World Diabetes Day 2025: Diabetes, Artery Health and Foot Care

Diabetes can affect the blood vessels long before a person notices a circulation problem. For World Diabetes Day, my video explains why looking after your arteries belongs alongside managing blood glucose. The aim is to recognise risk early, identify problems that need treatment and protect long-term health.

A circulation assessment is most useful when it answers a clear clinical question. It should be guided by symptoms, examination and individual risk, with a plan for what the findings will change.

How can diabetes damage the arteries?

Persistently high blood glucose can damage blood vessels and contribute to atherosclerosis, the build-up of plaque within artery walls. Blood pressure, cholesterol, smoking and other factors also influence risk. As arteries become narrowed, less blood may reach the tissues they supply.

The consequences depend on the location. Arterial disease can contribute to heart attacks, strokes and reduced blood flow to the legs and feet. In the legs, this is known as peripheral arterial disease, or PAD.

Diabetes does not mean that every artery is blocked. It means that vascular risk deserves active attention, even when someone feels well.

Why are the feet especially important?

Two problems can occur together: reduced circulation and nerve damage. Poor circulation can make wounds harder to heal. Nerve damage can reduce sensation, so a blister, pressure injury or small cut may go unnoticed.

This is why pain alone is an unreliable warning system. A foot can need attention even if it does not hurt. Look over both feet regularly, including the soles and between the toes, and seek help if you cannot examine them yourself. Appropriately fitting footwear and regular foot reviews are also important.

A diabetic foot ulcer is a serious complication, but it is not a prediction that an amputation is inevitable. Prompt assessment, infection treatment when needed, pressure relief and attention to circulation can all form part of a coordinated care plan.

What can an ABPI or arterial duplex ultrasound show?

An ankle–brachial pressure index, also called ABPI or ABI, compares blood pressure at the ankle with blood pressure in the arm. It helps assess whether arterial narrowing may be reducing blood flow to the legs.

Diabetes can make arteries stiff and difficult to compress. This can produce a normal-looking or high ankle pressure despite underlying disease. A normal ABPI therefore does not rule out PAD by itself in someone with diabetes.

Arterial duplex ultrasound uses sound waves to examine arteries and blood flow. Depending on the findings, other measurements, such as toe pressures, may also be helpful. These tests assess particular aspects of circulation; they do not provide a single all-clear for every artery in the body.

Does everyone with diabetes need the same vascular tests?

No. The assessment should start with the history and examination, including symptoms, foot condition, pulses and previous ulcers or vascular disease. Your clinician can then decide which tests are appropriate and whether a specialist review is needed.

Tell your care team about calf discomfort when walking, a change in walking distance, persistent foot pain, colour changes or a wound that is slow to heal. An absence of typical walking pain does not exclude a circulation problem.

When should a foot problem be checked urgently?

A new ulcer, spreading redness, discharge or a hot, swollen foot needs prompt medical assessment. Seek emergency care for a suddenly cold, pale or numb foot, severe new pain, blackened tissue or a foot infection accompanied by fever or feeling seriously unwell. Do not wait for a routine appointment if the foot is deteriorating.

What helps protect vascular health over time?

Work with your usual care team on blood glucose, blood pressure and cholesterol, take prescribed treatment consistently and seek support to stop smoking if needed. Combine these measures with foot care and physical activity suited to your condition.

For concerns about diabetes and leg circulation, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. An individual assessment can help clarify the next step.