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Diabetic Foot Ulcer And Peripheral Vascular Disease

Connecting The Dots Between Diabetic Foot Ulcers, Pad And Dangerous Complications

Connecting The Dots Between Diabetic Foot Ulcers, Pad And Dangerous Complications

Author(s): Desmond Bell, DPM, CWS, FACCWS Pink ribbon. The juxtaposition of these two words translates into arguably the most recognized symbol anywhere, the looping image firmly embedded in our collective psyche and associated with breast cancer awareness. These words also conjure up a range of thoughts, emotions and an awareness of breast cancer that has transformed this terrible disease into a cause that extends beyond medical research. It is safe to say that minus the ribbon, the color pink alone has come to symbolize breast cancer awareness. The pink ribbon has created an awareness that has resulted in a proactive approach and attitude among the general population, especially in regard to prevention and early detection. It is estimated that the five-year mortality rate attributed to breast cancer is approximately 14 to 18 percent.1,2 Why have I mentioned breast cancer and its associated symbols in a column dedicated to diabetes? Simply stated, we must perceive the complications associated with diabetes in the same manner as with breast cancer. It is safe to say that the majority of people, not to mention primary care providers, do not have an understanding of the magnitude of the problem. Typically, there is a lack of correlating catastrophic health events, such as heart attack, stroke and diabetic foot ulcers (DFU) to each other, not to mention disturbing mortality rates in which complications of diabetes are factors. If we are to make any significant progress in the healing of diabetic ulcers and simultaneously reducing lower extremity amputations, heart attack and stroke, we must begin the process of linking these complications into one comprehensive issue, instead of the myriad described as “complications from diabetes.” Raising Awareness Of DFUs Complicate Continue reading >>

Medical Management Of Peripheral Artery Disease In Patient With Diabetic Foot Ulcer: A Case Report

Medical Management Of Peripheral Artery Disease In Patient With Diabetic Foot Ulcer: A Case Report

Medical Management of Peripheral Artery Disease in Patient with Diabetic Foot Ulcer: A Case Report Medical Management of Peripheral Artery Disease in Patient with Diabetic Foot Ulcer: A Case Report Clayton Campus, Monash University, Locked Bag 1073, Mount Waverly VIC 3149, Melbourne, Australia Corresponding author:Aderemilekun Isaac Babatunde, Clayton Campus, Monash University, Locked Bag 1073, Mount Waverly VIC 3149, Melbourne, Australia, Tel: 61-420-247-487; E-mail: [email protected] . Citation: Babatunde AI (2017) Medical Management of Peripheral Artery Disease in Patient with Diabetic Foot Ulcer: A Case Report. Arc Cas Rep CMed 3(1): 136. Critical limb ischemia (CLI) is common in patients with peripheral artery disease (PAD) and concomitant diabetes. Minor leg or foot trauma may lead to ulceration in patients with PAD and diabetes. These patients are at risk due to microcirculation damage and associated diabetic sensory neuropathy and neuroischemia. The reduced ability to combat infection resulting from poor perfusion in patients with diabetes worsens the ulceration. A 63-year-old man presented with right foot dynia and an ulcer that had been present for 6 years. Initially the patient developed an ulcer on the plantar aspect of his right foot. The ulcer worsened and required amputation of his 1st, 2nd, 3rd and 5th toes about four years ago. Since then the ulcer was slow to heal despite debridement, courses of antibiotics and visits to diabetic foot clinic. He later presented with severe pain and was admitted for management with prostaglandin E1 (Alprostadil). There was complete healing of ischemic necrosis and ulceration in the patient treated with 60 mcg of prostaglandin E1 (Alprostaldil) in 250ml of isotonic NaCl solution q3h for 15 days. Keywords: Periphera Continue reading >>

An Assessment Of Peripheral Vascular Disease In Patients With Diabetic Foot Ulcer.

An Assessment Of Peripheral Vascular Disease In Patients With Diabetic Foot Ulcer.

Foot (Edinb). 2010 Dec;20(4):114-7. doi: 10.1016/j.foot.2010.09.002. Epub 2010 Oct 15. An assessment of peripheral vascular disease in patients with diabetic foot ulcer. Obafemi Awolowo University, Department of Medicine, Ile-Ife, Osun, Nigeria. Peripheral vascular disease (PVD) is a chronic limb ischaemia caused by atherosclerosis of the peripheral arteries. Diabetes mellitus is a risk factor for this disease. The most common symptom of PVD is muscle pain in the lower limbs on exercise. In diabetes, pain perception may be blunted by the presence of peripheral neuropathy. Therefore, a patient with diabetes and PVD is more likely to present with an ischaemic ulcer or gangrene than a patient without diabetes. The use of ankle-brachial-pressure index (ABI) in the clinic and bedside provide a measure of blood flow to the ankle. This could help early detection, initiate early therapy and may thus reduce the risk of critical limb ischaemia and limb loss. The purpose of this study is to evaluate the occurrence of peripheral vascular disease using ankle-brachial index in diabetic patients with and without foot ulcers and the risk factors associated with diabetic foot ulcer (DFU). This prospective study involved all type 2 DM patients with foot ulcer (DFU population) and those without foot ulcers (non-DFU population) seen in our hospital. Their demographic, clinical and laboratory parameters were noted and documented. Measurement of ABI was done using a portable hand held Doppler and ankle pressures<0.9 is suggestive of PVD. A total of 74 patients were recruited. Males were 42 (56.8%) and females were 32 (43.2%). The mean age of the patients was 62.8910.66 years and the duration of diabetes was 7.617.57 years. Forty-six (62.2%) presented with foot ulcer while 28 (37.8%) were wi Continue reading >>

Association Between Peripheral Arterial Disease And Diabetic Foot Ulcers In Patients With Diabetes Mellitus Type 2 - Sciencedirect

Association Between Peripheral Arterial Disease And Diabetic Foot Ulcers In Patients With Diabetes Mellitus Type 2 - Sciencedirect

Volume 19, Issue 76 , JulySeptember 2017, Pages 123-126 Association between peripheral arterial disease and diabetic foot ulcers in patients with diabetes mellitus type 2 Author links open overlay panel M..Tresierra-Ayala Open Access funded by Universidad Autnoma de Nuevo Len Diabetic foot ulcer (DFU) is a chronic complication of diabetes mellitus. It is reported that diabetes is associated with a two to four-fold increase in the incidence of peripheral arterial disease (PAD) compared to non-diabetic subjects. Peripheral arterial disease (PAD) may play a role in the etiology of foot ulceration in patients with diabetes mellitus. To determine the association between peripheral arterial disease and diabetic foot ulcers in patients with type II diabetes mellitus. A cross-sectional study was carried out at Hospital Belen of Trujillo, which all patients with type 2 diabetes mellitus 50 years were included. Presence or absence of both variables was measured in our study. Three hundred twenty-two patients were included in the study. We found that 129 patients had peripheral arterial disease and diabetic foot ulcers (OR 3, 95% IC 1.0878.242 and p<0.001). In this study, peripheral arterial disease was associated with diabetic foot ulcer in patients with type 2 diabetes mellitus. Continue reading >>

Diabetic Foot Ulcers And Vascular Insufficiency: Our Population Has Changed, But Our Methods Have Not

Diabetic Foot Ulcers And Vascular Insufficiency: Our Population Has Changed, But Our Methods Have Not

Diabetic Foot Ulcers and Vascular Insufficiency: Our Population Has Changed, but Our Methods Have Not 4Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina 1Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, Arizona 2Division of Plastic Surgery, Virginia Commonwealth University, Richmond, Virginia 4Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina Corresponding Author: David G. Armstrong, D.P.M., M.D., Ph.D., Southern Arizona Limb Salvage Alliance (SALSA), 1501 N. Campbell Ave., Room 4318, University of Arizona, College of Medicine, Tucson, AZ 85724; email address [email protected] Copyright 2011 Diabetes Technology Society This article has been cited by other articles in PMC. Diabetic foot complications are increasing in prevalence worldwide. Care and attention to these complications have improved greatly. Many advanced therapies are now being investigated or taken through final stages of clinical studies worldwide. However, the data upon which assumptions regarding morbidity, healing, and mortality have been based are grossly outdated. The purpose of this brief article is to report on current data regarding neuropathic and neuroischemic wounds and to propose that the latter category of advanced-stage diabetic foot wound may now be emerging as the most commonly encountered lesion in the developed world. Unfortunately, it is still systematically excluded from most clinical study criteria. Additionally, just as in the care of cancer, we call for therapy of these advanced-stage diabetic foot ulcers to be managed in similarly interdisciplinary centers where patients may Continue reading >>

Peripheral Vascular Disease

Peripheral Vascular Disease

What is peripheral vascular disease? What is a vascular ulcer and how do you treat it ? What is peripheral vascular disease ? Peripheral vascular disease means narrowing of the lumen of arteries in the legs, causing a reduction in circulation. It can occur in individuals without diabetes but is more common and more severe in people with diabetes. Why this is the case is not clear, but it is well established that smoking makes peripheral vascular disease much worse. Although both big and small blood vessels can be affected by diabetes (known as macrovascular and microvascular disease respectively), in diabetic peripheral vascular disease it is blockage of the larger arteries in the thigh and leg which causes most of the clinical problems. Peripheral vascular disease can affect both legs but is often more severe on one side (contrast with peripheral neuropathy which affects both feet symmetrically). The large arteries are blocked, causing problems. Here are the typical sites of blockages of the arteries (shown in green) What problems can be caused by peripheral vascular disease? If it is mild, peripheral vascular disease can be completely without symptoms. However, as blood supply becomes progressively inadequate, it can cause claudication, rest pain or vascular ulceration: Claudication is development of pain in the calf after walking for a distance or up an incline or stairs. The distance a person can walk before such pain occurs is referred to as claudication distance. The leg and foot look and feel normal as long as the person is resting. As claudication distance becomes shorter and shorter, physical activities become more and more restricted. Cessation of smoking is most important before one gets to this stage. Regular exercise by walking through the pain threshold ca Continue reading >>

Arterial Disease And Diabetic Foot Ulcers

Arterial Disease And Diabetic Foot Ulcers

Arterial Disease and Diabetic Foot Ulcers One of the most common vascular issues treated by Vascular Surgeons is diabetic foot ulcers (DFUs). Up to 25% of diabetic patients will have a foot ulcer during their lifetime. Diabetic foot ulcers are wounds of the lower extremities that develop because of poor blood circulation. These ulcers most commonly occur on the feet and toes, sometimes on the ankles. There are usually several factors that contribute to the development of these wounds including poorly fitting shoes, neuropathy, and disease of the arteries. DFUs are often missed and must be carefully sought after on physical examination. It is important for diabetic patients to regularly check their feet for development of ulcers. Diabetic patients often develop calcified plaques in their arteries, which can lead to narrowing or blocking of the artery (this is called arterial disease.) This can lead to decreased or complete absence of blood flow to the foot. The arteries commonly involved are the arteries below the knee. I distinctly remember caring for a young diabetic woman during my vascular surgery fellowship, who had a small lesion on her foot. Unfortunately, she missed a couple of appointments and returned 2 weeks later with a severe infection of her toe. I performed an angiogram and found a blockage in one of the arteries of her leg. I treated the blockage with ballooning and stent in order to restore blood flow to her foot. Luckily, with ongoing wound care and close follow up, the ulcer healed completely. I feel fortunate that we were able to avoid needing to amputate part of her foot. Some patients may have what we call multi-segment arterial disease, which means that there is narrowing or blockages in the arteries of the thigh or, even higher up, in the pelvis. Continue reading >>

Diabetic Foot Disease In The Elderly - Em|consulte

Diabetic Foot Disease In The Elderly - Em|consulte

[1]Department of Rehabilitation and Geriatrics, Hpital de Loex, Geneva University Hospitals, Switzerland [2]Hpital des Trois-Chne, Geneva University Hospitals, Switzerland Les patients diabtiques gs sont particulirement affects par les complications au niveau du pied. Les principales causes datteintes du pied sont la neuropathie priphrique, les dformations du pied et les artriopathies des membres infrieurs (AMI). Les autres facteurs de risque incluent les troubles de la vision, les troubles de lquilibre, une mobilit rduite et les co-morbidits mdicales. Le risque damputations majeures augmente avec lge, avec laugmentation de la prvalence de ces facteurs de risque. Le rel risque damputation et le poids des atteintes du pied chez les personnes ges sont trs certainement sous-estims par les donnes pidmiologiques actuelles. La prvalence de la neuropathie, des dformations du pied et des AMI, tout comme celle du risque damputation, augmentent toutes avec lge, mme chez les sujets non diabtiques. Les principes de prvention et de prise en charge du pied diabtique peuvent donc sappliquer galement une large part de la population des sujets non diabtiques. La prvention des ulcrations du pied repose sur lidentification des patients haut risque et sur des mesures cherchant viter les vnements dclenchants, tels un mauvais chaussage, la marche pieds nus ou une hygine insuffisante. Les AMI sont une cause majeure damputation et doivent tre prvenues par une attention permanente au contrle glycmique, au traitement de lhypertension artrielle et des dyslipidmies, et la suppression du tabagisme. Le traitement des ulcrations du pied repose sur la leve des hyperpressions par la mise en dcharge du pied, le dbridement des plaies, et le traitement de linfection et de lischmie. Il ncessite une approc Continue reading >>

Have Non-healing Diabetic Foot Ulcers? Waiting Too Long Could Lead To Pad Or Amputation

Have Non-healing Diabetic Foot Ulcers? Waiting Too Long Could Lead To Pad Or Amputation

If youve been diagnosed with diabetes, you probably already know you need to take care of your feet. Your doctor has likely told you to pay particular attention to any non-healing foot cuts or sores you notice. And then it happens: one day you may be looking down and find yourself wondering how long has that sore been there? What are diabetic foot ulcers? Diabetic foot ulcers are wounds present on the foot or below the ankle, which do not heal. The presence of these ulcers is a leading cause of amputation due to diabetes.[i] The Centers for Disease Control and Prevention estimates that about 73,000 lower-limb amputations, not related to trauma, are performed every year on people with diabetes.[ii] This is why if youre living with diabetes and have a sore, or an open area, on your foot that: you may have a non-healing diabetic foot ulcer, and should make an appointment with your doctor as soon as possible. Non-Healing Foot Ulcers and Peripheral Artery Disease (PAD) Foot Ulcers may be a sign that you may have peripheral artery disease (PAD) . PAD develops when the build up of plaque in the arteries of the limbs, typically the legs, decreases the amount of blood and oxygen getting to your legs and feet. Its estimated that 50% of people living with diabetes and non-healing foot ulcers also have PAD.[iii] If you have a foot ulcer, find out if you are at risk for PAD by taking our online PAD risk assessment . Ulcers begin with an injury or an irritation to the foot. Even a seemingly small injury, such as a splinter in the foot, stepping on a tack, or a blister from a shoe, can lead to an ulcer if you have diabetes or PAD. The following conditions make the development of an ulcer more likely: Diabetic neuropathy is one of the most common complications of diabetes, as well as Continue reading >>

Peripheral Vascular Disease In Patients With Diabetic Foot Ulcers - An Emergingtrend: A Prospective Study From North India.

Peripheral Vascular Disease In Patients With Diabetic Foot Ulcers - An Emergingtrend: A Prospective Study From North India.

1. J Assoc Physicians India. 2017 May;65(5):14-17. Peripheral Vascular Disease in Patients with Diabetic Foot Ulcers - An EmergingTrend: A Prospective Study from North India. Bajaj S(1), Mahajan A(2), Grover S(3), Mahajan V(4), Goyal P(1), Gupta VK(5). (2)Consultant Diabetologist and Physician, Tagore Hospital and Heart care Centre, Jalandhar, Punjab. (3)Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab. (4)Managing Director and Head of Department, Department of Medicine, Tagore Hospital and Heart care Centre, Jalandhar, Punjab. (5)Assistant Professor, Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab. BACKGROUND: Diabetic foot ulcer is one of the chronic complications of diabetesmellitus (DM) with 25% of patients with diabetes developing a foot ulcer duringtheir lifetime leading to amputation. Diabetic foot is classified into 2 maintypes: neuropathic ulcers (NPU) and neuro-ischemic ulcer (NIU) where in addition to neuropathy peripheral vascular disease (PVD) is also present.AIMS: We aimed to a) assess the prevalence of Peripheral vascular disease (PVD)in patients of type 2 diabetes mellitus (T2DM) presenting with New Diabetic Foot ulcers (DFU). b) To compare the clinical profile and risk factors responsible fordevelopment of NPU and NIU in North Indian population.SETTING AND DESIGN: Cross sectional study conducted on first 100 T2DM patientspresenting with new DFU in tertiary referral institute for one year period fromAugust 2012 to July 2013.METHODS AND MATERIAL: Detailed relevant clinical history including age, sex andduration of diabetes, history of smoking and hypertension (HTN) and prevalence ofother complications like retinopathy, nephropathy, coronary artery disease (CAD) Continue reading >>

Diagnosing A Diabetic Foot Ulcer, Assessment Of Ischemia-perimed

Diagnosing A Diabetic Foot Ulcer, Assessment Of Ischemia-perimed

Diabetic foot ulcers can be classified as: The prevalence of the neuroischemic ulcers is rising and today 50% of all diabetic foot ulcers are neuroischemic compared to 20-25% in the 1990s.5 Once diagnosis of peripheral arterial disease has been established, an estimate of the wound healing potential will help to identify the correct management strategy for each diabetic foot ulcer. No specific symptom or signs of PAD will reliably predict healing of the ulcer. Several societies recommend objective vascular tests for this purpose. The International Working Group on the Diabetic Foot,for example, indicate that, a toe pressure > 30 mmHg, a tcpO2 > 25 mmHg or a a skin perfusion pressure > 40 mmHg increases the likelihood for healing.3-5 Learn more about guidelines and recommendations for PAD The severity of Peripheral Arterial Disease is not the only factor affecting the healing outcome. Other factors will also influence each individual diabetic foot ulcer; the presence of infection, amount of tissue loss, mechanical load on the ulcer, and co-morbidities, such as heart failure, and end stage renal disease. Consequently, various degrees of ischemia may prove "critical depending on the overall status of the limb. As an example, a diabetic patient with mild PAD but a foot ulcer complicated with infection, might benefit from revascularization to speed up healing of smaller wounds or be essential to heal an extensive wound.3-5 Assessing diabetic foot ulcers is challenging. PeriFlux 6000 offers a unique combination of simultaneous vascular tests to ensure accurate diagnosis of peripheral arterial disease and wound healing assessment also in the diabetic population. Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

Foot Care Guidelines – Society for Vascular Surgery, American Podiatric Association, Society for Vascular Medicine Source: Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. Refer to source document for full recommendations, including class of recommendation and level of evidence Peripheral Artery Disease & Diabetic Foot Ulceration Diabetes is a major risk factor for PAD 10% to 40% prevalence of PAD among people with diabetes ABI measurement is recommended for all patients with diabetes starting at the age of 50 Grade 2C Patients who have a prior history of DFU, prior abnormal vascular exam, prior intervention for PVD, or ASCVD: Annual exam of lower extremities and feet, including ABI and toe pressures Grade 2C Patients with DFU: Pedal perfusion assessed by ABI, ankle and pedal Doppler arterial waveforms, and toe systolic pressure or transcutaneous oxygen pressure for patients with DFU Grade 1B Patients with PAD and DFU: Revascularization by surgical bypass or endovascular therapy Grade 1B DFU=diabetic foot ulceration; PAD=peripheral artery disease; PVD=peripheral vascular disease June 2016 This content was created by Ashfield Healthcare Communications, and was not associated with funding via an educational grant or a promotional/commercial interest. Continue reading >>

Peripheral Vascular Disease

Peripheral Vascular Disease

Peripheral Vascular Disease is a topic covered in the Johns Hopkins Diabetes Guide. Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics: -- The first section of this topic is shown below -- Peripheral vascular disease (PVD) includes disorders of the blood vessels (arteries and veins) outside the heart and brain. Persons with diabetes are especially at risk for ischemia in arteries of the legs and feet, termed "lower extremity peripheral artery disease (PAD)". Claudication is defined as limb pain with activity. It is due to muscle ischemia caused by arterial insufficiency. Critical Leg Ischemia (CLI) is defined as rest pain, ulcerations, or gangrene, with expectation of threatened limb loss within 6 months. "Diabetic Foot Syndrome" includes the combined effect of vascular and neuropathic (foot ulcer) injuries that lead to lower-extremity amputations[19]. Major cause of PAD is atherosclerosis but many conditions, including venous insufficiency, mimic symptoms of PAD -- these are called "pseudoclaudication"; see "differential diagnosis" below. -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Continue reading >>

Diabetic Foot Ulcers

Diabetic Foot Ulcers

The UCSF Center for Limb Preservation & Wound Care is the first in the Bay Area to focus on amputation prevention and high risk diabetic patients. We save limbs because we offer efficient, coordinated care with a high level of expertise and because we are aggressive in our goal of preserving a functional foot. A diabetic foot ulcer is an open sore or wound on the foot of a person with diabetes, most commonly located on the plantar surface or bottom of the foot. Diabetic foot ulcers occur in approximately 15% of persons with diabetes. Of those who develop a foot ulcer, 6% will be hospitalized due to infection or other ulcer-related complication. The risk of foot ulceration and limb amputation increases with age and the duration of diabetes. Diabetes is the leading cause of non-traumatic lower extremity amputations in the U.S. Between 14-24% percent of patients with diabetes who develop a foot ulcer will require an amputation and foot ulceration precedes 85% of diabetes-related amputations. In the U.S., 82,000 amputations are performed each year on persons with diabetes, half of those age 65 or older. The good news is that a foot ulcer is preventable if the underlying conditions causing it, diabetic peripheral neuropathy and/or peripheral arterial disease, are appropriately diagnosed and treated. Causes Peripheral neuropathy (nerve damage) and lower extremity ischemia (lack of blood flow) due to peripheral artery disease are the primary causes of diabetic foot ulcers. Diabetic Peripheral Neuropathy Diabetic peripheral neuropathy is a precipitating factor in almost 90% of diabetic foot ulcers. Chronically high glucose (blood sugar) levels damage nerves including the sensory, motor and autonomic nerves. Diabetic neuropathy also damages the immune system and impairs the body Continue reading >>

Peripheral Arterial Disease In People With Diabetes

Peripheral Arterial Disease In People With Diabetes

ABI, ankle-brachial index CABG, coronary artery bypass graft CAPRIE, Clopidogrel versus Aspirin in Patients At Risk of Ischemic Events CLI, critical limb ischemia CRP, C-reactive protein eNOS, endothelial cell nitric oxide synthase FDA, Food and Drug Administration FFA, free fatty acid MI, myocardial infarction MRA, magnetic resonance angiogram NF-κB, nuclear factor-κB PAD, peripheral arterial disease PAI-1, plasminogen activator inhibitor-1 PI, phosphatidylinositol PKC, protein kinase C PVR, pulse volume recording RAGE, receptor for advanced glycation end products UKPDS, U.K. Prospective Diabetes Study VSMC, vascular smooth muscle cell Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities. While PAD is a major risk factor for lower-extremity amputation, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease. Although much is known regarding PAD in the general population, the assessment and management of PAD in those with diabetes is less clear and poses some special issues. At present, there are no established guidelines regarding the care of patients with both diabetes and PAD. On the 7–8 of May 2003, a Consensus Development Conference was held to review the current knowledge regarding PAD in diabetes. After a series of lectures by experts in the field of endocrinology, cardiology, vascular surgery, orthopedic surgery, podiatry, and nursing, a vascular medicine panel was asked to answer the following questions: 1) What is the epidemiology and impact of PAD in people with diabetes? 2) Is the biology of PAD different in people with diabetes? 3) How is PAD in diabetes best diagnosed and evaluated? 4) What are the appropriate treatments for PAD in peo Continue reading >>

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