Peripheral vascular disease

Peripheral vascular disease is an important risk factor for diabetic foot disease which still leads to the loss of 5,000 lower limbs every year in the UK. It should be detected early by examining pedal pulses at the annual review and managed actively with lipid modification, smoking cessation, antiplatelet agents and surgical referral for revascularisation.

HbA1c

An essential baseline when considering any diabetes complication.

Fasting lipids

A full fasting lipid profile - including total and HDL cholesterol, LDL cholesterol and triglycerides - is an important first step to managing cardiovascular risk in diabetes.

U+Es

An essential baseline when considering any diabetes complication. It may also alert the physician to the potential presence of reno-vascular disease.

ECG

An ECG should be performed if there is the slightest suspicion of ischaemic heart disease as it can be asymptomatic.

In some clinics, ECGs are performed routinely on all new patients as part of baseline assessment.

Doppler probe

If the pedal pulses are impalpable they should next be sought by hand held Doppler probe.

ABPI

The ankle-brachial pressure index is measured by taking the blood pressure in the arm and the blood pressure in the leg with a cuff around the calf and a Doppler probe on the dorsalis pedis/posterior tibial artery. The systolic in the foot is then expressed as a ratio to the systolic in the arm.

When the ABPI is normal (close to or above one) this can give false reassurance as the arterial wall in diabetes may become hardened and in compressible. However, ABPIs less than 0.7-0.6 are significant as they show reduced perfusion pressure in the pedal arteries.

Doppler duplex arterial scanning

Doppler duplex scanning is a non-invasive method of assessing the arterial tree in considerable detail. It provides information about stenoses and flow by assessing wave form.

Arteriography

Arteriography may be performed by a number of different methods including intra-arterial injection of contrast, MRI angiography and CT angiography. 

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