Diabetes and peripheral arterial disease

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)
  

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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.