Assessment of Peripheral Vascular Disease in Diabetes

R ecognizing the considerable excess burden of both cerebrovascular and lower extremity arterial disease suffered by persons with insulindependent or non-insulin-dependent diabetes mellitus,1,2 a workshop was convened to 1. Provide a current review of the knowledge pertaining to the prevalence, incidence, and risk factor associations of cerebral and peripheral vascular disease in diabetes and 2. Review and make recommendations about the methodology for identifying and quantifying lower extremity arterial disease in either the clinical or research setting. The workshop focused on the specific problems of, and the need for a standard approach to, measurement of peripheral vascular disease in diabetes to ensure appropriate care and facilitate comparability of research findings across studies and over time. Recommendations for the measurement of lower extremity arterial disease (LEAD) in a primary care setting and for epidemiological studies were developed, along with recommendations for more detailed assessment after referral to a vascular clinic. Specific recommendations for the assessment of cerebrovascular disease were not addressed. The detection and appropriate measurement of LEAD was determined to be of great importance, not only in terms of the disease, but also for the strong predictive power that LEAD has for subsequent cardiovascular mortality.3 The workshop started with a series of presentations, which are briefly summarized below, followed by the development of specific recommendations. This report has been written on behalf of all the participants who subsequently reviewed, revised, and approved the final version.