|
Recommendations for
Glycemic Control |
|
COR |
LOE |
Recommendations |
|
I |
C-EO |
Management of diabetes mellitus
in the patient with PAD should be coordinated between members of
the healthcare team. |
|
N/A |
Diabetes mellitus is an important risk
factor for the development of PAD.187 Furthermore, the presence
of diabetes mellitus increases the risk of adverse outcomes among
patients with PAD, including progression to CLI, amputation, and
death.188,189 A comprehensive
care plan for patients with PAD and diabetes mellitus is important
and may include diet and weight management, pharmacotherapy for
glycemic control and management of other cardiovascular risk
factors, and foot care and ulcer prevention.25,190 Guidelines for glycemic control among
patients with diabetes mellitus and atherosclerotic vascular disease
have been previously published.25,29
Regular follow-up with and communication among the patient's
healthcare providers, including vascular specialists and diabetes
care providers (eg, primary care physicians, endocrinologists)
constitute an important component of care for patients with PAD and
diabetes mellitus. |
|
IIa |
B-NR |
Glycemic control can be
beneficial for patients with CLI to reduce limb-related
outcomes.191,192
|
|
See Online Data Supplement
22. |
In a cohort of 1974 participants with
diabetes mellitus from the Strong Heart Study, compared with
patients without PAD, patients with PAD and a Hg A1c level
<6.5% had lower age-adjusted odds of major
amputation compared to patients with PAD and hemoglobin A1c
6.5% to 9.5% and hemoglobin A1c
>9.5%.188 Glycemic control is particularly important
for patients with PAD and diabetes mellitus who have CLI.
Single-center observational studies have demonstrated improved
limb-related outcomes, including lower rates of major amputation and
improved patency after infrapopliteal intervention, among patients
with CLI who have more optimized glycemic control parameters
compared with patients with inferior glycemic control.191,192
|
|