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NICE issues new recommendations for diagnosis of PAD in patients with diabetes

National Institute for Health and Care Excellence (NICE) has updated the guidance on diagnosis and management of peripheral arterial disease (PAD). The updated guidance now includes 2 new recommendations on diagnosing PAD in individuals with diabetes.

A new recommendation asks clinicians not to exclude a diagnosis of PAD in individuals with diabetes exclusively based on a normal or raised ankle brachial pressure index. Although evidence shows that Doppler ankle brachial pressure index under an agreed cut-off improves the probability of PAD diagnosis, this may not be applicable to those with diabetes as they are likely to have a normal or raised index resulting from hardened arteries.

Another recommendation advises clinicians to avoid the use of pulse oximetry for diagnosing PAD in individuals with diabetes. The recommendation was made based on the lack of evidence supporting the utility of pulse oximetry in PAD diagnosis. The appraisal committee also highlighted that absence of an established universal cut-off point could cause variation in interpretation of results.

NICE has emphasised the importance of PAD diagnosis in patients with diabetes, as they tend to have an increased risk for cardiovascular events and foot problems including diabetic neuropathy, foot ulcers, and limb loss.


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