Intermittent claudication (IC) — pain on walking that resolves at rest — is not a trivial complaint but is the first recognisable symptom of peripheral arterial disease (PAD). Diabetes is one of the most important risk factors for PAD and in people with diabetes it tends to be more distal and severe, and more likely to result in gangrene and amputation. Early diagnosis of PAD can reduce the substantial morbidity of the condition, which can culminate in limb loss for some patients. IC in the patient with diabetes can be treated with lifestyle modification, exercise programmes, medical treatment or bypass surgery.
Leng GC, Lee AJ, Fowkes FG et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol1996;25:1171-81.
2.
Brand FN, Abbot RD, Kannel WBDiabetes, intermittent claudication and risk of cardiovascular events. The Framingham Study. Diabetes1989;38: 504-09.
3.
Hendra T.New guidelines for antiplatelet agents. Geriatric Medicine2003;October:89-96.
4.
Dormandy JANatural history of intermittent claudication. Hospital Update1991;17:314-20.
5.
Dormandy JA, Rutherford RBManagement of peripheral arterial disease (PAD): TASC Working Group.TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg2000;31(1pt 2): S1-S296.
6.
Jonason T., Ringqvist I.Factors of prognostic importance for subsequent rest pain in patients with intermittent claudication. Acta Med Scand1985;218:27-33.
7.
Fowkes FG, Housley E., Cawood EH, Macintyre CC, Ruckley CV, Prescott RJEdinburgh Artery Study: Prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol1991;20:384-92.
8.
LoGerfo FW, Gibbons GWClinical features and treatment of peripheral vascular disease in diabetes mellitus In: KGMM Alberti, P Zimmer, RA DeFronzo , H Keen (eds.). International Textbook of Diabetes Mellitus, Second Edition. Chichester: John Wiley & Sons Ltd, 1997.
9.
Weitz JI, Byrne J., Clagett GP et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation1996;94:3026-49.
10.
Schmieder FA , Comerota AJIntermittent claudication: magnitude of the problem, patient evaluation and therapeutic strategies. Am J Cardiol2001;87:3D-13D.
11.
Leng GC, Fowkes FGThe Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. J Clin Epidemiol1992;45:1101-09.
12.
Kannel WBThe demographics of claudication and the ageing American population . Vasc Med1996;1:60-4.
13.
Olin JWClinical evaluation and office-based detection of peripheral arterial disease . In: An office-based approach to the diagnosis and treatment of peripheral arterial diseaseAm J Med `Continuing Medical Education Series,'1998;10-17.
Robless P., Mikhailidis DP, Stansby G.Systematic review of antiplatelet therapy for the prevention of myocardial infarction, stroke or vascular death in patients with peripheral vascular disease. Br J Surg2001;88: 787-800.
16.
The Heart Outcomes Prevention Evaluation Study Investigators.Effects of an angiotensin converting enzyme inhibitor, ramipril, on cardiovascular events in high risk patients . New Engl J Med2000;342:145-53.
17.
Heart Protection StudyCollaborative Group.MRC/BHF Heart protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet2002;360:7-22.
18.
British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary43. March 2002, BMA and RPSGB, London.
19.
Chapman TM, Goa KLCilostazol. A review of its use in intermittent claudication. Am J Cardiovas Drugs2003;3:117-38.
20.
Hittel N., Donnelly R.Treating peripheral arterial disease in patients with diabetes. Diabetes Obes Metab2002;4(suppl 2):S26-S31.
21.
Rendell M., Cariski AT, Hittel N., Zhang P.Cilostazol treatment of claudication in diabetic patients. Curr Med Res Opin2002;18:479-87.
