The Connection Between Diabetes and Peripheral Artery Disease

Diabetes and peripheral artery disease (PAD) are conditions that impact blood vessels and circulation. The high blood sugar levels caused by diabetes damage blood vessels over time, leading to reduced blood flow. This damage then increases the risk of developing PAD. To prevent severe complications from PAD, early detection and management are particularly important for individuals with diabetes.

Diabetes and peripheral artery disease affect millions of people worldwide. While they are often discussed separately, the connection between diabetes and PAD is significant, and for those with diabetes, their increased risk of developing PAD makes it important to understand the link and prevent severe or even life-threatening complications.

Statistics clearly demonstrate the increased risk of peripheral artery disease among individuals with diabetes. PAD is significantly more prevalent in people with diabetes compared to those without diabetes, occurring in 20% to 50% of those with diabetes, compared with 10% to 26% of those without. When comparing blood sugar levels, studies have found that for each 1% increase in A1c levels, there was a 28% increase in developing PAD.

CardioVascular Health Clinic leads the country in innovative new treatments for cardiovascular diseases and conditions like PAD. By combining the most advanced modalities for minimizing symptoms with a comprehensive, whole-person approach to care, our multidisciplinary team of national-caliber physicians, interventional radiologists, and cardiovascular specialists can provide integrative PAD and diabetes management options that lower the risk of complications and limb amputation, improve quality of life, and deliver superior outcomes in cardiovascular and overall health.

The Connection Between Diabetes and PAD

Diabetes is a chronic condition that develops when you don’t have enough insulin, or your body doesn’t properly use the insulin you have, leading to high blood sugar levels. 

Globally, over 10% of the adult population has diabetes, which can cause severe health issues like heart disease, kidney failure, and nerve damage. Common symptoms include blurred vision, frequent urination, excessive hunger or thirst, and fatigue. To prevent complications, diabetes must be managed through medication, lifestyle changes, and regular monitoring.

Peripheral artery disease (PAD) is a circulatory condition in which narrowed or blocked arteries reduce the blood flow to the limbs, most often the legs. This narrowing is usually because of a buildup of fatty deposits on the artery walls.PAD affects 5% to 7% of adults worldwide and is more common among older adults, especially those with risk factors such as smoking, high blood pressure, and diabetes. Symptoms include leg pain while walking, numbness, and coldness in the lower extremities. If left untreated, PAD can lead to severe complications like ulcers, infections, and limb amputation.

Diabetes contributes to the development of peripheral artery disease through the effects of high blood sugar levels on blood vessels. 

Chronic, untreated hyperglycemia (high blood sugar levels) that can result from diabetes leads to inflammation and plaque buildup on artery walls, restricting blood flow. Additionally, insulin resistance exacerbates these issues by causing vascular stiffness and narrowing.

The combination of these factors results in reduced blood flow to the limbs and raises the risk of developing PAD. This is why, for those with diabetes, managing blood sugar levels is critical to mitigating their risk and preventing peripheral artery disease from getting worse.

Shared Risk Factors Between Diabetes and PAD

In addition to frequently occurring together as comorbidities, diabetes and peripheral artery disease also share several common risk factors, including:

• Obesity, which promotes inflammation and insulin resistance, increasing the likelihood of both conditions.
• High blood pressure, which contributes to arterial damage and atherosclerosis, worsening both diabetes and PAD.
• High cholesterol. This leads to plaque buildup in arteries and exacerbates both conditions.
• Smoking, which impairs blood vessel function and accelerates the progression of vascular diseases, increasing the risk of both diabetes and PAD.

4 Signs of PAD in Diabetic Patients

There are some notable differences in how peripheral artery disease presents in diabetic patients as compared to non-diabetic patients. This is because diabetes can cause peripheral neuropathy, which is a numbness or tingling in different parts of the body, especially in the feet or hands. When neuropathy is present, you may be less likely to feel the symptoms of PAD and it can make symptom recognition more challenging in diabetic patients. Proactive screening for peripheral artery disease is essential, particularly in diabetic individuals, even when they don’t present classic PAD symptoms, as is being aware of the most common signs of PAD in diabetic patients.

1. Leg Pain

Leg pain is a common symptom of PAD. For those without diabetes, pain, cramping, or aching in the calves, thighs, or buttocks is often felt while walking and is relieved with rest.

However, patients with diabetes may have more subtle symptoms due to peripheral neuropathy, which can mask pain signals. They may walk more slowly and experience leg fatigue but attribute these symptoms to aging rather than PAD.

2. Coldness in the limbs

Your feet or lower legs may feel colder than other parts of the body from peripheral artery disease. For people with diabetes, neuropathy may interfere with these sensations, and they are less likely to notice or report this PAD symptom.

3. Numbness

Diabetic patients with PAD are more likely to experience numbness in their legs and feet compared to non-diabetics with PAD. This is due to the compounding effect of diabetic neuropathy, which disrupts and distorts nerve signals and leads to reduced sensation.

4. Foot Ulcers and Gangrene

People with diabetes are more likely to present with advanced stages of PAD, such as ischemic ulcers or gangrene, as compared to PAD patients without diabetes. High blood sugar levels interfere with the body’s ability to heal and may lead to wounds that heal slowly or not at all and become infected. Neuropathy compounds this because the individual cannot feel the injury or ulcer until it has advanced and may be severely infected or gangrenous.

Additionally, patients with both diabetes and PAD have a four times higher risk of amputation due to complications from slow-healing ulcers and gangrene.

Treating and Managing PAD and Diabetes

Early detection and management of peripheral artery disease in diabetic patients are crucial for preventing severe complications and improving overall health outcomes. By addressing the underlying risk factors and symptoms promptly, individuals can greatly improve their quality of life and preserve their overall health.

Most treatment plans for managing PAD and diabetes on their own include lifestyle changes–such as adopting a healthy diet, increasing physical activity, and eliminating smoking or tobacco use–as well as medication for controlling symptoms, regulating blood sugar levels and blood pressure, and preventing complications. Proper foot care is also important to prevent infections and ulcers, and if PAD progresses unchecked, surgical interventions such as angioplasty, stenting, or bypass surgery may be needed to restore blood flow to the limbs.

However, there are additional considerations for patients who have both diabetes and PAD.

Treating peripheral artery disease in diabetic patients often requires adjustments to standard treatment protocols. Because of the complexities in managing both conditions, healthcare providers must consider the link between blood sugar control and vascular health. Medications may need to be tailored to prevent side effects that could worsen either condition. For instance, certain blood sugar-lowering medications might influence blood pressure or cholesterol levels, requiring a careful balance in treatment plans.

Diabetic patients with PAD must be as vigilant in managing their PAD as they are with their diabetes, including recognizing PAD symptoms before they worsen, practicing self-care, and receiving regular checkups, monitoring, and adjustments in medications or treatment to identify early signs of complication.  

Trust CardioVascular Health Clinic for Comprehensive PAD Treatment and Management

Understanding and managing these two conditions through lifestyle changes, medical treatments, and preventive measures are the keys to maintaining good health and quality of life. For patients with diabetes, the risk of developing peripheral artery disease is significant, and for patients with PAD and diabetes, the importance of interdisciplinary care cannot be overstated. Involving cardiologists, endocrinologists, and vascular specialists in your  overall care provides a complete approach to managing the challenges of PAD and diabetes. 

Regular screening and monitoring can provide early detection of the subtle symptoms of PAD and help slow its progression, while regular communication and coordinated care among specialists leads to personalized treatment and strategies that address all aspects of your health leading to better outcomes and improved quality of life.

At CardioVascular Health Clinic, we specialize in conditions like PAD and in innovative PAD treatments that focus on limb salvage and amputation prevention. We’re Oklahoma’s only endovascular specialist who routinely treats the small arteries within the feet and below the knees, and our multidisciplinary team includes physicians, interventional radiologists, and cardiovascular specialists who work together to provide the high standard of integrative, comprehensive care patients deserve for optimal health. Contact us today to schedule a consultation.