Which diabetics are at risk for lower-extremity problems and what preventive measures can be taken?

Diabetes mellitus is a well-known risk factor for development and progression of peripheral arterial disease. Prospective cardiovascular clinical trials have also clearly demonstrated that diabetics fare worse than their nondiabetic counterparts. Diabetics also differ from nondiabetics in that multiple revascularization procedures may be required in order for the clinical outcome to be equivalent to that of a nondiabetic patient. However, by advocating an aggressive approach to peripheral arterial disease, good results in survival and limb salvage can be achieved in diabetic patients despite the presence of increased medical comorbidities. Key to the management of such patients will be identifying which diabetic patients will be at most risk so that preventive measures can be undertaken.