Introduction

Diabetes significantly raises the risk of Peripheral Arterial Disease (PAD), a serious condition that restricts blood flow to the limbs, particularly the legs. Individuals with diabetes are two to three times more likely to develop PAD than the general population. PAD in people with diabetes may lead to non-healing diabetic foot ulcers (DFUs), resulting in increased hospital admissions, reduced quality of life, lower limb amputation, and even mortality. Understanding the link between diabetes and PAD can help in taking preventive steps and recognizing symptoms early, potentially reducing the risk of severe complications.

How Diabetes Impacts Blood Vessels and Increases Peripheral Arterial Disease Risk

Diabetes can cause long-term damage to blood vessels throughout the body. When blood sugar is not well-managed, it contributes to plaque buildup inside the arteries, a condition known as atherosclerosis. Over time, this plaque hardens and narrows the arteries, restricting blood flow to the legs, arms, and other areas. Reduced blood flow affects not only limb function but also overall health, such as that of the heart and brain, as tissues in the body rely on a steady supply of oxygen-rich blood.
For people with diabetes, the likelihood of developing PAD is two to four times higher than for those without diabetes. Diabetes can also lead to other cardiovascular issues, making it essential to monitor blood sugar, blood pressure, and cholesterol levels regularly. Consistent management of these factors can improve circulation and help reduce the risk of developing PAD.

Atherosclerosis- Plaque Built Up in an Artery

Recognizing Early Warning Signs of Peripheral Arterial Disease

Early detection of PAD in people with diabetes can make a significant difference in treatment outcomes. Recognizing the symptoms early on enables prompt medical care. Here are some common signs and symptoms of PAD in individuals with diabetes:

• Leg Pain During Activity (Claudication)

One of the most common symptoms of PAD is pain, cramping, or discomfort in the legs during physical activities, such as walking or climbing stairs. This pain, known as claudication, usually disappears with rest but returns with activity. It occurs because restricted blood flow cannot meet the muscles’ oxygen needs during movement, leading to pain. Claudication may start mildly, but as PAD progresses, the pain may become more intense or even occur at rest.

• Numbness or Weakness in the Legs

Many people with PAD experience a sensation of weakness or numbness in their legs, especially after periods of activity. Reduced blood flow causes the legs to feel heavy, weak, or unresponsive. This numbness may occur in one or both legs and can disrupt daily activities, making it challenging to maintain an active lifestyle.

• Cold Feet or Legs, Especially on One Side

When one foot or leg consistently feels colder than the other, it can be a sign of PAD. This temperature difference occurs because poor blood flow reduces warmth in the affected limb. Even in warm environments, you may notice one leg or foot is cooler to the touch. If you experience this regularly, it’s worth discussing with a healthcare provider, as coldness in the legs is often a strong indicator of PAD.

• Slow-Healing Wounds or Sores on Feet and Legs

Reduced circulation due to PAD slows the body’s ability to heal wounds, leading to sores or cuts that heal very slowly or do not heal at all. These non-healing wounds are at risk of infection, which can become severe if left untreated. For people with diabetes, monitoring the feet and legs for any cuts, blisters, or wounds that don’t heal is crucial. Early intervention can prevent infections and improve recovery.

• Skin Changes, Including Discolouration and Texture Differences

PAD often causes visible changes in the skin of the legs or feet. You may notice shiny, smooth skin or a bluish or purplish tint in areas with poor blood flow. Some people also observe that their skin becomes pale when the leg is elevated, returning to a reddish colour when lowered. These changes in colour and texture are important to monitor, as they can indicate poor circulation in the affected areas.

Why People with Diabetes Face a Higher Risk of Developing Peripheral Arterial Disease

Diabetes increases the risk of Peripheral Arterial Disease (PAD) primarily due to its impact on blood sugar levels. Persistently high blood sugar can damage artery walls, leading to the formation of fatty deposits that build up as plaque. This buildup narrows the arteries, restricting blood flow. Over time, this widespread damage makes people with diabetes more vulnerable to PAD and other cardiovascular diseases.
Diabetes is a major risk factor for PAD, along with smoking, high blood pressure, and high cholesterol. These additional risk factors, combined with diabetes, can accelerate plaque formation in the arteries, further raising PAD risk. Lifestyle changes, medications, and regular monitoring can help control these risk factors, reducing the likelihood of developing PAD and its related complications.

The Importance of Early Detection and Management of Peripheral Arterial Disease in Diabetes

Early detection of PAD is critical for individuals with diabetes, as it can prevent severe health consequences such as infections, ulcers, and, in advanced cases, amputation. Regular screenings and check-ups are essential for those at risk. Your healthcare provider may perform an Ankle-Brachial Index (ABI) test, which compares blood pressure in the ankles with blood pressure in the arms. This non-invasive test can help detect PAD early, even before symptoms appear.

An ultrasound scan is typically the first imaging method used to detect the location and severity of an artery blockage. In some cases, computed tomography (CT) and magnetic resonance angiography (MRA) may be recommended.

If PAD is diagnosed, your doctor may suggest lifestyle changes, medication, or procedures to improve blood flow. Treatments may include cholesterol-lowering drugs, blood pressure management, and exercise therapy, all aimed at enhancing circulation. In some cases, a procedure to open up narrowed arteries may be recommended to restore blood flow.

Preventive Measures to Reduce Peripheral Arterial Disease (PAD) Risk for People with Diabetes

Taking proactive steps to reduce PAD risk is essential for individuals with diabetes. By focusing on these key lifestyle habits, you can protect your vascular health and lower the chances of developing PAD:

• Control Blood Sugar Levels

Keeping blood sugar within a healthy range helps protect blood vessels from damage, reducing plaque buildup and the risk of PAD.

• Exercise Regularly

Regular physical activity improves circulation, strengthens the cardiovascular system, and helps lower blood pressure, all of which reduce PAD risk. Aim for activities that promote leg movement, such as walking, swimming, or cycling.

• Quit Smoking

Smoking significantly narrows blood vessels and contributes to PAD progression. Quitting smoking can reduce PAD symptoms and improve overall vascular health.

• Monitor Blood Pressure and Cholesterol

High blood pressure and elevated cholesterol are major risk factors for PAD. Regularly monitoring these levels and taking prescribed medications can help manage these risks effectively.

• Blood Thinners (Antiplatelet Therapy)

If you have PAD symptoms, a blood thinner (antiplatelet medication) may be recommended, as it has been shown to reduce mortality, heart attacks, and strokes in this population.
By adopting these preventive measures, individuals with diabetes can protect their vascular health, reduce the risk of developing PAD, and improve their overall quality of life.

Treatment to Restore Blood Flow

A procedure to restore blood flow, known as revascularization, may be indicated if claudication (leg pain due to PAD) impairs quality of life or if a wound on the leg or foot fails to heal. Revascularization often involves opening blocked blood vessels through balloon angioplasty or stenting or bypassing the blockage through open surgical bypass. This treatment helps ensure that tissues receive the oxygen-rich blood they need to function properly.

Balloon Angioplasty of a Narrowed Artery

Stenting of a Narrowed or Blocked Artery

Angiography images- Before and After Angioplasty

  Open Surgical Bypass for a Blocked Artery in the Leg

Taking Control of Your Health with Knowledge and Prevention

Understanding the connection between Diabetes and Peripheral Arterial Disease (PAD) empowers you to take proactive steps for your health. Regular check-ups, effective diabetes management, and healthy lifestyle choices can all reduce your risk of PAD and support strong vascular health. Talk to your healthcare provider about PAD screenings and share any symptoms you notice. Acting early can make a significant difference in preserving your health and well-being over the long term.