Guidelines address PAD management in patients with diabetes and foot ulcer

  • Hinchliffe RJ & al.
  • Diabetes Metab Res Rev
  • 20 Jan 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • New guidelines from the International Working Group on the Diabetic Foot address diagnosis and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes.

Why this matters

  • Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which raises morbidity risks.

Recommendations include:

  • Examine feet of all patients with diabetes annually for PAD, even without ulceration, via history and palpating foot pulses.
  • For those with foot ulcers, evaluate pedal Doppler arterial waveforms, ankle systolic pressure, systolic ankle-brachial index (ABI), or toe systolic pressure and toe-brachial index (TBI).
  • PAD is less likely with:
    • ABI 0.9-1.3,
    • TBI ≥0.75, and
    • Triphasic pedal Doppler waveforms.
  • Perform ≥1 of the following bedside tests in patients with diabetic foot ulcers and PAD, all of which increase pretest healing probability by ≥25%:
    • Skin perfusion pressure ≥40 mmHg,
    • Toe pressure ≥30 mmHg, or
    • Transcutaneous oxygen pressure (TcPO2) ≥25 mmHg.
  • Consider urgent vascular imaging and revascularization in patients with foot ulcer and:
    • Ankle pressure
    • ABI
    • Toe pressure
    • TcPO2
  • Provide intensive cardiovascular risk management, including smoking cessation support, and treatment of hypertension, hyperglycemia, dyslipidemia, and use of low-dose clopidogrel or aspirin.