Peripheral Arterial Disease vs. Diabetic Neuropathy: Managing Lower Limb Pain and Claudication with Ankle-Brachial Index Assessment

Managing lower limb pain in patients with diabetes presents a significant clinical challenge, particularly when differentiating between peripheral arterial disease (PAD) and diabetic neuropathy. Both conditions are prevalent in this population and can coexist, complicating diagnosis and treatment. PAD is characterized by claudication and ischemic pain, while diabetic neuropathy manifests with neuropathic pain and sensory loss.

Diving Deeper into the Topic

Peripheral arterial disease is a common complication in individuals with diabetes, with a prevalence ranging from 10% to 20% [1]. This condition is often asymptomatic but can lead to diabetic foot ulcers and lower limb amputations [2]. Diagnosis is primarily made using the ankle-brachial index (ABI), which is the most accurate non-invasive method for assessing PAD [3].

Conversely, diabetic neuropathy is a complication affecting a large number of diabetic patients and is a significant risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy [4]. Neuropathy can mask ischemic pain, making it challenging to detect PAD in these patients [5].

Managing pain in these conditions requires a multidisciplinary approach. For PAD, revascularization and control of cardiovascular risk factors are essential [6]. For diabetic neuropathy, glycemic control and lifestyle modifications are fundamental, along with managing neuropathic pain through pharmacological and non-pharmacological therapies [7].

Conclusions

Differentiating between peripheral arterial disease and diabetic neuropathy is crucial for the appropriate management of lower limb pain in diabetic patients. Utilizing the ankle-brachial index and other diagnostic assessments can aid in identifying PAD, while a comprehensive approach is necessary to address diabetic neuropathy. Collaboration among various medical specialties is key to improving outcomes in these patients.

Referencias

• [1] Peripheral Arterial Disease, Foot Ulcers, Lower Extremity Amputations, and Diabetes.
• [2] Lower limb arterial disease in patients with diabetes.
• [3] Characteristics of peripheral arterial disease and its relevance to the diabetic population.
• [4] Prevention and Management Strategies for Diabetic Neuropathy.
• [5] An evaluation of inflammatory and endothelial dysfunction markers as determinants of peripheral arterial disease in those with diabetes mellitus.
• [6] High Mortality in Patients With an Ischemic Foot Ulcer Following Revascularization.
• [7] Bypass surgery versus endovascular revascularization for occlusive infrainguinal peripheral artery disease.

Created 6/1/2025