Two new articles have been published from two completely different resources, both pointing at the importance of timely vascular assessment in people with diabetes. In people with diabetes, absent pedal pulses are independent predictors of major vascular outcomes, and in people with a foot ulcer revascularisation needs to take place within two weeks to avoid poor limb salvage outcomes.
The first study results come from Australian researchers that are part of the ADVANCE collaborative group. Although being relatively old (first patients in this database were included 15 years ago), the data of these 11,120 patients still provide a valuable resource for new insights on diabetes and vascular disease. In the current analyses, the researchers looked at the absence of peripheral pulses at baseline. Absence of pulses was associated with a great deal of major vascular outcomes, from macro- and microvascular events, to all-cause mortality. When more pulses are absent, the risk increases.
Despite questions on the consistency between clinicians to adequately assess pedal pulses, findings from such a large cohort and using such a simple clinical indicator stress the importance of vascular assessment in people with diabetes, to be followed with treatment to prevent these severe vascular outcomes.
The speed with which treatment starts is even more important in people with a diabetic foot ulcer. This well-known clinical paradigm was nicely underlined in new Finnish research. A comparison of revascularisation in 246 limbs (159 with diabetes) showed poorer limb salvage for people with diabetes. However, this effect was not apparent when people with diabetes were revascularised within two weeks.
If not already part of your daily clinical practice, these two studies confirm just how important timely vascular assessment and treatment is, by both the internist and the surgeon. A patient with absent pedal pulses deserves treatment to prevent major vascular outcomes, and a patient with an ischemic foot ulcer deserves revascularisation within two weeks.