2017","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.jvs.2019.05.050","article-title":"Critical analysis and limitations of resting ankle-brachial index in the diagnosis of symptomatic peripheral arterial disease patients and the role of diabetes mellitus and chronic kidney disease","volume":"71","author":"AbuRahma","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_14","first-page":"362","article-title":"Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment","volume":"99","author":"Firnhaber","year":"2019","journal-title":"Am. Fam. Physician"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"da Fonseca Cerqueira, M.M.B., Bastos, N.S.S.G., da Silva, D.A.R., Gregori, D., Magalh\u00e3es, L.B.N.C., and Pimentel, M.M.W. (2024). Accuracy of ankle-brachial index in screening for peripheral arterial disease in people with diabetes. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0309083"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1177\/1358863X231190433","article-title":"Ultrasound-detected tibial artery calcification as a marker of cardiovascular and lower-limb risk in asymptomatic patients with type-2diabetes","volume":"28","author":"Salle","year":"2023","journal-title":"Vasc. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1313","DOI":"10.1161\/CIR.0000000000001251","article-title":"2024 ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/SVM\/SVN\/SVS\/SIR\/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Gornik","year":"2024","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1177\/0267659120957849","article-title":"Arterial spectral waveform analysis in the prediction of diabetic foot ulcer healing","volume":"36","author":"Normahani","year":"2020","journal-title":"Perfusion"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"63","DOI":"10.4093\/dmj.2018.42.1.63","article-title":"Color Doppler Ultrasonography Is a Useful Tool for Diagnosis of Peripheral Artery Disease in Type 2 Diabetes Mellitus Patients with Ankle-Brachial Index 0.91 to 1.40","volume":"42","author":"Hur","year":"2018","journal-title":"Diabetes Metab. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Whiting, P., Rutjes, A.W.S., Reitsma, J.B., Bossuyt, P.M.M., and Kleijnen, J. (2003). The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med. Res. Methodol., 3.","DOI":"10.1186\/1471-2288-3-25"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"108602","DOI":"10.1016\/j.envint.2024.108602","article-title":"A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E)","volume":"186","author":"Higgins","year":"2024","journal-title":"Environ. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e7035","DOI":"10.1097\/MD.0000000000007035","article-title":"Differences between healthy adults and patients with type 2 diabetes mellitus in reactivity of toe microcirculation by ultrasound combined with a warm bath test","volume":"96","author":"Zou","year":"2017","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"223","DOI":"10.23736\/S0391-1977.16.02352-X","article-title":"The value of color Doppler ultrasound in the diagnosis of lower extremity vascular disease in type 2 diabetes and an analysis of related factors","volume":"42","author":"Jiang","year":"2017","journal-title":"Minerva Endocrinol."},{"key":"ref_25","first-page":"e23119","article-title":"A Triplex Ultrasound Evaluation of Preclinical Changes in Type 2 Diabetes in Foot Arteries","volume":"14","author":"Ali","year":"2022","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12938-026-01539-0","article-title":"Investigating the early diagnostic value of popliteal artery wall shear stress in lower extremity arterial disease in type 2 diabetes patients using color Doppler ultrasound combined with WSS quantitative analysis","volume":"25","author":"Zhao","year":"2026","journal-title":"Biomed. Eng. OnLine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11795514231220780","DOI":"10.1177\/11795514231220780","article-title":"Cardiometabolic Risk Factors Associated With Type 2 Diabetes Mellitus: A Mechanistic Insight","volume":"16","author":"Chakraborty","year":"2023","journal-title":"Clin. Med. Insights Endocrinol. Diabetes"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wang, M., Li, Y., Li, S., and Lv, J. (2022). Endothelial Dysfunction and Diabetic Cardiomyopathy. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.851941"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Yang, D.R., Wang, M.Y., Zhang, C.L., and Wang, Y. (2024). Endothelial dysfunction in vascular complications of diabetes: A comprehensive review of mechanisms and implications. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1359255"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"De La Cruz-Ares, S., Cardelo, M.P., Guti\u00e9rrez-Mariscal, F.M., Torres-Pe\u00f1a, J.D., Garc\u00eda-Rios, A., Katsiki, N., Malag\u00f3n, M.M., L\u00f3pez-Miranda, J., P\u00e9rez-Mart\u00ednez, P., and Yubero-Serrano, E.M. (2020). Endothelial Dysfunction and Advanced Glycation End Products in Patients with Newly Diagnosed Versus Established Diabetes: From the CORDIOPREV Study. Nutrients, 12.","DOI":"10.3390\/nu12010238"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Radzik, E., Schulz, M., Przywara-Chowaniec, B., and Tomasik, A. (2025). Noninvasive Assessment of Arterial Wall and Soluble ST2 in Patients with Type 2 Diabetes and Coronary Artery Disease. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26157561"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kozakova, M., Morizzo, C., Penno, G., Chiappino, D., and Palombo, C. (2024). Diabetes-Related Changes in Carotid Wall Properties: Role of Triglycerides. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185654"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Jaminon, A., Reesink, K., Kroon, A., and Schurgers, L. (2019). The Role of Vascular Smooth Muscle Cells in Arterial Remodeling: Focus on Calcification-Related Processes. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20225694"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1161\/01.CIR.102.10.1186","article-title":"Arterial remodeling: Mechanisms and clinical implications","volume":"102","author":"Ward","year":"2000","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/1538574418791622","article-title":"A Review of Distribution of Atherosclerosis in the Lower Limb Arteries of Patients With Diabetes Mellitus and Peripheral Vascular Disease","volume":"52","author":"Lowry","year":"2018","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/XCE.0000000000000168","article-title":"Vascular disease in the lower limb in type 1 diabetes","volume":"8","author":"Edmonds","year":"2019","journal-title":"Cardiovasc. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ejvs.2006.11.022","article-title":"Vascular Involvement in Diabetic Subjects with Ischemic Foot Ulcer: A New Morphologic Categorization of Disease Severity","volume":"33","author":"Graziani","year":"2007","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_38","first-page":"e20200053","article-title":"Comparative study of angiographic changes in diabetic and non-diabetic patients with peripheral arterial disease","volume":"22","author":"Trainotti","year":"2023","journal-title":"J. Vasc. Bras."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7580\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:10:25Z","timestamp":1791432625000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":38,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197580"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197580","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}