Running head: RELATIONSHIP BETWEEN DIABETES AND PERIPHERAL ARTERIAL DISEASE 1
Relationship between Diabetes and Peripheral Arterial Disease
RELATIONSHIP BETWEEN DIABETES AND PERIPHERAL ARTERIAL DISEASE 2
The purpose of this proposal is to determine the relationship between uncontrolled diabetes mellitus (DM) and the development of peripheral arterial disease (PAD) in patients who are >60 years old in Macon, Georgia.
With the ongoing rise of the diagnosis of diabetes in the American population, the prevalence of PAD is also rising in these same patients. As noted by the ...view middle of the document...
In a study by Jude, Eleftheriadou, and Tentolouris (2010), typical symptoms of PAD include
ongoing pain in the leg(s) (unilateral or bilateral), intermittent claudication (pain or cramping
of the hips, thighs, buttocks, or calf with activity), and loss of sensation and mobility in the
legs. But, it is noted that up to 75% of patients with PAD have none of the listed symptoms.
Other signs of PAD may include wasting of the leg muscles, loss of hair on the extremities, skin
that is cool to touch, glossy skin, inability to palpate pulses in the ankles and/or feet, and
inability of sores or ulcers to heal properly, leading to gangrene. Approximately 40-60% of
diabetic patients with foot ulcers have PAD, which leads to a higher rate of amputation and
death. After diagnosis of PAD, the aim is to begin a treatment regimen to promote symptom
relief and avoid further injury and death. The first step is lifestyle changes,
which include dietary adjustments, promoting smoking cessation, encouraging weight
reduction, beginning or increasing lipid management, increasing physical activity, and
optimizing blood pressure control.
In a different study by Hinchliffe et al. (2012), patients whose PAD did not respond to
lifestyle changes, a first line opportunity of vascular angioplasty was offered to improve
arterial blood flow to the distal leg and foot. Following this endovascular revascularization, the
percentage of 1-year limb salvage was 70.5-85.5%. Some patients, either with ongoing non-
RELATIONSHIP BETWEEN DIABETES AND PERIPHERAL ARTERIAL DISEASE 4
healing ulcers or those for whom angioplasty was not a feasible option, chose open surgery
resulting in a bypass procedure to improve arterial blood flow to the distal leg and foot.
Patients requiring open surgery had a 1-year limb salvage rate success of 80-90%.
In a study done by Premanath and Raghunath (2010), the usual approach to diagnosing
PAD, in the outpatient setting, is in the physician office, using a doppler probe and blood
pressure cuff to calculate an ankle brachial index (ABI), which is considered the “gold standard
measurement.” But often, the diagnosis of PAD is neglected by the primary care physician at
routine medical visits, due to lack of equipment, time needed to perform the test, or lack of
staff training needed to accurately perform the test. PAD symptoms are discussed with only
37% of patients, peripheral pulses are felt in <60% of patients, and ABI measurements
performed in <8% of patients.
A study conducted by Smith (2012), showed that PAD happens primarily in older adults
and worsens with age. Diabetes and uncontrolled glucoses are believed to be powerful
factors in the advancement of PAD. Patients with diagnosed PAD and diabetes are more