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Medicina
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Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic...
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Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 January 2025) | Viewed by 11651

Special Issue Editors

Dr. Giuseppe Miceli

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Guest Editor
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
Interests: peripheral artery disease; neurosonology; atherosclerosis; transcranial doppler; cerebral hemodynamic
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Antonino Tuttolomondo

E-Mail Website
Guest Editor
1. Internal Medicine and Stroke Care Ward, Policlinico P. Giaccone, Palermo, Italy
2. ProMISE Department, University of Palermo, Palermo, Italy
Interests: ischemic stroke in diabetes; diabetic foot; Anderson-Fabry disease; cytokines
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Peripheral artery disease (PAD) in individuals with diabetes presents a multifaceted challenge that demands comprehensive prevention, early diagnosis and innovative therapeutic approaches. Diabetes is a major risk factor for PAD, characterized by progressive artery stenosis, particularly in limbs, leading to a reduced blood flow and the potential complications such as pain, ulcers and even amputation.

Prevention is pivotal in mitigating the impact of PAD in diabetic patients. Tight glycemic control, alongside lifestyle modifications including regular exercise and smoking cessation, plays a central role in averting the progression of arterial disease. Moreover, reducing cardiovascular risk is mandatory for these patients. Early detection through non-invasive diagnostic methods like ankle-brachial index (ABI) is crucial, enabling the timely intervention to impede the advancement of PAD. Furthermore, the emerging diagnostic technologies, such as advanced imaging modalities and artificial intelligence, promise an enhanced precision in identifying vascular atherosclerotic lesions.

In the realm of therapeutics, a paradigm shift is underway. Targeted pharmacological interventions and innovative revascularization techniques, including angioplasty and stent placement, offer new avenues for managing PAD in diabetes. Additionally, research into regenerative medicine and gene therapies holds promise for novel approaches to restore vascular health.

This Special Issue aims to attract original research and review articles interested in describing the complex interplay between diabetes and PAD, focusing on the importance of new strategies for cardiovascular risk control, emerging diagnostic tools and innovative therapeutic paradigms.

Dr. Giuseppe Miceli
Prof. Dr. Antonino Tuttolomondo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral artery disease
  • diabetes
  • atherosclerosis
  • cardiovascular risk
  • diabetic foot
  • antithrombotic therapy
  • oral hypoglycemic agents
  • regenerative medicine
  • artificial intelligence

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Published Papers (4 papers)

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Review

31 pages, 1976 KiB  
Review
The Potential Impact of SGLT2-I in Diabetic Foot Prevention: Promising Pathophysiologic Implications, State of the Art, and Future Perspectives—A Narrative Review
by Giuseppe Miceli, Maria Grazia Basso, Andrea Roberta Pennacchio, Elena Cocciola, Chiara Pintus, Mariagiovanna Cuffaro, Martina Profita, Giuliana Rizzo, Mariachiara Sferruzza and Antonino Tuttolomondo
Medicina 2024, 60(11), 1796; https://doi.org/10.3390/medicina60111796 - 1 Nov 2024
Cited by 1 | Viewed by 3469
Abstract
The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF’s development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. [...] Read more.
The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF’s development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. Sodium–glucose cotransporter 2 inhibitors (SGLT2-i), novel oral hypoglycemic drugs used as an adjunct to standard treatment, have recently changed the pharmacological management of diabetes. Nevertheless, data about the risk of limb amputation, discordant and limited to canagliflozin, which is currently avoided in the case of peripheral artery disease, have potentially discouraged the design of specific studies targeting DF. There is good evidence for the single immunomodulatory, neuroprotective, and beneficial vascular effects of SGLT2-i. Still, there is no clinical evidence about the early use of SGLT2-i in diabetic foot due to the lack of longitudinal and prospective studies proving the effect of these drugs without confounders. This narrative review aims to discuss the main evidence about the impact of SGLT2-i on the three complications of diabetes implicated in the development of DF, the state of the art, and the potential future implications. Full article
(This article belongs to the Special Issue Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms)
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18 pages, 1079 KiB  
Review
From MASLD to PAD: Looking for Cardiovascular Disease Starting from Metabolic Status
by Andrea Boccatonda, Damiano D’Ardes, Veronica Moronti, Jessica Santilli, Alessia Cipollone, Gianfranco Lessiani, Nicoletta Di Gregorio, Carla Serra, Fabio Piscaglia, Claudio Ferri and Francesco Cipollone
Medicina 2024, 60(11), 1781; https://doi.org/10.3390/medicina60111781 - 31 Oct 2024
Cited by 2 | Viewed by 1735
Abstract
Background: Peripheral artery disease (PAD) is still the least studied and evaluated form in clinical practice among atherosclerotic pathologies, despite the increased mortality and comorbidities related to it. The relationship between steatotic liver disease and an increased risk of cardiovascular disease has been [...] Read more.
Background: Peripheral artery disease (PAD) is still the least studied and evaluated form in clinical practice among atherosclerotic pathologies, despite the increased mortality and comorbidities related to it. The relationship between steatotic liver disease and an increased risk of cardiovascular disease has been extensively documented. Methods: The purpose of this work is to perform a review of the evidence linking NAFLD or MASLD to PAD, and examine possible clinical scenarios that arise from this new terminology. Results: The new definition of metabolic dysfunction-associated steatotic liver disease (MASLD) includes the presence of cardiometabolic risk factors and hepatic steatosis without any other underlying causes of hepatic steatosis; this terminology, coined in the hepatological field, could generate confusion, especially in the initial stages of its diffusion and among different medical specialists. Conclusions: Some recent data in the literature have strengthened the evidence of a pathological link between hepatic metabolic alteration (NAFLD or MAFLD) and PAD. Full article
(This article belongs to the Special Issue Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms)
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27 pages, 467 KiB  
Review
Cardiovascular Effectiveness and Safety of Antidiabetic Drugs in Patients with Type 2 Diabetes and Peripheral Artery Disease: Systematic Review
by Antonio Cimellaro, Michela Cavallo, Marialaura Mungo, Edoardo Suraci, Francesco Spagnolo, Desirée Addesi, Medea Pintaudi and Carmelo Pintaudi
Medicina 2024, 60(9), 1542; https://doi.org/10.3390/medicina60091542 - 20 Sep 2024
Cited by 1 | Viewed by 2328
Abstract
Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more [...] Read more.
Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more arduous, often due to bilateral, multi-vessel, and distal vascular involvement, in addition to increased systemic polyvascular atherosclerotic burden. On the other hand, the pathophysiological link between PAD and T2D is very complex, involving mechanisms such as endothelial dysfunction and increased subclinical inflammation in addition to chronic hyperglycemia. Therefore, the clinical approach should not ignore vascular protection with the aim of reducing limb and overall CV events besides a mere glucose-lowering effect. However, the choice of the best medications in this setting is challenging due to low-grade evidence or lacking targeted studies in PAD patients. The present review highlighted the strong relationship between T2D and PAD, focusing on the best treatment strategy to reduce CV risk and prevent PAD occurrence and worsening in patients with T2D. The Medline databases were searched for studies including T2D and PAD up to June 2024 and reporting the CV effectiveness and safety of the most used glucose-lowering agents, with no restriction on PAD definition, study design, or country. The main outcomes considered were MACE—including nonfatal acute myocardial infarction, nonfatal stroke, and CV death—and MALE—defined as lower-limb complications, amputations, or need for revascularization. To the best of our current knowledge, GLP-1 receptor agonists and SGLT2 inhibitors represent the best choice to reduce CV risk in T2D and PAD settings, but a personalized approach should be considered. GLP-1 receptor agonists should be preferred in subjects with prevalent atherosclerotic burden and a history of previous MALE, while SGLT2 inhibitors should be used in those with heart failure if overall CV benefits outweigh the risk of lower-limb complications. Full article
(This article belongs to the Special Issue Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms)
14 pages, 342 KiB  
Review
Current Opinion on Diagnosis of Peripheral Artery Disease in Diabetic Patients
by Francesca Ghirardini and Romeo Martini
Medicina 2024, 60(7), 1179; https://doi.org/10.3390/medicina60071179 - 20 Jul 2024
Cited by 5 | Viewed by 3443
Abstract
Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, [...] Read more.
Peripheral arterial disease (PAD) prevalence and diabetes mellitus (DM) prevalence are continuously increasing worldwide. The strong relationship between DM and PAD is highlighted by recent evidence. PAD diagnosis in diabetic patients is very important, particularly in patients with diabetic foot disease (DFD); however, it is often made difficult by the characteristics of such diseases. Diagnosing PAD makes it possible to identify patients at a very high cardiovascular risk who require intensive treatment in terms of risk factor modification and medical therapy. The purpose of this review is to discuss the diagnostic methods that allow for a diagnosis of PAD in diabetic patients. Non-invasive tests that address PAD diagnosis will be discussed, such as the ankle-brachial index (ABI), toe pressure (TP), and transcutaneous oxygen pressure (TcPO2). Furthermore, imaging methods, such as duplex ultrasound (DUS), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are described because they allow for diagnosing the anatomical localization and severity of artery stenosis or occlusion in PAD. Non-invasive tests will also be discussed in terms of their ability to assess foot perfusion. Foot perfusion assessment is crucial in the diagnosis of critical limb ischemia (CLI), the most advanced PAD stage, particularly in DFD patients. The impacts of PAD diagnosis and CLI identification in diabetic patients are clinically relevant to prevent amputation and mortality. Full article
(This article belongs to the Special Issue Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms)
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