Diabetes & Peripheral Artery Disease

Peripheral artery disease (PAD) is a common comorbidity in diabetics. According to the World Health Organization 2004 report, there will be a total of nearly 366 million people with diabetes by 2030, thus making it necessary to understand and evaluate the presence of PAD and critical limb ischemia. While atherosclerotic plaques do not differ histologically between diabetic and nondiabetic individuals, the clinical features differ in anatomical localization, spread, calcification extent, and severity. Smoking, age, hypertension, and lack of glycemic control are reported positive risk factors, whereas HDL and apolipoprotein A-1 exert protective effects. Foot examination correlates poorly to the diagnosis of PAD, whereas the ankle-brachial index measurement is considered the most accurate noninvasive diagnostic method when evaluating PAD. The coexistence of significant neuropathy and arterial calcifications are primary determinants for underdiagnosing PAD. Pharmacological management includes antiplatelet therapy of aspirin or the use of clopidogrel for those individuals who are sensitive to aspirin. Patients who have had bypass surgery or cardiac stent placement require dual antiplatelet therapy per ACC/AHA guidelines. Treatment with beta-blockers and ACE inhibitors is appropriate pharmacotherapy to treat PAD. Other FDA-approved medications such as Cilostazol and Pentoxifylline are also used in the treatment of pain associated with intermittent claudication.

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