Historically, diabetes management focused on blood glucose control and preventing severe complications such as neuropathy and amputation. Over the past two decades, this limited view has proven insufficient for long-term health. Many now emphasize risk factor management, lifestyle changes, and early screening instead of crisis response.
The vascular health risk of a diabetes surge
Diabetes is an epidemic: In the last decade alone, the number of adults living with the disease globally more than quadrupled since 1990, and now exceeds 800 million people. Even more concerning, younger individuals increasingly present symptoms typically only seen in older adults. Incident rates in youth have risen 94 percent from 1990 to 2021, with type 2 rates surpassing those of type 1, which is especially concerning given that type 2 significantly increases the chance of developing peripheral artery disease (PAD), the leading cause of amputation in the U.S.
Despite this, many people with diabetes remain unaware of the link between their condition, PAD, and other vascular diseases. In fact, according to a consumer survey from the Society for Vascular Surgery, more than half (55 percent) of Americans would wait at least a few days before scheduling an appointment with a provider if they noticed persistent leg pain or difficulty walking, the most common symptoms of vascular disease. This underscores the growing urgency for early vascular evaluation, not just glucose control, to prevent complications from progressing to the point of limb loss.
From silos to synergy
Collaboration is needed among clinicians for early interventions like comprehensive vascular assessments, consistent glucose monitoring, and tracking glycemic control to avoid amputations. Routine tests that monitor blood sugar and circulation, such as podiatry referrals, pulse checks, and ankle-brachial and toe-brachial indices (ABIs and TBIs), can make limb preservation a greater reality. With recent SVS survey findings showing that 80 percent of primary care providers are not confident in recognizing and diagnosing vascular conditions, the path forward is clear: Primary care providers and vascular specialists must work together to shift outcomes and prioritize patient mobility, independence, and quality of life.
No single clinician can preserve limbs alone; the best outcomes stem from a unified, multidisciplinary approach. Patients should have a robust care team, made up of vascular surgeons, podiatrists, endocrinologists, cardiologists, nutritionists, physical therapists, and primary care professionals. This allows us to work more efficiently while improving diagnosis, treatment, and management effectiveness for our patients with diabetes.
This collaborative approach allows us to best utilize the resources around us. That includes telehealth and remote studies for follow-up, as well as using entire care teams. Advanced practice practitioners (APPs) serve as critical force multipliers to manage patients with diabetes in both inpatient and outpatient settings. When APPs receive ongoing, specialized training, for example, in modern wound care that prioritizes advanced products over outdated wet-to-dry dressings, we can ensure consistent, high-quality patient management since diabetes often affects the body’s ability to heal. This not only provides us with additional support but also empowers APPs to advocate for patients, navigate hospital barriers, and improve throughput. When all members of the care team are aligned, we create a system capable of sustained limb preservation rather than reactive intervention.
Early intervention isn’t optional, it’s the future of diabetes care
As diabetes and vascular disease continue to evolve, it is our collective responsibility as health care providers to ensure we are utilizing early treatment methods. Timely, team-based intervention is no longer optional; it is essential in every patient’s diabetes care journey.
By embedding preventive strategies into routine diabetes care, proactive vascular screenings, patient education, and lifestyle management, we dramatically reduce the incidence of severe complications like amputations. Preventive care is not simply a clinical step, but a cultural shift toward improving mobility, independence, and longevity. When we prioritize early detection, multidisciplinary collaboration, and patient empowerment, we move beyond simply managing diabetes and instead transform outcomes by redefining what quality care truly means.
Palma Shaw is a vascular surgeon.
