Peripheral artery disease in diabetes

Peripheral artery disease in diabetes mellitus represents a distinct clinical entity characterized by diffuse distal arterial disease, medial calcification, microvascular dysfunction, neuropathy, and a pro-thromboinflammatory milieu. These features contribute to atypical presentations, diagnostic challenges, accelerated progression, and elevated risks of limb loss and cardiovascular events. Management requires integrated strategies encompassing metabolic optimization, lifestyle modification, pharmacotherapy, antithrombotic therapy, supervised exercise, and timely revascularization. Emerging approaches, including GLP-1 receptor agonists, SGLT2 inhibitors, and regenerative therapies, show promise in improving vascular, functional, and limb outcomes. Advancing outcomes in diabetic peripheral artery disease will depend on mechanism-driven screening, individualized therapies, and novel interventions to prevent complications.