Diabetes Education: A Role in PAD Prevention

Peripheral artery disease (PAD) has long been identified as a significant contributor of progressive cardiovascular complications associated with diabetes (Clark, 2003).  PAD begins with a series of complex inflammatory processes resulting in blood vessel narrowing or blockage. The formation of plaque affects circulation from the heart and perfusion to the lower extremities (CDC, 2016). The prevalence of peripheral artery disease (i.e., lack of blood flow) in patients with diabetes and foot ulcers is fifty percent. Perfusion deficits and foot ulcers precede an estimated 85% of non-traumatic lower extremity amputations (Fernando et al., 2016). Studies estimate that one in three individuals with PAD are asymptomatic, for this reason, many individuals with PAD go undiagnosed until perfusion deficits become serious manifesting as tissue impairments such as  foot ulcers or limb threatening ischemia.

Early diagnosis and lifestyle behavioral management interventions are crucial in preventing chronic cardiovascular complications associated with PAD for individuals with diabetes. A primary early onset symptom of PAD (when PAD is not asymptomatic) involves claudication (pain to the legs or feet that occurs with exertion (i.e., climbing stairs) that is relieved with rest. According to the American Heart Association and The American College of Cardiology (AHA/ACC), leg pain is overwhelmingly associated with occlusion. Diabetes and smoking are the most influential risk factors for PAD, as well as advanced age, hypertension, and hyperlipidemia (AHA/ACC, 2017)

Diabetes educators play a pivotal role in the implementation of self-management behavioral and interventional treatments for diabetes and PAD.  They are in a unique position to encourage individuals to seek primary care for early onset PAD symptoms (i.e., claudication). The AADE-7 diabetes lifestyle behavior self-management education for individuals with diabetes is the recommended interventional treatment for individuals with PAD and other cardiovascular complications.  Educators share crucial knowledge with those with diabetes thereby delaying perfusion deficits, lower extremity ischemia, improving patient outcomes and quality of life for those with PAD and diabetes. (CDC, 2016).

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