Management of PAD in Patients With Diabetes Addressed in ACC Scientific Statement

December 29, 2025—The American College of Cardiology (ACC) announced that a new scientific statement on the management of peripheral artery disease (PAD) in adults with diabetes was published by Sandeep R. Das, MD, et al in JACC.

According to ACC, the new scientific statement adds context to the multisociety lower extremity PAD guideline that was published in May 2024.

The ACC noted that the statement provides specific evidence-based consensus recommendations for screening, diagnosis, and management of PAD in this patient population, which is at higher risk for cardiovascular events and amputations. The document states that screening for PAD is reasonable for asymptomatic adults with diabetes and other risk-enhancing factors such as smoking, diabetes duration, foot complications, age (> 65 years), and others.

As outlined by ACC, recommendations from the statement cover the following:

• When to use measurement of the ankle-brachial index versus toe-brachial index in screening
• Smoking cessation, physical activity (including structured exercise therapy), and healthy diets
• Daily foot inspections by the patient or caregiver and an annual foot evaluation by a qualified clinician
• Routine evaluation with hemoglobin A1C testing and assessment for diabetic retinopathy, diabetic kidney disease, diabetic neuropathy, and other forms of atherosclerotic cardiovascular disease
• Prioritization of SGLT2 inhibitors and GLP-1RA (for their broad cardio-kidney-metabolic benefit) as well as targets for treating low-density lipoprotein cholesterol and hypertension
• Use of rivaroxaban (2.5 mg twice a day) and aspirin (75-100 mg daily) to reduce major adverse cardiac and limb events in patients not at high risk for bleeding events
• Evaluation by a limb salvage team before an amputation
• Use of multidisciplinary care teams as clinically indicated, including cardiology, endocrinology, podiatry, primary care, vascular medicine, and vascular surgery