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Peripheral Arterial Disease in Diabetic Foot: One Disease with Multiple Patterns
Marco Meloni1,2, Prashanth R J Vas3,4,5
1Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy.
Journal of Clinical Medicine
|March 27, 2025
Summary
Peripheral arterial disease (PAD) in diabetes requires better characterization. Identifying distinct patterns like below-the-knee, below-the-ankle, and small artery disease is crucial for tailored treatments and improved outcomes in diabetic foot ulcers.
Area of Science:
- Vascular Medicine
- Diabetology
- Regenerative Medicine
Background:
- Peripheral arterial disease (PAD) is a significant complication for individuals with diabetes, particularly those with diabetic foot ulcers (DFUs).
- Current characterization of PAD in diabetic patients is insufficient, leading to suboptimal management and patient outcomes.
- Understanding the anatomical and biological variations of PAD in diabetes is essential for improving care.
Purpose of the Study:
- To highlight the necessity for a more nuanced understanding of PAD's anatomical and biological aspects in diabetic patients.
- To describe distinct patterns of PAD in diabetes and their unique therapeutic challenges.
- To emphasize the need for individualized treatment strategies for PAD in diabetic patients.
Main Methods:
- Review of current literature on PAD in diabetic patients.
- Categorization of PAD into three distinct patterns: below-the-knee (BTK), below-the-ankle (BTA), and small artery disease (SAD).
- Analysis of the specific challenges and potential treatment approaches for each identified PAD pattern.
Main Results:
- PAD in diabetes presents with significant variations in atherosclerotic plaque distribution, influencing prognosis and treatment.
- Three key patterns identified: Pattern 1 (BTK disease), Pattern 2 (BTA disease), and Pattern 3 (SAD).
- Each pattern requires tailored therapeutic approaches, with SAD potentially benefiting from autologous cell therapy.
Conclusions:
- A refined characterization of PAD in diabetes is crucial for developing effective, individualized treatment strategies.
- Current oversimplification of PAD terminology can lead to inadequate therapeutic approaches and suboptimal patient care.
- Improved understanding and classification of PAD patterns in diabetes can enhance patient outcomes and reduce the burden of diabetic foot complications.
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