Recent Advances In The Research Of Diabetic Patients With Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes mellitus (DM) is fourfold higher compared to non-diabetic population. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI<0.9is not only diagnostic of PAD even in the asymptomatic patient,but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. A range of factors (higher age, arterial hypertension, smoking, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified,but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. In recent years, blood vessels was new renewable become hot, mainly refers to the exogenous angiogenesis induced factor into the ischemia organization, promote its angiogenesis and collateral formation of blood vessels. Therapeutic angiogenesis including two strategies, is to use a cell factors of recombinant protein or genes promote angiogenesis, and the other is will have the multiplex differentiation potential stem cell transplantation to ischemic tissues, through the cell differentiation for vascular endothelial cells, and promote blood vessel growth factors have to realize angiogenesis.Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD.