Complications of diabetic peripheral vascular disease: diagnosis and medical treatment

2021-07-27 10:49 PM

To prevent micro-and macro-complications, such as peripheral vascular disease, aggressive, targeted therapy should be initiated immediately after diagnosis

General perception

The risk of peripheral vascular disease is increased in patients with diabetes, occurs earlier, and is often more severe and diffuse. Endothelial dysfunction, vascular smooth muscle cell dysfunction, inflammation, and hypercoagulability are major factors in diabetic arterial disease. The presence of peripheral vascular disease, in addition to the risk of hypertension, ischemic ulceration, gangrene, and amputation, is also a marker for generalized atherosclerosis and a predictor for ischemic cardiovascular events. However, despite acknowledging that peripheral vascular disease is associated with increased rates of ischemic events and mortality, particularly in diabetic patients, this specific manifestation of systemic atherosclerosis Most are diagnosed and treated. In type 1 diabetes, early intensive insulin treatment reduces both microvascular (nephropathy, retinopathy and neuropathy) and macroscopic complications of diabetes. In type 2 diabetes, it has been shown that tight glucose control reduces micro and macro complications when treatment is initiated early after diagnosis and early intervention has a long-term protective effect. However, recently published trials have shown that lowering blood glucose goals to near-normal levels does not further reduce cardiovascular events in people with long-term type 2 diabetes and Hypoglycemia is to be avoided in people with ischemic heart disease. Finally, the trial demonstrated a significant reduction in peripheral vascular disease, ischemic events, and mortality in type 2 diabetes, enhanced multifactorial therapy of all risk factors. change is necessary. Therefore, to prevent micro and macro complications,

Diabetes and smoking are the two main risk factors for peripheral vascular disease. For patients with diabetes, the risk of peripheral vascular disease increases with age, duration of disease, and presence of peripheral neuropathy.

Diagnose

Clinical symptoms of peripheral vascular disease of the lower extremities include early stage is intermittent pain at rest, severe can lead to limb embolism, causing tissue necrosis, even amputation. Some patients may be asymptomatic because of the associated neurological complications.

Clinical examination: weak peripheral pulse even loss of pulse, hair loss, lack of nail nourishment, dry and cold skin.

Doppler ultrasound of the extremities helps diagnose patients with peripheral vascular disease.

Angiography is only when suspected occlusive stenosis requires intervention (at specialized levels).

Treatment

Control the risk factors as above: blood pressure, blood lipids, weight, quit smoking...

Use of antiplatelet drugs: clopidogrel (Plavix) 75mg/day or aspirin 100mg/day.

For claudication, claudication can be treated with rehabilitation exercises and increased mobility to create collateral circulation.

In case of embolism: angioplasty, stenting, atheroma removal, or bypass surgery.

Prevention

Active treatment and strict control of risk factors such as blood sugar, hypertension, dyslipidemia, smoking cessation.

Vascular Doppler ultrasound is indicated every year for timely detection of atherosclerotic plaques.