We read with great interest the article by Gyldenkerne et al. (1), which was published in the January 2025 issue of Diabetes Care. We commend the authors for their insightful research on time trends in peripheral artery disease (PAD) among patients with incident type 2 diabetes (T2D). Their retrospective study, conducted in Denmark, highlights a significant decrease in the 5-year cumulative incidence of PAD (adjusted hazard ratio [aHR] 0.55 [95% CI 0.52–0.57]) between 1996–2000 and 2011–2015. T2D and PAD represent growing global health concerns, with important implications for cardiovascular and limb-related morbidity and mortality, quality of life, and health care resource use and costs (2). Diabetes is a recognized risk factor for PAD, and the occurrence of PAD in individuals with T2D serves to further increase the risk of long-term complications (2,3). The important study by Gyldenkerne et al. contributes valuable insights into the positive effects of improved diabetes management over time in the transition to the technology age.

To build upon their work, we conducted a retrospective analysis in Germany using a similar, but not identical, study design, using data from the Disease Analyzer database (IQVIA). This database comprises anonymized demographic data, diagnoses, and prescriptions derived from office-based German practices (4). In our analysis, we examined two distinct time periods, comparing individuals with a new-onset T2D diagnosis between the periods 2000–2005 and 2013–2018. Patients from both periods were followed for up to 5 years to evaluate and compare the cumulative incidence of PAD.

Our analysis included 30,524 individuals with T2D treated by 685 physicians in 2013–2018 (median age 62 years, 51% male) and 126,604 individuals treated by 1,261 physicians in 2000–2005 (median age 62 years, 51% male). The 5-year cumulative incidence of PAD was assessed using Kaplan–Meier curves, while associations between the periods (2013–2018 vs. 2000–2005) and PAD risk were evaluated using multivariable Cox regression models.

In line with the findings of Gyldenkerne et al. (1), our analysis revealed a decline in the 5-year cumulative incidence of PAD, from 5.2% to 4.5%, with an aHR of 0.83 (95% CI 0.78–0.88), between 2000–2005 and 2013–2018. Despite the shorter interval between the comparison periods in our study (13 years) compared with that of Gyldenkerne et al. (>20 years), the decline in PAD incidence among individuals with T2D remains evident and significant. By examining a different time frame, our analysis provides complementary insights into the pace of these improvements.

Our investigation supports and extends the findings of Gyldenkerne et al. (1), confirming that the cumulative incidence of PAD has also decreased in Germany over time. This cross-country comparison underscores the generalizability of the trend, showing that reductions in PAD incidence are observed across distinct health care systems despite differences in infrastructure and patient populations. The findings underscore significant advancements in treatment of T2D and cardiovascular disease over recent decades, likely driven by improved early detection, risk factor management, and therapeutic interventions.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Handling Editors. The journal editor responsible for overseeing the review of the manuscript was Steven E. Kahn.

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