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Peripheral Arterial Disease in People With Diabetes

The first 300 words of the full text of this article appear below.

	Introduction

 
Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities. While PAD is a major risk factor for lower-extremity amputation, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease. Although much is known regarding PAD in the general population, the assessment and management of PAD in those with diabetes is less clear and poses some special issues. At present, there are no established guidelines regarding the care of patients with both diabetes and PAD.

On the 7-8 of May 2003, a Consensus Development Conference was held to review the current knowledge regarding PAD in diabetes. After a series of lectures by experts in the field of endocrinology, cardiology, vascular surgery, orthopedic surgery, podiatry, and nursing, a vascular medicine panel was asked to answer the following questions:

1. What is the epidemiology and impact of PAD in people with diabetes?
   
2. Is the biology of PAD different in people with diabetes?
   
3. How is PAD in diabetes best diagnosed and evaluated?
   
4. What are the appropriate treatments for PAD in people with diabetes?
   

	1) WHAT IS THE EPIDEMIOLOGY AND IMPACT OF PERIPHERAL ARTERIAL DISEASE IN PEOPLE WITH DIABETES?

 
PAD is a manifestation of atherosclerosis characterized by atherosclerotic occlusive disease of the lower extremities and is a marker for atherothrombotic disease in other vascular beds. PAD affects 12 million people in the U.S.; it is uncertain how many of those have diabetes. Data from the Framingham Heart Study¹ revealed that 20% of symptomatic patients with PAD had diabetes, but this probably greatly underestimates the prevalence, given that many more people with PAD are asymptomatic rather than symptomatic. As well, it has been reported that of those with PAD, over one-half are asymptomatic or have atypical symptoms, about one-third have claudication, and the remainder have more severe forms of the disease.²

The most common symptom of PAD is intermittent claudication, defined . . . [Full Text of this Article]

Impact of PAD
Diagnosis of PAD

	2) IS THE BIOLOGY OF PAD DIFFERENT IN PEOPLE WITH DIABETES?

 
Diabetes, inflammation, and risk for PAD
Diabetes and endothelial cell dysfunction
Diabetes and the VSMC
Diabetes and the platelet
Diabetes, coagulation, and rheology

	3) HOW IS PAD IN DIABETES BEST DIAGNOSED AND EVALUATED?

 
Clinical evaluation: history and physical
Noninvasive evaluation for PAD: ABI
Vascular lab evaluation: segmental pressures and pulse volume recordings
Treadmill functional testing
Additional evaluation
Anatomic studies: duplex sonography, magnetic resonance angiogram, and contrast angiography

	4) WHAT ARE THE APPROPRIATE MEDICAL TREATMENTS FOR PAD IN PEOPLE WITH DIABETES?

 
Treatment of systemic atherosclerosis associated with PAD
Treatment of symptomatic PAD
Treatment of infection
Indications for revascularization

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