Diabetes as a Risk Factor for PAD

multiple diabetes related items scattered, including pills, insulin shots, blood sugar measuring machine, measuring tape

When we talk about peripheral artery disease or PAD, we often focus on one of the most common causes of atherosclerosis, cholesterol. After all, excess fat in the bloodstream caused by high blood cholesterol is why plaque begins to form on the walls of the arteries. However, focusing only on cholesterol misses other serious concerns that may increase the risk of PAD, including type 2 diabetes, also known as adult-onset diabetes. Diabetes is a significant concern in the United States and worldwide. In fact, according to the WHO, the incidence of diabetes worldwide almost quadrupled between 1980 and 2014.

What Exactly Is Diabetes?

Diabetes occurs when the pancreas cannot produce adequate amounts of insulin or the body does not use insulin properly. As a result, excess sugar circulates in the blood. Diabetes is called the silent killer because it circulates in the body for years or even decades before causing significant symptoms. However, once these symptoms occur, they are typically severe and can lead to life-threatening consequences if left untreated.

Did You Know Diabetes Is One of the Strongest Risk Factors for Pad?

Not only is diabetes a risk factor for PAD, but the risk is further increased by the length of time the patient has had diabetes. A UK study estimated that every 1% increase in glycosylated hemoglobin was related to a 28% increase in PAD incidence. It is estimated that approximately 20% of diabetes patients over 40 have PAD, which increases to almost 30% in patients over 50. Further, these numbers are likely underestimated because many early-stage PAD patients do not have symptoms and are consequently not screened for the disorder.

How Diabetes Increases the Risk of Pad

  • Inflammation is one of the critical issues associated with metabolic disorders such as diabetes. Patients with diabetes tend to have more significant inflammation around their bodies, specifically in their blood vessels, due partly to increased levels of circulating cytokines and C-reactive protein.
  • Cellular problems can cause the hardening, or inflexibility, of the arteries and reduce the smooth flow of blood while increasing the risk of PAD. Endothelial cell disruption reduces the critical delivery of nutritive nitric oxide.
  • Diabetes can also cause blood to clot more easily and lead to an increased risk of PAD. Taken together with other factors above, this can also lead to plaque rupture that can cause a blood clot, accelerated symptoms, and serious cardiovascular consequences.

These are only three of the many potential concerns caused by diabetes related to atherosclerosis and PAD in the extremities. Importantly, it shows the relationship between certain metabolic disorders and the risk of PAD. We encourage all patients who aren’t at elevated risk for PAD to speak to their primary care physician about the possibility of a simple ankle-brachial index or ABI test that can help diagnose and direct treatment for PAD. This is especially useful for patients suffering from obesity and metabolic diseases associated with excess weight.

If you suffer from diabetes or have experienced peripheral neuropathy (unusual pain or sensation in the extremities), you can also schedule a consultation with one of our physicians to evaluate your peripheral arterial health.


  1. Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes. 2015 Jul 10;6(7):961-9. doi: 10.4239/wjd.v6.i7.961. PMID: 26185603; PMCID: PMC4499529.