Definition and Overview

Diabetic peripheral angiopathy (DPA) is a blood vessel disease caused by high blood sugar levels (glucose). It is one of the most common complications of diabetes. It affects blood vessels that carry oxygen-rich blood away from the heart. These vessels supply blood to many different parts of the body. However, DPA often affects blood vessels in the legs and feet.

Diabetes is a chronic disease that occurs when the body does not produce enough insulin. It can also occur if cells do not respond well to insulin. Diabetes prevents glucose (the body’s main source of energy) from reaching the cells. Thus, glucose builds up in the blood.

DPA has two main types, namely macroangiopathy and microangiopathy. The former causes blood clots to form in large blood vessels and cause a blockage. This prevents blood from reaching vital organs, such as the heart and the brain. Thus, it increases the risk of heart attack and stroke. Microangiopathy, on the other hand, affects the smaller blood vessels. The condition makes them thick and weak. As a result, the flow of blood throughout the body is slowed down. This increases the risk of diabetic retinopathy (which can lead to blindness) and kidney disease.

Causes of Condition

Diabetic peripheral angiopathy occurs due to uncontrolled diabetes.

Diabetes increases the risk of atherosclerosis. This refers to the build-up of plaque in the arteries. Plaque is made up of substances found in blood, such as calcium and cholesterol. Too much plaque in the arteries can limit the amount of blood that flows through the affected blood vessel. It can also completely obstruct or cut off blood supply to other body parts.

Without enough blood supply, tissues on the affected body parts will not survive. This may create the need for amputation.

Key Symptoms

Peripheral angiopathy brought on by diabetes usually results in poor blood circulation. This often leaves the lower limbs without enough blood supply. This means that the affected parts are not getting enough oxygen, nutrients, and white blood cells they need to fight infections. This often leads to serious problems, including permanent damage to limbs.

Signs of the condition are leg pain (especially when walking), cramping, and muscle pain. In mild to moderate cases, the symptoms go away after a few minutes of rest. In severe cases, on the other hand, patients suffer from symptoms even when they are resting. Leg pain can be severe and may restrict mobility.

Other symptoms include:

  • A weak pulse in the legs or feet.

  • Coldness in the lower leg or foot due to insufficient supply of warm blood.

  • Leg weakness or numbness. This prevents a person from standing or walking normally.

  • Legs that appear bluish in colour.

  • Reduced hair growth on the legs.

  • Thick and opaque toenails.

  • Wounds on the foot or leg that are slow to heal.

Who to See and Types of Treatments Available

People with diabetes are at risk of DPA. This is why regular screening for DPA is part of the management of their disease. This helps doctors diagnose DPA before it can cause damage. A diabetes specialist, called an endocrinologist, treats and manages the condition.

DPA is diagnosed with the following tests:

  • A physical exam to look for signs of DPA - These include a weak pulse and wounds that are slow to heal.

  • Imaging tests - A Doppler ultrasound and magnetic resonance angiogram (MRA) are used to check blood flow to the limbs. These tests can show if the arteries are narrowed or blocked by plaque or blood clots. The tests can also help doctors identify the exact location of the blockage.

Treatment of DPA focuses on preventing the condition from progressing and complications from developing. This may involve the following:

  • Maintaining normal blood sugar levels - Insulin therapy is recommended for patients with type 1 or type 2 diabetes. This treatment helps normalise their blood sugar levels. Patients are also advised to achieve and maintain an ideal weight by exercising regularly and making dietary changes.

  • Treatment of high blood pressure - Many patients with diabetes also have high blood pressure. This makes diabetes even worse. This can be managed with medications and healthy lifestyle changes. Patients are advised to stop smoking, exercise more often, and avoid drinking alcohol. They are also advised to eat a healthy, well-balanced diet.

  • Improving cholesterol levels - This can also be achieved by making healthy lifestyle changes.

  • Regular eye check-ups - Patients must undergo a general eye examination at least once a year if they have DPA. This can help reduce their risk of vision-related complications.

  • Proper foot care - Patients must make it a habit to check their feet and legs for wounds on a daily basis. This is because DPA slows down healing. A simple cut or bruise can increase a patient’s risk of infection. Because their legs do not receive enough blood supply, it is likely that a wound can lead to tissue death and later, to amputation.

In many cases, DPA is difficult to cure especially in patients with other medical conditions, such as hypertension. Thus, the preferred approach is to prevent it from occurring. Patients with diabetes must work closely with their endocrinologist to keep their blood sugar under control. With medications and a healthy lifestyle, the many complications of diabetes can be prevented.

References:

  • Holt, Richard I. G.; Cockram, Clive; Flyvbjerg, Allan; Goldstein, Barry J. (2016). Textbook of Diabetes. John Wiley & Sons. p. 543. ISBN 9781118924877. Retrieved 19 October 2017.

  • Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103–117. doi: 10.1016/0168-8227(95)01064-K.

  • Waltenberger J. VEGF resistance as a molecular basis to explain the angiogenesis paradox in diabetes mellitus. Biochem Soc Trans. 2009;37:1167–1170. doi: 10.1042/BST0371167.

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