The ADA Standards of Care in Diabetes (2024) state that chronic hyperglycemia contributes to both microvascular and macrovascular damage. This includes:
Blood Sugar & Diabetes
Damage to small blood vessels (microvascular complications such as neuropathy)
Damage to larger arteries (macrovascular disease such as coronary artery disease and peripheral artery disease)
Similarly, the AHA Scientific Statement on Cardiovascular Disease in Diabetes explains that diabetes accelerates atherosclerosis — the buildup of plaque inside arteries — increasing the risk of heart attack, stroke, and peripheral artery disease (PAD).
When blood vessels narrow or stiffen due to plaque buildup, circulation to the lower extremities decreases. The feet, being the farthest point from the heart, are particularly vulnerable.
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