Understanding Diabetes and Peripheral Artery Disease (PAD): A Complete Guide

Peripheral Artery Disease (PAD) is a circulatory condition in which narrowed arteries reduce blood flow to the extremities, primarily the legs. This poor circulation is caused by atherosclerosis, a buildup of fatty deposits on the artery walls.

In diabetics, PAD progresses more rapidly and often remains undiagnosed until complications arise. Reduced blood flow can lead to pain, non-healing wounds, and even tissue death or gangrene, making PAD a serious concern.

Studies indicate that PAD affects around 15–20% of diabetic patients in India, with rural areas being more impacted due to limited healthcare access.

Diabetes accelerates the development and progression of PAD through several mechanisms:

• Chronic High Blood Sugar: Elevated glucose levels damage the endothelial cells lining blood vessels, causing arterial stiffness and narrowing.
• Increased Plaque Formation: High blood sugar promotes the buildup of cholesterol and other debris in arteries, obstructing blood flow.
• Neuropathy and Delayed Detection: Diabetes-induced nerve damage (neuropathy) can mask PAD symptoms like pain, leading to delayed diagnosis and treatment.
• Reduced Healing Ability: Impaired circulation and immune function in diabetics make it harder for wounds to heal, worsening PAD outcomes.

According to the Journal of Clinical Diabetology, patients with diabetes are up to four times more likely to develop PAD compared to non-diabetics, highlighting the strong link between these two conditions.

PAD often presents subtly, making early recognition crucial:

• Leg Pain During Activity (Claudication): Pain or cramping in the calves, thighs, or hips during walking, which eases with rest.
• Numbness or Weakness: Reduced sensation in the legs or feet.
• Cold or Pale Feet: Poor blood flow makes one foot colder or paler than the other.
• Slow-Healing Wounds: Cuts or ulcers on the legs or feet that take unusually long to heal.
• Changes in Skin Texture: Shiny, discolored skin and slower growth of nails or hair on the legs.

If any of these symptoms occur, seeking a vascular specialist is essential to prevent further complications.

Both diabetes and PAD share common risk factors, which amplify their combined impact:

• Smoking: Nicotine damages arterial walls and promotes plaque buildup.
• High Cholesterol and Hypertension: Common comorbidities in diabetics worsen arterial narrowing.
• Obesity: Excess weight increases inflammation and pressure on arteries.
• Sedentary Lifestyle: Lack of exercise weakens circulation, compounding the effects of diabetes and PAD.

When left untreated, PAD can result in severe, life-altering complications:

• Limb Ischemia: Critically reduced blood flow can cause gangrene, requiring amputation.
• Infections and Non-Healing Ulcers: Poor circulation hinders the immune system’s ability to fight infections. Some of these infections may spread rapidly.
• Increased Cardiovascular Risk: PAD often coexists with coronary artery disease, increasing the risk of heart attacks and strokes.

India has one of the highest rates of diabetes-related amputations, with studies showing that 85% of these begin as non-healing foot ulcers, underscoring the importance of early PAD management.

Managing diabetes and PAD requires more than just medication. Lifestyle changes play a pivotal role in improving vascular health:

• Adopt a Balanced Diet: Choose whole grains, lean proteins, healthy fats, and vegetables. Avoid processed sugars and trans fats, which contribute to arterial damage.
• Engage in Regular Physical Activity: Walking is particularly beneficial for PAD, as it helps improve blood flow and build collateral circulation.
• Quit Smoking: Smokers with PAD face significantly higher risks of amputation. Quitting is one of the most impactful changes you can make.
• Maintain Optimal Weight: Shedding extra pounds reduces arterial strain and improves overall vascular health.
• Control Blood Sugar Levels: Use medications as prescribed and monitor glucose regularly to prevent further vascular damage.

Simple lifestyle changes like walking 30 minutes a day and eating a healthy diet can drastically reduce complications associated with diabetes and PAD.

For diabetics, taking extra care of their feet is crucial to prevent PAD-related complications:

• Daily Foot Inspection: Look for cuts, blisters, or color changes and address them promptly.
• Proper Footwear: Avoid tight shoes and opt for cushioned, supportive footwear.
• Moisturize Carefully: Keep the skin hydrated, but avoid applying lotion between the toes to prevent fungal infections.
• Regular Vascular Check-ups: Routine visits to a vascular surgeon can help detect PAD early.