The association between hemoglobin Ale levels and the severity of peripheral arterial disease (PAD) was investigated in 224 patients with diabetes mellitus and PAD. The mean hemoglobin Ale levels were 9.1 +/- 2.1% in patients with diabetes with ankle-brachial indexes (ABIs) < 0.60 and 7.1 +/- 0.9% in those with ABIs of 0.60 to 0.89 (p < 0.0001). Hemoglobin A(1c) levels < 6.5% were present in 2 of 89 patients with diabetes (2%) with ABIs < 0.60 and in 24 of 135 (18%) with ABIs of 0.60 to 0.89 (p = 0.0004). Hemoglobin A(1c) levels < 7.0% were present in 24 of 89 patients with diabetes (27%) with ABIs < 0.60 and in 63 of 135 (47%) with ABIs of 0.60 to 0.89 (p = 0.003). Hemoglobin A(1c) levels < 7.5% were present in 30 of 89 patients with diabetes (34%) with ABIs < 0.60 and in 92 of 135 (68%) with ABIs of 0.60 to 0.89 (p < 0.0001). In conclusion, the higher the hemoglobin Ale levels in patients with diabetes with PAD, the higher the prevalence of severe PAD. (c) 2007 Elsevier Inc. All rights reserved.