Chapter 23. The Management of Peripheral Arterial Disease in Patients with Type 2 Diabetes

  1. William H. Herman3,
  2. Ann Louise Kinmonth4,
  3. Nicholas J. Wareham5 and
  4. Rhys Williams6
  1. Sydney A. Westphal1 and
  2. Pasquale J. Palumbo2

Published Online: 12 JAN 2010

DOI: 10.1002/9780470682807.ch23

The Evidence Base for Diabetes Care, Second Edition

The Evidence Base for Diabetes Care, Second Edition

How to Cite

Westphal, S. A. and Palumbo, P. J. (2010) The Management of Peripheral Arterial Disease in Patients with Type 2 Diabetes, in The Evidence Base for Diabetes Care, Second Edition (eds W. H. Herman, A. L. Kinmonth, N. J. Wareham and R. Williams), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470682807.ch23

Editor Information

  1. 3

    Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA

  2. 4

    General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

  3. 5

    MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK

  4. 6

    School of Medicine, Swansea University, Swansea, UK

Author Information

  1. 1

    Department of Medicine, Maricopa Medical Center, Phoenix, AZ, USA

  2. 2

    Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA

Publication History

  1. Published Online: 12 JAN 2010
  2. Published Print: 19 FEB 2010

ISBN Information

Print ISBN: 9780470032749

Online ISBN: 9780470682807



  • type 2 diabetes;
  • peripheral arterial disease;
  • atherosclerosis;
  • cardiovascular disease


Patients who have peripheral arterial disease (PAD) are at risk for developing symptomatic disease in their lower extremities that can threaten their ability to ambulate because of intermittent claudication or put them at risk for an amputation because of the development of critical leg ischaemia or wound complications. Even more worrisome is that patients with PAD commonly have coexisting cardiovascular disease, and this is the cause of death in most. The combination of diabetes and PAD magnifies these problems. Patients with type 2 diabetes and PAD are at much higher risk for morbidity and mortality from both lower extremity complications and cardiovascular disease compared with those with only PAD. For these high-risk patients with type 2 diabetes and PAD, the primary treatment should be aimed at preventing cardiovascular events from occurring. This includes addressing smoking cessation, lipid management, blood pressure control and antiplatelet therapy. Some of these measures may also favourably affect atherogenesis in the lower extremity. In addition, there are some limited options for treating the symptoms of intermittent claudication. For patients with diabetes whose disease requires surgical bypass, it appears that bypass surgery of the lower limbs is an effective option