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Diabetes Standards of Care & Clinical Practice Resources

Peripheral Arterial Disease

Peripheral arterial disease (PAD) is atherosclerosis of arteries to the head, organs, and limbs. PAD manifests most commonly in patients with diabetes as symptoms of leg claudication. If left untreated, PAD can progress to critical leg ischemia that can threaten limb viability. Moreover, PAD is a marker of systemic atherosclerosis, indicating patients are at increased risk for myocardial infarction (MI), stroke, and death. Risk factors associated with PAD include older age, cigarette smoking, diabetes, hyperlipidemia, hypertension, and possibly genetic factors.

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Peripheral Arterial Disease Sections

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Clinical Practice Recommendations

Recommendations for Peripheral Arterial Disease

  • Assist patients who smoke to quit. See the section on tobacco use.
  • Obtain a history of claudication symptoms and assess pedal pulses as part of routine diabetes care.
  • Obtain an Ankle-Brachial Index (ABI) in patients with diabetes:
    • Screen all patients with diabetes > 50 years of age.
    • In addition, consider a screening ABI in patients < 50 years of age who have ≥1 additional PAD risk factor, including smoking, hypertension, hyperlipidemia, or duration of diabetes >10 years.
    • Obtain a diagnostic ABI in any patient with suspected lower extremity (LE) PAD, including those with abnormal pulses, symptoms of claudication, or non-healing LE wounds.
    • ABI results are defined as follows: abnormal <0.9; normal range is 0.9-1.4.
  • Refer patients with either significant symptoms or an abnormal ABI for vascular evaluation.
  • Order one-time ultrasound screening for abdominal aortic aneurysm (AAA) in men aged 65 to 75 years who have ever smoked and in patients ≥ 65 years of age with a family history of AAA .