Type 2 Diabetes Mellitus and Chronic Venous Disease of the Lower Extremities: A Narrative Review

Chronic venous disease (CVD) is a highly prevalent but often under-recognized condition, affecting up to 60% of the general population. In patients with diabetes mellitus, the burden of CVD appears to be higher, with more severe clinical manifestations, suggesting shared pathophysiological mechanisms between the two disorders. This narrative review explores the relationship between diabetes mellitus and CVD, focusing on underlying mechanisms, clinical implications, and management strategies. A comprehensive review of the literature was conducted, integrating evidence from clinical studies, mechanistic research, and current guidelines. Epidemiological data indicate that diabetes mellitus is more frequently observed in patients with CVD compared with the general population (17.8% versus 8.6%; P < 0.0001). Diabetes contributes to the development and progression of CVD through multiple interconnected mechanisms, including endothelial dysfunction, chronic inflammation, oxidative stress, and microangiopathy, leading to structural and functional alterations such as valvular incompetence, venous reflux, and sustained venous hypertension, which may exceed 60 mmHg at the capillary level in advanced stages. Patients with diabetes are more likely to develop advanced manifestations, including edema, skin changes, and venous ulceration. Impaired wound healing due to microangiopathy and immune dysfunction increases the risk of infection and ulcer chronicity. In addition, the coexistence of peripheral arterial disease further complicates diagnosis and management, often resulting in mixed-etiology ulcers. Chronic venous disease and diabetes mellitus share overlapping risk factors and pathophysiological pathways that contribute to disease progression and clinical complexity. Early recognition, accurate diagnosis, and a multidisciplinary management approach are essential to improve outcomes. Targeted strategies, including glycemic control, compression therapy, lifestyle modification, and appropriate pharmacological interventions, may help reduce complications and improve quality of life in this high-risk population.