By Kym McNicholas, Chairman & CEO of the Global PAD Association
PAD happens when the arteries in your legs become narrowed, reducing blood flow to your muscles. This creates a frustrating situation: walking is the best treatment, but the pain makes walking incredibly difficult.
For people living with both diabetes and PAD, this challenge is even greater. But there’s exciting news that could change your life.
(Watch full interview with The Stride Trial lead researcher Dr. Marc Bonaca below)
Why Diabetes and PAD Together Are Concerning
If you have diabetes, you’re at higher risk for developing PAD. Here’s why: the high blood sugar levels in diabetes can damage the walls of your blood vessels over time. This damage leads to inflammation and the buildup of fatty deposits (plaque) in your arteries, especially those in your legs.
What makes this combination particularly dangerous is that PAD often goes unrecognized in people with diabetes because the symptoms can be different from what doctors typically look for.
“Many doctors were taught to look for calf pain when walking that goes away with rest. That’s classic PAD,” explains Dr. Marc Bonaca from the University of Colorado School of Medicine. “But that’s only a small percentage of people with PAD. Most people experience very different symptoms—heavy legs, aching in other places, or unusual fatigue.”
If you have diabetes, PAD might show up as:
- Burning in your feet
- Numbness in your legs or feet
- Pain that doesn’t follow the typical pattern
- Wounds on your feet that heal slowly or not at all
These symptoms are often mistaken for diabetic neuropathy (nerve damage) rather than recognized as signs of poor circulation.
“Back pain can also mask PAD,” Dr. Bonaca adds. “I’ve seen many patients whose leg pain was blamed on back problems, and no one checked their circulation.”
This confusion often leads to delayed treatment. Dr. Bonaca shared a story about “a woman in her 40s, a nurse without diabetes, who had a wound on her heel that she couldn’t feel. She saw several doctors, but none of them considered PAD.” Sadly, by the time she was correctly diagnosed, “she needed an amputation.”
Getting Properly Diagnosed
If you have any of these symptoms, especially if you have diabetes, it’s crucial to ask your doctor specifically about checking for PAD. As Dr. Bonaca advises: “If you don’t know whether you have PAD, you need to ask your doctor to check. And if they don’t take your shoes and socks off in the office and feel the pulses in your feet, they’re not checking properly.”
He urges patients to be honest about their symptoms rather than minimizing them. “Don’t make excuses. It’s not okay if you can’t walk. You should be able to walk.”
Early diagnosis can make all the difference in preventing serious complications like wounds that won’t heal or even amputation. This is especially true for people with diabetes, who face a significantly higher risk of these complications when PAD is present.
A Breakthrough Treatment Offers New Hope
For patients diagnosed with both conditions, there’s exciting news. A recent study called the STRIDE trial has discovered that semaglutide—a medication you might know as Ozempic or Wegovy—significantly improves walking ability in people who have both type 2 diabetes and PAD.
This finding was so important that it earned Dr. Bonaca’s team the Breakthrough Walking as Therapy Research of the Year Award at the recent Global PAD Impact Awards.
“It’s been 25 years since we’ve had an effective therapy shown to help people with PAD walk better,” Dr. Bonaca explained. “The last medication was approved around 2000. Many doctors thought this was an unsolvable problem.”
The STRIDE trial results change everything. In this carefully conducted study involving 792 patients across 20 countries, weekly injections of semaglutide 1.0 mg showed remarkable improvements.
“People taking semaglutide could walk 40 meters farther than those taking a placebo,” Dr. Bonaca said. “To put that in perspective, most studies consider a 20-meter improvement to be meaningful for patients. This was double that. And they were walking on a 12% grade—a pretty steep hill.”
Even more impressive, semaglutide improved patients’ ankle-brachial index (ABI), a test that measures blood flow in your legs. According to Dr. Bonaca, “To my knowledge, it’s the first medication to improve that measurement.”
How Does This New Treatment Work?
While you might know semaglutide (Ozempic, Wegovy) for its weight loss effects, the benefits for PAD appear to work differently.
“Weight loss was actually quite modest in our study,” Dr. Bonaca explained. “Many people with PAD don’t have obesity, and in our study, it didn’t matter how much weight a person lost. The improvement in walking ability had very little connection to weight change.”
Instead, the medication seems to work directly on your blood vessels—especially the tiny vessels that supply your muscles and skin, which are often damaged when you have diabetes.
“This appears to be a direct effect on the blood vessels, not just the large arteries but also the tiny ones,” Dr. Bonaca said. “That’s exciting because we haven’t had effective treatments for those small vessels before.”
Researchers first got this idea from an earlier study called LEADER, which showed that a similar medication reduced diabetic foot ulcers and amputations by 30-40%. This led them to investigate whether these medications might be helping blood vessels directly.
The improvement in these small blood vessels could explain why patients can walk farther and with less pain. Better circulation means your muscles receive more oxygen during activity, reducing the cramping and pain that typically forces you to stop.
Combining Medication with Walking: The Perfect Partnership
Dr. Bonaca emphasizes that semaglutide should be used alongside, not instead of, regular walking.
“Exercise therapy is still the foundation of PAD treatment,” he stressed. “This medication doesn’t replace walking—it helps make walking possible.”
This combination creates a powerful partnership. Exercise benefits fade quickly when you stop, but many PAD patients can’t walk far enough to get those benefits in the first place. Having a medication that helps you walk far enough to engage in meaningful exercise could create an upward spiral of improvement.
The more you can walk, the stronger your circulation becomes. Your body actually grows new blood vessels (called collateral vessels) that act as natural bypasses around blockages. These new pathways can significantly improve blood flow to your legs over time.
The STRIDE trial also showed the medication “delayed or prevented the need for rescue treatments”—potentially reducing the need for invasive procedures like stenting or bypass surgery, which Dr. Bonaca notes “don’t last very long” and come with “many complications.”
Who Can Benefit from This Treatment?
The researchers are continuing to analyze their data and have found consistent benefits across different groups of patients.
At the American Diabetes Association meeting in June, they showed the benefits were the same regardless of:
- A1C levels (a measure of blood sugar control)
- How long someone had diabetes
- What other medications they were taking
At another major medical meeting, they demonstrated that both men and women benefited equally—an important finding since women with PAD sometimes have different symptoms or responses to treatment.
The researchers will soon report on whether the medication works for people who smoke, though early analysis suggests “the effect was consistent whether or not you smoke.”
These findings indicate that semaglutide could help a wide range of patients with both diabetes and PAD, regardless of their specific situation.
When Will This Treatment Be Available?
If you’re wondering when you might be able to discuss this treatment with your doctor, there’s good news. The STRIDE trial’s results are already influencing regulatory decisions. The European Medicines Agency has issued “a very positive statement about STRIDE for approval,” according to Dr. Bonaca, and FDA review is likely coming soon.
Dr. Bonaca hopes doctors won’t wait for updated guidelines before considering this therapy for appropriate patients. “I hope action doesn’t wait for the guidelines. The guidelines are important, but we have data today and these medications are already available.”
For people who have PAD but don’t have diabetes, there’s also promising news. “We don’t know from STRIDE whether semaglutide would improve function in someone with PAD without diabetes,” Dr. Bonaca acknowledged, “but we do know in that population, if they have a BMI above 27 based on another trial called SELECT, that they would have a reduction in heart attack and stroke.”
New studies looking at semaglutide’s effects in people with PAD who don’t have diabetes may begin within the next year or two.
Success Stories: PAD Can Be Improved
Most importantly, understand that PAD is not an inevitable downward spiral. “You can improve this condition,” Dr. Bonaca emphasized. “It is not a foregone conclusion. We all have the power to make things better.”
He shared a story of a patient with severe disease below the knee who seemed headed for amputation. Instead, through exercise, dietary changes, and aggressive cholesterol management, “she got a job in a grocery store where she was walking around all the time, stocking shelves, and forced herself to be active.” Two years later, “she functions excellently. She doesn’t complain of pain. She doesn’t have pain at rest. We’re not even discussing any procedures for her legs.”
Stories like this demonstrate that with the right approach, PAD symptoms can improve significantly. The addition of medications like semaglutide could make this journey easier for many patients, especially those with diabetes.
Taking Action: What You Can Do Today
Doctors understand it’s not easy to stay active when you have leg pain. That’s why the STRIDE trial represents such an important step forward. By improving your ability to walk, semaglutide could help you engage in the exercise that builds life-saving “natural bypasses” around blockages in your arteries.
As Dr. Bonaca put it: “Walking is truly the best medicine. This therapy helps patients build a vital network of vessels that bypass those blockages.”
For the millions of people living with both diabetes and PAD, this breakthrough offers new hope and a path to maintain mobility, independence, and quality of life.
Do you have symptoms that might be PAD? If you experience leg pain, cramping, numbness, or have wounds that won’t heal, call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS (1-833-723-5347) to discuss your symptoms and learn more about how walking can be your medicine.
Disclaimer: The Global PAD Impact Awards are not an endorsement of any specific doctor. Awards are based on clear criteria, nominated by patients and approved by a diverse panel of experts. Always call the Leg Saver Hotline for help finding the right doctor for your specific situation.