Diabetes and peripheral artery disease: A review

Abstract

Peripheral arterial disease (PAD) refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs. It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries. The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors. Nonhealing ulcers, limb amputation and physical disability are some of its major complications. Diabetes mellitus (DM) remains a major risk for PAD, with DM patients having more than two-fold increased prevalence of PAD compared with the general population. The clinical presentation in people with DM also differs slightly from that in the general population. In addition, PAD in DM may lead to diabetic foot ulcers (DFUs), which precipitate hyperglycaemic emergencies and result in increased hospital admissions, reduced quality of life, and mortality. Despite the epidemiological and clinical importance of PAD, it remains largely under diagnosed and hence undertreated, possibly because it is largely asymptomatic. Emphasis has been placed on neuropathy as a cause of DFUs, however PAD is equally important. This review examines the epidemiology, pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population. It also highlights recent innovations in the management of PAD.

Diabetes Mellitus and Its Impact on Patient-Profile and In-Hospital Outcomes in Peripheral Artery Disease

“…PAD is concerned with an elevated risk for cerebrovascular and coronary disease as well as mortality [ 3 ]. DM associated lower extremity complications concern approximately 131 million people worldwide with rising tendency [ 4 ]. Approximately 20–30% of patients with PAD suffer from diabetes mellitus (DM), which is the second most relevant risk factor for development of PAD after cigarette smoking [ 5 ].…”

“…Approximately 20–30% of patients with PAD suffer from diabetes mellitus (DM), which is the second most relevant risk factor for development of PAD after cigarette smoking [ 5 ]. On the other hand, diabetics are at more than doubled risk of developing PAD in contrast to the general population [ 4 ]. The prevalence of DM was shown to be even higher in PAD compared to patients with coronary artery disease [ 6 ].…”

Modest association between health literacy and risk for peripheral vascular disease in patients with type 2 diabetes

“…Peripheral vascular disease can cause lower limb amputation or mortality, especially in people with T2DM, due to the risk factors for DM—hypertension, smoking, and hyperlipidemia—along with other traditional risks, such as age or low kidney function ( 31 , 32 ). At-risk indicators include an older patient cohort, diabetes duration of longer than 10 years, high HbA1c, obesity, and neuropathy ( 33 ).…”

Advances for the treatment of lower extremity arterial disease associated with diabetes mellitus

“…Although the pathogenesis of diabetic LEAD is still not fully clarified, it is believed that the key factor contributing to LEAD is atherosclerosis. The hallmark of atherosclerosis is endothelial dysfunction, which is caused by multiple interrelated risk factors, such as the overproduction of advanced glycation end products (AGEs), excessive oxidative stress and inflammation ( Soyoye et al, 2021 ). Besides, the migration of low-density lipoprotein cholesterol (LDL-C) to the intima is a precursor of atherosclerosis ( Suzuki et al, 2001 ; Taniwaki et al, 2001 ; Yang et al, 2017 ).…”