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