Management of peripheral arterial disease in patients with diabetes

Peter Sheehan, George Kikano

Research output: Contribution to journalReview articlepeer-review

Abstract

PURPOSE: Peripheral arterial disease (PAD) is a debilitating atherosclerotic disease of the lower limbs. PAD is an indicator of systemic vascular disease, and is associated with an increased risk of cardiovascular morbidity and mortality. Diabetes is a powerful risk factor for the development and progression of PAD. The purpose of this review is to increase awareness among primary care physicians of the health risks associated with PAD in patients with diabetes; the epidemiology and diagnosis of PAD in patients with diabetes are discussed, together with recommended treatment options. EPIDEMIOLOGY: PAD affects 8 to 12 million individuals in the United States. Patients with diabetes have a higher risk of developing PAD than those without diabetes. Patients with diabetes also tend to have more severe PAD, which is frequently accompanied by peripheral neuropathy. REVIEW SUMMARY: Treatment of PAD in patients with diabetes is aimed at reducing atherosclerotic events via aggressive risk factor management, and providing symptom relief. In addition to strict hypertension and lipid management, a consensus statement from the American Diabetes Association (ADA) recommends that patients with PAD and diabetes receive an anti-platelet agent to prevent atherosclerotic events; evidence suggests that clopidogrel is an effective antiplatelet agent in this population. Supervised exercise therapy and cilostazol may be helpful for the relief of symptomatic PAD. TYPE OF AVAILABLE EVIDENCE: Review of the ADA consensus statement, prospective cohort studies, unstructured reviews, meta-analyses. GRADE OF AVAILABLE EVIDENCE: Poor to good. CONCLUSION: With aggressive risk factor modification and pharmacotherapy, patients with PAD and diabetes can expect a lower risk of both serious vascular events and limb amputation.

Original languageEnglish
Pages (from-to)459-467
Number of pages9
JournalAdvanced Studies in Medicine
Volume5
Issue number9
StatePublished - Oct 2005

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