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Diabetes & PAD Risk

What is diabetes?

Diabetes is a serious, lifelong condition in which the body cannot properly control the level of sugar in the blood. Insulin is a hormone that regulates sugar ( glucose) levels in the blood. In women with diabetes, the body does not make enough insulin or cannot use insulin as well as it should.

During digestion, carbohydrates from food are broken down into sugar, which is then absorbed into the bloodstream. In response to this absorption, the pancreas secretes insulin, allowing sugar to be absorbed from the blood into cells and tissues. Cells and tissues then use the sugar for energy. When you have diabetes, sugar builds up in your blood instead of being used for energy.

Women with diabetes have an increased risk of developing Peripheral Artery Disease. Diabetes also puts you at risk for heart disease, stroke, and kidney, nerve, and eye damage. The good news is that proper treatment and lifestyle changes can drastically reduce the risk of future problems, including PAD, in women with diabetes.

See also:

Diabetes & Vein Disease Risk
Diabetes and Heart Risk
Diabetes and Stroke Risk
What are the different types of diabetes?
Diabetes Testing & Blood Sugar Numbers

How is diabetes related to PAD?

The excess sugar in the blood of women with diabetes damages the blood vessel walls, making them thicker and less elastic. These changes contribute to atherosclerosis (hardening of the arteries)—the buildup of fatty plaque on the walls of the arteries that can cause PAD in the legs, carotid artery disease, heart disease, and stroke. As the arteries become progressively more damaged, it is more difficult for blood to flow through them. This can also lead to high blood pressure, a major risk factor for PAD.

Stiff and narrowed arteries reduce the flow of blood and oxygen to muscles and organs. In women with PAD in the legs, the leg muscles may not be able to get enough blood, causing leg pain that occurs during exercise (when the muscle needs more oxygen) but goes away at rest. This is known as intermittent claudication, one of the major symptoms of PAD.

How does diabetes affect my PAD risk?

Along with smoking, diabetes is one of the strongest risk factors for PAD. As many as one in three diabetic women and men older than 50 also have PAD.1 PAD is up to 4 times as common in women with diabetes compared with non-diabetic women.2-5 The longer you have had diabetes, the more likely you are to develop PAD.6

In addition to increasing PAD risk, women with diabetes tend to have worse leg function than non-diabetic women,7 and have more severe disease by the time they are diagnosed compared with non-diabetic PAD patients.8

Women with diabetes tend to develop PAD earlier than women who do not have diabetes. They also tend to have a higher body mass index (BMI) and have more other heart and blood vessel problems than PAD patients without diabetes.7 This may be because the process of atherosclerosis starts earlier and progresses more quickly in women with diabetes.

Diabetes can also cause problems that make PAD symptoms more difficult to recognize. Diabetes often causes nerve problems in the legs or feet (peripheral neuropathy) that blunt pain signals, making the symptoms of PAD harder to detect. For this reason, it is especially important that women with diabetes get regular testing with an Ankle-Brachial Index test to identify PAD early so it can be properly treated.

See also: Should I be tested for PAD?

Who should be tested for diabetes and PAD?

Everyone 45 years or older should be tested for diabetes. If you are younger than 45, you should be tested if you are overweight and have one or more risk factors for diabetes, especially high blood pressure or high cholesterol. If your test results are normal, you should be tested again every 3 years. If you have pre-diabetes, you should be checked every 1 to 2 years after your diagnosis.

Women with diabetes are more likely than non-diabetics to miss PAD symptoms, so it is especially important that they have screening tests to detect PAD early. Women and men 50 or older with diabetes should have an Ankle-Brachial Index (ABI) test, a simple, reliable, painless test to detect PAD. If the result is normal, you should be checked again in 5 years.6

Your doctor may consider an ABI test if you are younger than 50 but have diabetes along with other PAD risk factors (such as high blood pressure or high cholesterol), or if you have had diabetes for more than 10 years.6

Learn More:

Diabetes Treatment & Prevention
Diabetes Tests

How can I prevent PAD if I have diabetes?

If you have diabetes, the best way to prevent PAD is to get your diabetes under control and to take steps to control your other PAD risk factors. All women with diabetes should follow the ABCs of Diabetes Management and learn how to watch for diabetes complications.

The ABCs of Diabetes Management

There are three major treatment goals to keep your diabetes under control, called The ABCs of Diabetes Management. Following the ABCs lowers your risk of dying or having complications of diabetes, including PAD. Ask your doctor what your numbers are, what your individual goals should be, and what you need to do to reach and maintain them. The closers your numbers are to your goals, the less likely you are to develop PAD.

A is for A1C test (short for hemoglobin A1C). This simple blood test measures your average blood sugar over the last 3 months, and you should have it done at least twice a year. Aim to have an A1C level less than 7%.

B is for blood pressure. You should aim for a blood pressure less than 130/80. Have your blood pressure checked at every doctor’s visit.

C is for cholesterol. Aim to have your LDL (bad) cholesterol less than 100 mg/dL. Have your cholesterol checked at least once a year.

Your health care provider can help you develop a plan for things you should do every day to take care of your diabetes, including following a healthy eating plan (eat your meals and snacks around the same time each day) and being physically active for a total of 30 minutes most days.

Watch for Diabetes Complications

It is also important that you keep an eye out for other problems that diabetes can cause. This means regular visits with an eye doctor to check for vision problems and checkups for foot and leg problems. Ask your doctor how to practice proper foot care, and check your feet everyday for cuts, blisters, red marks, or swelling. If you have any non-healing or slow-healing wounds or sores, call your doctor right away.

Get Your Other PAD Risk Factors Under Control

You will also need to address any other conditions or characteristics that are putting you at risk for PAD. Basic steps include lifestyle changes such as a heart-healthy diet, maintaining a healthy weight, and getting your blood pressure and cholesterol under control. To learn more about how to reduce your overall risk, see Preventing PAD: The Basics. You should also learn to recognize the symptoms of PAD and contact your doctor if you notice any of them.

Women with diabetes and PAD, and some women with diabetes who are at risk for PAD because of other conditions, should take blood-thinning medication ( aspirin or clopidogrel) to reduce the risk of heart attack and stroke.9 Be sure to discuss your options with your doctor before starting an aspirin regimen.

For more information

American Diabetes Association
National Institute of Diabetes & Digestive & Kidney Diseases
National Diabetes Education Program
CDC Diabetes Public Health Resource



  1. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care. JAMA. September 19, 2001 2001;286(11):1317-1324.
  2. Beks PJ, Mackaay AJ, de Neeling JN, de Vries H, Bouter LM, Heine RJ. Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn study. Diabetologia. Jan 1995;38(1):86-96.
  3. Fowkes FG, Housley E, Riemersma RA, et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol. Feb 15 1992;135(4):331-340.
  4. Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol. Feb 1998;18(2):185-192.
  5. Murabito JM, D'Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication. A risk profile from The Framingham Heart Study. Circulation. Jul 1 1997;96(1):44-49.
  6. Peripheral Arterial Disease in People With Diabetes. Clinical Diabetes. October 2004 2004;22(4):181-189.
  7. Dolan NC, Liu K, Criqui MH, et al. Peripheral artery disease, diabetes, and reduced lower extremity functioning. Diabetes Care. Jan 2002;25(1):113-120.
  8. Kannel WB. Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. J Cardiovasc Risk. Dec 1994;1(4):333-339.
  9. Colwell JA. Aspirin therapy in diabetes. Diabetes Care. Jan 2003;26 Suppl 1:S87-88.

Filed in Am I at Risk? > Peripheral Artery Disease

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