Peripheral Arterial Disease in People With Diabetes: Consensus Statement Recommends Screening

American Diabetes Association consensus statements, such as “Peripheral Arterial Disease in People with Diabetes” (reprinted in this issue starting on p. 181), are occasioned when clinicians need more specific guidance than is generally available and when evidence-based data remain insufficient for developing guidelines.

The concensus development panel for this statement was charged with addressing four issues around peripheral artery disease (PAD) and diabetes: 1) the epidemiology and impact, 2) the biology, 3) patient evaluation, and 4) best treatments. The consensus panel worked from an underlying assumption that PAD in people with diabetes is different from the vascular disease from other risk factors in its biology, in its clinical presentation, and in its management.

As far as the prevalence and impact, diabetes is the most powerful risk factor for PAD. Among those with diabetes, age, duration of diabetes, and the presence of neuropathy are particularly important as risk factors for the development of PAD.

With diabetes, there is usually a unique involvement of the tibial vessels below the knee. Because of the pattern of involvement distally, the majority of patients lack classic symptoms, such as claudication. In addition, there is an almost invariable association with neuropathy with blunted pain perception. Patients are therefore likely to experience more subtle symptoms than with classic claudication, for example, fatigue or poor functioning. A more devastating consequence of neuropathy is that PAD patients with diabetes present late, having already developed limb-threatening ischemia with tissue loss, gangrene, or rest pain. This unfortunate progression lends urgency to the task of uncovering PAD in asymptomatic individuals in order to …