Abstract
The burden of peripheral arterial disease (PAD) is steadily increasing worldwide and smoking, diabetes, hypertension, and hypercholesterolemia are major risk factors. While it was estimated that in 2010 202 million people lived with PAD, this number increased to 237 million in 2015. In parallel, the number of people with diabetes is increasing, which was at 422 million in 2014 and is estimated increase to 578 million by 2030 according to the World Health Organization. It is likely that the increase in PAD is driven in part by the global diabetes pandemic and also by aging populations. The prevalence of PAD is twice as high in diabetic versus nondiabetic populations and up to 74% of patients with lower limb amputations have been diagnosed with diabetes. Overall, patients with concomitant diabetes and PAD exhibit worse outcomes regarding perioperative complications, amputation rate, and mortality rate when compared to nondiabetic patients. However, PAD is often underdiagnosed and undertreated. The best management of patients with PAD entails early and intensive treatment of both (cardiometabolic) risk factors and limb-specific symptoms, including revascularization, wound care, and improvement of patency after revascularization. It includes optimal pharmacological therapy as well as nonpharmacological measures such as smoking cessation, healthy diet, weight loss, and regular physical exercise.