Expert Opinion on Pharmacological Treatment of Diabetic Peripheral Arterial Disease: Clinical Utility of Cilostazol/Ginkgo biloba Extract Combination (Renexin®)
Year: 2026
Type: article
Abstract: Peripheral arterial disease (PAD) is a macrovascular complication of diabetes mellitus associated with a high risk of cardiovascular events, lower-extremity amputation, and impaired quality of life. Cilostazol, a phosphodiesterase-3 (PDE3) inhibitor, is recommended as a first-line pharmacological agent for symptomatic PAD based on evidence that it helps improve walking distance and potentially stabilizes plaques, partly mediated by favorable effects on triglycerides and high-density lipoprotein cholesterol. Ginkgo biloba extract improves hemorheological parameters, including plasma viscosity and hematocrit, and may increase ankle-brachial index in patients with type 2 diabetes mellitus. Also, when used in combination therapy, cilostazol attenuates carotid intima-media thickness progression. However, high-quality evidence for G. biloba extract in diabetic PAD remains limited. Based on a comprehensive review of available clinical evidence and expert consensus, this expert opinion recommends G. biloba extract combination with cilostazol (Renexin®) as a second-line agent or adjunctive therapy primarily for symptom control—particularly the improvement of maximal walking distance—in patients with diabetic PAD who experience insufficient symptom control or intolerance to cilostazol monotherapy. This expert opinion also emphasizes individualized patient selection, careful screening for contraindications, and regular clinical monitoring, and urges large-scale randomized controlled trials in Korean patients with PAD to further establish a greater evidence base for pharmacological treatment.
Source: Journal of Korean Diabetes
Authors: Hwi Seung Kim, Won Jun Kim, Chang Hoon Lee, Hyunmin Ko, Jun Hwa Hong, Seon Mee Kang, Ah Reum Khang, Soo Kyoung Kim, Sang Joon Park, Yeoree Yang, Tae Jung Oh, Jeehee Yoon, Ju Hee Lee, Jin Woo Jeong, Hochan Cho, Dughyun Choi, Hwa Young Kim, Jung-Hwa Lee, Sun Young Kim, Ji-Hyun Lee, Dal Lae Ju, Chong Hwa Kim
Institutions: Seoul National University, Seoul National University Bundang Hospital, University of Ulsan, Gangneung Asan Hospital, Veterans Health Service Medical Center, Chung-Ang University Gwangmyeong Hospital, Daejeon Eulji Medical Center, Eulji University, Soonchunhyang University, Soonchunhyang University Hospital Cheonan, Pusan National University Yangsan Hospital, Gyeongsang National University, Samsung Medical Center, Gyeongsang National University Hospital, Soonchunhyang University Hospital Seoul, The Catholic University of Korea Seoul St. Mary's Hospital, Catholic University of Korea, Chonnam National University, Chonnam National University Hwasun Hospital, Chungnam National University, Ajou University Hospital, Chungnam National University Hospital, Kyung Hee University Hospital at Gangdong, Wonkwang University Hospital, Wonkwang University, Keimyung University Dongsan Hospital, Keimyung University, Soonchunhyang University Hospital Bucheon, Seoul National University Hospital, Sejong General Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7166685255
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