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Medical Negligence

The importance of diabetes management in PAD patients

November 7, 2023

Written by Kate Lozynska, Associate & Solicitor 

Medically Reviewed by Mr Jonothan Earnshaw MBBS DM FRCS, Consultant Vascular Surgeon 

Dated: 7th November 2023 

What is Peripheral Arterial Disease? 

Peripheral Arterial Disease (PAD), also known as peripheral vascular disease (PVD), is a common condition where a build-up of fatty deposits in the arteries restricts blood supply to leg muscles.  

Diabetes and PAD

Many people with PAD have no symptoms. However, some may develop intermittent claudication which is a painful ache in their legs when they walk, which usually disappears after a few minutes’ rest. PAD raises your risk for diabetes, and diabetes raises your risk for PAD.  

Diabetes is a condition that causes a person’s blood sugar level to become too high. About 20%-30% of people diagnosed with PAD also have diabetes. Diabetes not only raises your risk of getting PAD, it also can worsen symptoms and bring them on more quickly. 

PAD diagnosis and treatment  

PAD is not immediately life-threatening, but the process of atherosclerosis that causes it, can lead to serious and potentially fatal problems; including cardiovascular disease (coronary heart disease, stroke, heart attack, angina) and critical limb ischaemia (CLI).  

Timely diagnosis and treatment is crucial. An angioplasty or bypass graft is usually recommended if you have CLI, although these may not always be successful or possible. In a few cases, an amputation below the knee may be required. It is often that at this point we are contacted by clients to investigate potential clinical negligence claims. 

How to ease the symptoms of PAD 

The good news is that even if you are diagnosed with both, diabetes and PAD, certain lifestyle changes, including smoking cessation, healthy diet, and weight control, can ease the symptoms of PAD and reduce the chances of it getting worse.  

We have asked one of our frequently instructed experts and esteemed vascular surgeons, Mr Jonothan Earnshaw, to discuss what lifestyle changes he recommends in his daily practice to control diabetes, especially in PAD patients. We hope this will provide useful guidance to our readers.  

The management consists of two parts: first control of the diabetes itself, and second general care of the diabetic patient. 

Mr Earnshaw advises that: “Control of diabetes is fundamental. It is well known that all the complications of diabetes occur earlier and deteriorate more quickly in patients with poor diabetic control (raised glucose). Diabetic patients must take responsibility for good control. They should test themselves regularly (check their blood sugar), and report to their GP initially if control is poor. Most diabetic patients will have a team supporting them: GP, nurse specialists at the surgery, endocrine clinic. It is usually possible to get good control with medicines – oral hypoglycaemics and/or insulin. Special monitoring devices through a mobile phone may help in difficult cases. It is well worth getting this right for the reasons above.”  

He goes further to say that “general care of diabetic patients includes them keeping as healthy as possible. A good diet, and careful weight control, particularly in obese patients will also help diabetic control. A sensible exercise programme, depending on age, will keep the diabetic patient as active as possible for as long as possible. Diabetics are also at risk of neuropathy, vascular disease and retinopathy.” 

The following life hacks are recommended by the expert: 

  • Annual diabetes checks at your GP surgery – where among other things your feet will be examined for neuropathy and vascular disease.  
  • Good foot care – this is paramount; you will require well-fitted shoes, keeping the skin soft and supple with moisturiser, and prompt reporting of any skin breaks or infections. 
  • Medication – for individuals with hypertension, blood pressure control is required; for patients with raised cholesterol, and particularly if there is any evidence of PAD, a statin and aspirin may be beneficial. This can all be arranged through your GP surgery, often at the diabetes check. 

It is important to remember that should you develop any new skin breakdown on the feet, immediately contact your treating clinician for an urgent diabetic patient referral to a multidisciplinary foot clinic. 

For advice on making a clinical negligence claim, speak to our team today. You can call us on 0330 013 0249 or contact us online.  

Sources/Notes
[1] https://www.nhs.uk/conditions/peripheral-arterial-disease-pad/ 
[2] https://www.nhs.uk/conditions/diabetes/ 
[3] https://www.nhs.uk/conditions/atherosclerosis/?dom=prime&src=syn 
[4] Between 51–93% of all lower limb major amputations are due to PAD –world comparative data (Abryet al. Peripheral Artery Disease Leading to Major Amputation: Trends in Revascularization and Mortality Over 18 Years.  Ann Vasc Surg, 78,2022, 295-301) 
[5] Neuropathy normally affects the feet causing numbness and discomfort. 
[6] Retinopathy affects the vision, and all diabetics are offered regular screening by an optician, and should be encouraged to attend. Retinopathy is the commonest cause of blindness in the UK, but is treatable by laser therapy if caught early enough.