The American Diabetes Association develops evidence-based clinical practice recommendations, or position statements, on medical issues related to diabetes. These statements are typically based on a thorough, balanced review of the literature.
Consensus statements are developed when there are clinical issues and insufficient evidence to produce a definitive position statement, as is the case for peripheral arterial disease (PAD) in diabetes. Before the development of a consensus statement, a panel of experts listens to presentations on the particular subject. A consensus statement represents the panel’s collective analysis, evaluation, and opinion, based in part on the presentations.
Based on the available evidence and the prevalence and burden of PAD in diabetes, the consensus panel believes that reasonable recommendations were made regarding screening and treatment.
A primary reason to diagnose PAD is to identify a person who has a high likelihood of having a cardiovascular event and begin intensive risk-reduction interventions. Although diabetes alone is considered a cardiovascular disease risk equivalent, most diabetic patients are not under optimal management. In fact, a recent study (1) found that just 7.3% of patients with diabetes meet the recommended goals for HbA1c, blood pressure, and cholesterol. A diagnosis of PAD confers additional cardiovascular risk to the patient with diabetes and gives further impetus to aggressively manage risk factors that may be overlooked.
A diagnosis of PAD may also prevent a limb-threatening event. This applies especially to the asymptomatic patients who may suddenly develop critical limb ischemia. Thus, patients with diabetes and PAD should be placed in preventative care by foot care specialists. This includes skin care, nail care, and shoe prescriptions as recommended by the American Diabetes Association (2).
When medical societies and other organizations agree that particular screening tests are important and impact outcomes, reimbursement may likely be influenced. The panel believes that publishing these screening recommendations is the first step to ensuring that government and other health insurers reimburse for the ankle brachial index, the preferred screening test for PAD, in the future to help defray the costs of extra time and equipment that the busy practitioner must incur.
