Newman Medical News

PAD and Diabetes: Understanding the Correlation

Risk Factors for Type 2 Diabetes and PAD

Both PAD and diabetes are growing global problems linked strongly to one another. Diabetes is a vascular disease caused by the body’s inability to produce enough insulin, which the body needs to break down sugar as too much sugar in the bloodstream can cause serious damage to the body. The damage that a high blood sugar count causes to the body and organs can also generate many other health complications over time.

Diabetes affects the lining around the cells in the blood vessels which makes the vessels less flexible, impeding a smooth blood flow.  When the blood flow is impacted this way, the risk of additional complications, such as PAD, or peripheral arterial disease, go way up. PAD is a serious complication that often develops in people with Type 2 diabetes.

PAD develops when plaque consisting of fatty substances, cholesterol, and other deposits builds up on the walls of blood vessels, causing them to narrow. Even though it’s extremely prevalent in diabetics, this vascular disease also commonly affects people who also tend to have other risk factors which include:

  • Smoking
  • Advanced age
  • High blood pressure
  • Family history of coronary artery disease
  • High cholesterol

Risk factors for developing type 2 diabetes are almost identical to the risk factors associated PAD, and include:

  • Obesity
  • Inactivity
  • Smoking
  • High blood pressure
  • High cholesterol
  • Family history of cardiovascular disease 

Peripheral Artery Disease Symptoms

While having both diabetes and PAD is a huge problem, the bigger problem is that many people with PAD don’t know they even have it because of the lack of signs and symptoms. About 20%-30% of people diagnosed with PAD have diabetes, but because the symptoms are almost non-existent, that number may be much higher. Even if there are a few noticeable signs, it is easy to overlook them an assume they are related to something else other than disease, such as aging.  Some of the biggest signs that PAD may be present include:

  • Pain in calves while walking or exercising, also known as claudication
  • Numbness and/or tingling in the legs or feet
  • Sores on the lower extremities that do not heal or heal very slowly 

The Link Between Diabetes and Peripheral Arterial Disease

The relationship between diabetes and PAD is complex, but the overall notion is that people with diabetes have a higher risk of atherosclerosis, or the buildup of plaque on the inner walls of blood vessels. Atherosclerosis is the most common cause of PAD, and because people with diabetes are more likely to develop atherosclerosis, they’re more likely to develop PAD as well. If a person has diabetes and another PAD risk factor, their risk of developing PAD increases significantly.

Diabetes and PAD: How Does One Affect the Other?

Having diabetes raises the risk for PAD, and having PAD raises the risk for diabetes. Even some of the common symptoms of each disease can increase the risk for the other. Some of the symptoms that occur include:

  • Inflammation – when inflammation is present, the levels of certain proteins go up in the body. These proteins show higher levels when PAD and diabetes are both present.
  • Changes in cells – diabetes reduces the flexibility of the lining around the cells in blood vessels, making it difficult for a healthy blood flow, which makes the risk of PAD go up.
  • Blood clots – the presence of diabetes causes blood platelets to clump together, speeding up the process that causes PAD.
  • Resistance to insulin – when diabetes is present, the body does not respond to insulin very well.  This throws off the balance of chemicals and other substances that come in and out of the cells that line the blood vessels, increasing the chance of PAD.

When PAD Is Left Undiagnosed

PAD can wreak havoc if it is goes on undiagnosed, including having a stroke, heart attack, leg amputation, and even death.  The added layer of diabetes makes it that much more important to find out if the disease is present so action can be taken. Diabetes and PAD working together can also increase the chances of lower extremity wounds and sores that do not heal, further complicating the patient’s outcome.  The presence of both PAD and diabetes can hinder the ability to feel the pain of a foot wound and weaken the body’s ability to heal an ulcer, and high blood glucose levels can impede the ability to fight infection, leading to further damage and increasing the danger of amputation.

Diabetes and PAD: Finding and Managing Both Diseases

While all of this may seem ominous, the good news is that there is a path that can be taken, depending on the severity of both diseases, which can slow the progression and improve the outcome of each patient. The first step to improving each patient’s outcome begins with testing to see the extent of the disease’s severity.  As with most medical technology, PAD testing has been improved greatly over the years, making it very easy to assess whether a patient has the disease as well its progression. PAD testing can and SHOULD take place in most clinics, including primary care and point-of-care facilities.

Every patient who has a potential risk factor for developing PAD should be screened often, even if symptoms are not present. The tests are performed using an ABI machine, or Ankle Brachial Index machine, which measures the flow of blood in the legs compared to the flow of blood in the arms. ABI machines can do everything from a 5-minute rapid screen for basic PAD detection to advanced multi-segmental tests which are more in-depth tests that show where the disease is in the legs, as well as the progression.  If PAD is detected early and immediate intervention mitigates the progression, this not only saves the healthcare system a lot of potential costs down the road, but it also minimizes the patient’s costs, as well as preventing amputation or even death.  PAD testing by physicians is encouraged through reimbursement of the tests.  Even basic tests are reimbursed which means that after only a few tests the ABI system will pay for itself.

Once the disease is assessed, a plan can be formulated to help the patient and slow the progression. A major threat to patients that have diabetes and PAD is a cardiac event. Therefore the primary goal of therapy for patients who have both diseases is to modify the atherosclerotic risk factors.  This can be done through lifestyle changes, medication therapy, and exercise programs.  In some cases, surgery may take place when lifestyle changes, exercise and medication will not work on their own.

Both PAD and diabetes are growing global problems; PAD is heavily influenced by the presence of diabetes.  A heightened awareness of the complications and symptoms of PAD and diabetes will encourage earlier detection and aggressive treatment.  This will allow for better patient outcomes all together.

April 18, 2022 PAD