ADA recommends that most people with diabetes should be screened for peripheral arterial disease.
People with diabetes are at elevated risk for atherosclerosis -- the buildup of plaques (fatty deposits) in artery walls. Atherosclerosis in the coronary and carotid arteries causes most heart attacks and strokes. But these plaques can also develop in the arteries of the legs and cause a condition called peripheral arterial disease (PAD).
Close to 30% of people over age 50 with diabetes have peripheral arterial disease, and people with peripheral arterial disease are at increased risk for heart attacks, strokes, limb loss, and death. As a result, the American Diabetes Association (ADA) now recommends that all people over age 50 with diabetes undergo screening for peripheral arterial disease.
The most common symptom of peripheral arterial disease is painful cramping in the calves, thighs, or buttocks that occurs while walking and subsides promptly with rest. Because the pain tends to come and go, it is referred to as intermittent claudication (from the Latin word claudicatio, meaning limping or lameness). It occurs when plaque buildup reduces blood flow to the legs. As plaques grow and further block blood flow, patients may experience pain at rest as well as leg ulcers and tissue death that may require amputation of a portion of the limb. But many people with diabetes and peripheral arterial disease have no symptoms at all or experience only mild symptoms such as leg fatigue or slowed walking speed.
Who should be screened for peripheral arterial disease? The American Diabetes Association recommends that all people with diabetes over age 50 be screened for peripheral arterial disease with a test called an anklebrachial index (ABI).
How is peripheral arterial disease treated? Smoking cessation is the most important step in reducing the symptoms of peripheral arterial disease and in preventing limb loss. It is also important to prevent heart attacks and strokes associated with atherosclerosis. Keeping blood pressure, blood cholesterol, and blood glucose under control also can be helpful. In addition, antiplatelet drugs, such as aspirin or clopidogrel (Plavix), may be given to reduce the risk of blood clots. A structured exercise program -- walking a prescribed distance several times a week -- is often recommended to reduce the leg pain associated with intermittent claudication. In fact, most people with peripheral arterial disease can gradually increase their pain-free walking distance with regular moderate exercise.
Medications such as pentoxifylline (Trental) and cilostazol (Pletal) may also be prescribed to help relieve leg pain while walking. Patients with more severe disease may need a revascularization procedure, such as angioplasty or bypass surgery, to relieve the arterial blockage and ease symptoms. Angioplasty, which involves inflating a balloon at the site of the blockage, is usually used to treat small, localized blockages. Surgery to bypass the diseased segment of artery, using a vein from another part of the body or a synthetic blood vessel, is preferred for more widespread arterial disease.
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