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.

Keywords: Diabetes; Diabetic foot ulcers; Lower limb complications; Peripheral arterial disease.

Figure 1

Schematic representation of the pathophysiology of peripheral arterial disease in diabetes mellitus. Pathogenetic processes and their mechanisms are shown in black and white type, respectively. AGEs: Advanced glycation end products; DM: Diabetes mellitus; NO: Nitric oxide; PAD: Peripheral arterial disease; PAI-1: Plasminogen activator inhibitor-1; ROS: Reactive oxygen species; TGF-β: Transforming growth factor-beta; VSMC: Vascular smooth muscle cell.