Diabetes and peripheral arterial disease

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The prevalence of diabetes in intermittent claudication is up to 20%, with some cases of diabetes previously undiagnosed (therefore, consider screening for diabetes).

Intermittent claudication is about twice as common in patients who have diabetes compared with patients who do not.

Neuropathy associated with diabetes greatly increases the risk of foot sepsis and progression to amputation; more intensive management of all risk factors in patients with intermittent claudication and diabetes is indicated.

Ankle–brachial pressure index may be spuriously high in patients with diabetes because arteries are incompressible (calcified).

Strategies for secondary prevention of serious vascular events in patients with Peripheral arterial disease

• Smoking cessation (E32)
  
• Regular exercise and weight loss (E32)
  
• Treatment of diabetes (E2)
  
• Treatment of hypertension (E2)
  
• Treatment of hyperlipidaemia with Statins (E2)
  
• Antiplatelet drug therapy (E1)
  
• Angiotensin-converting enzyme inhibitor (E2)

References
# National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999.

# Rosenberg L, Palmer J, Shapiro S. Decline in the risk of myocardial infarction among women who stop smoking. N Engl J Med 1990; 322: 213-217.

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Peripheral arterial disease Prognosis   Questions that need to be answered: peripheral arterial disease   Dietary Fiber Reduces Peripheral Arterial Disease Risk in Men: study   The management of PAD   What does the future hold for the patient with peripheral arterial disease?   Critical Leg Ischemia in Peripheral Arterial Disease   Peripheral Arterial Disease: Conclusions   Interventional Therapy for PAD   Claudication Medical Therapy for Peripheral Arterial Disease   Peripheral Arterial Disease Medical Therapy   Antiplatelet Therapy for Peripheral Arterial Disease   Peripheral Arterial Disease Pathogenesis

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