Diabetes, Leg Swelling, and Circulation: When Compression Therapy May Be Part of the Care Plan
November is American Diabetes Month, making it a good time to talk about an issue that can sometimes be overlooked: swelling in the legs and feet.
For people living with diabetes, lower-extremity symptoms may have several possible causes. Diabetes is associated with complications including peripheral neuropathy and peripheral artery disease, both of which can affect the feet and legs. The American Diabetes Association recommends regular foot and vascular assessments for people with diabetes and advises prompt evaluation of unexplained swelling, redness, increased skin temperature, or open wounds.
For some patients who also have edema or lymphedema, compression therapy may become part of the treatment plan. But the key word is individualized.
Why Can Leg Swelling Occur in Someone With Diabetes?
Diabetes itself is not synonymous with lymphedema, and swelling should never automatically be attributed to diabetes.
Lower-extremity swelling can have many causes, including venous disease, lymphedema, reduced mobility, heart or kidney problems, infection, medication effects, and other medical conditions. That is why a healthcare professional should evaluate persistent or new swelling rather than treating it on your own.
People with diabetes also have an increased risk of peripheral artery disease (PAD) and peripheral neuropathy. PAD reduces blood flow to the extremities, while neuropathy may decrease a person's ability to feel pain, pressure, heat, or injury. The ADA emphasizes assessment of circulation and sensation as part of routine diabetic foot care.
These factors become especially important when considering compression.
Can People With Diabetes Use Compression Therapy?
In some circumstances, yes.
Having diabetes alone does not automatically rule out compression therapy. Research has found that carefully selected patients with diabetes and lower-extremity edema may benefit from compression without compromising vascular status.
For example, a study of patients with diabetes and lower-extremity edema found that mild compression reduced swelling without evidence of impaired vascularity during the study period.
However, compression is not appropriate for every patient.
A 2023 review of diabetic foot ulcers complicated by lower-limb edema found that compression therapy should generally be avoided in the presence of severe peripheral arterial disease and emphasized individualized clinical decision-making when diabetes, edema, wounds, and vascular disease overlap.
That is one reason a medical evaluation matters before beginning compression.
What About Pneumatic Compression Devices?
A pneumatic compression device uses an inflatable garment to apply controlled, sequential pressure to an affected limb. For appropriately selected patients, clinicians may prescribe intermittent pneumatic compression as one component of edema or lymphedema management.
Growing research supports its use in lower-extremity lymphedema.
A 2026 systematic review of randomized controlled trials found moderate-certainty evidence that intermittent pneumatic compression can reduce lower-limb edema, limb volume, or circumference compared with standard care or no pneumatic compression.
There is also research specifically involving patients with type 2 diabetes and lower-limb lymphedema. In a small randomized pilot study, researchers compared manual lymphatic drainage combined with therapeutic intermittent pneumatic compression against manual lymphatic drainage with sham pneumatic compression. The group receiving therapeutic pneumatic compression improved on several clinical measures, including limb-related outcomes, range of motion, and quality-of-life measures. Because only 30 patients were included, the results should be considered promising rather than definitive.
In other words, pneumatic compression may help some patients with diabetes who also have lymphedema or edema, but the underlying cause of swelling and the patient's vascular health matter.
Why Circulation Needs to Be Evaluated First
When someone has diabetes, checking circulation is especially important before starting compression treatment.
The American Diabetes Association recommends screening for signs of peripheral artery disease by examining the feet and lower extremities and pursuing further vascular testing when indicated.
This matters because compression changes pressure within the tissues and circulatory system. A treatment that is appropriate for one patient may not be appropriate for someone with significant arterial disease, an active infection, certain cardiovascular conditions, or another contraindication.
Patients should therefore never begin pneumatic compression solely because they have swollen legs or because another person with similar symptoms uses a compression device.
A healthcare provider should first determine:
what is causing the swelling,
whether circulation is adequate,
whether compression is medically appropriate,
what type of compression should be used, and
what treatment settings and schedule are appropriate for that individual.
How PWS Medical Pumps Can Help
If a healthcare provider determines that a pneumatic compression device is appropriate, the next concern for many patients is simply:
“How am I supposed to do this at home?”
That is where PWS Medical Pumps can help.
We work with patients, caregivers, and healthcare providers to help eligible patients obtain prescribed pneumatic compression equipment. We also understand that receiving a medical device can feel intimidating, particularly when someone is already managing diabetes or other chronic health conditions.
Patients receive education and support with their prescribed equipment so they understand how to use the device according to their provider's treatment plan.
The goal isn't simply to deliver a machine. It is to help patients feel comfortable and confident using the equipment prescribed for them.
The Bottom Line During Diabetes Awareness Month
If you have diabetes and notice new or increasing swelling in your feet or legs, don't assume it is simply another part of living with diabetes.
Swelling can have many causes, and diabetes can make careful evaluation of the feet, circulation, skin, and nerves even more important.
For patients diagnosed with edema or lymphedema who are medically appropriate candidates, compression therapy—including pneumatic compression in some cases—may become part of a comprehensive treatment plan.
The first step is not choosing a compression device. The first step is understanding why the swelling is happening and working with your healthcare provider to determine the safest treatment.
Medical Disclaimer
This information is provided for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease or replace advice from a physician or other qualified healthcare provider. Diabetes, leg swelling, vascular disease, and lymphedema require individualized medical assessment. Pneumatic compression therapy is not appropriate for every patient. Always consult your healthcare provider before beginning or changing compression therapy.
Medical Research & Sources
Wu SC, et al. Safety and efficacy of mild compression therapy in patients with diabetes and lower extremity edema. The study found reductions in lower-extremity swelling with mild compression, with no evidence of compromised vascularity during the study period.
Tansley J, et al. Off-loading and compression therapy strategies to treat diabetic foot ulcers complicated by lower limb oedema: a scoping review. The authors emphasize caution with compression in severe peripheral arterial disease and individualized clinical decision-making.
De Sire A, et al. Effects of Intermittent Pneumatic Compression on Lower Limb Lymphedema in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Controlled Trial. Medicina. 2021.
A 2026 systematic review of randomized controlled trials found moderate-certainty evidence that intermittent pneumatic compression can reduce lower-extremity lymphedema measures such as edema, limb volume, or circumference.
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