Introduction In patients with peripheral artery disease (PAD) the presence of diabetes mellitus (DM) is associated with higher morbidity and mortality. Because huge efforts are made to improve medical care of patients with DM including chronic disease programs, the aim of the present study was to investigate temporal trends regarding the clinical burden of DM on PAD patients within a 15‐year observational period. Methods We analyzed all patients hospitalized because of PAD between 2005 and 2019 in Germany stratified regarding DM. Results Overall, 2 654 871 hospitalizations of PAD patients (865 823 with DM) were included. Hospitalizations based on PAD inclined from 142 778 in 2005 to 190 135 in 2019 (β 3956 per year; 95% confidence interval CI 3034–4878, p < .001) with simultaneous increase of hospitalizations of PAD patients with DM (2005: 41609 (29.1%) versus 2019: 65 302 (34.3%); β 2019 per year 95% CI 1593–2446, p < .001). Amputation rates (β −0.42 95% CI −0.44 to −0.40; p < .001) as well as in‐hospital case‐fatality rate (2005: 4.7%, 2019: 2.8%; β −0.64 95% CI −0.69 to −0.59; p < .001) decreased in diabetic PAD patients during the observational time. In spite of improved morbidity and mortality in the last years of the observational period, patients with DM still suffered from an increased risk for morbidity and mortality during the observational period compared to nondiabetic PAD patients. Conclusions Despite the progress in DM treatments, DM still was associated with an unfavorable clinical patient profile and remained a substantial risk factor for morbidity and mortality in hospitalized patients with PAD and DM in Germany between 2005 and 2019. 摘要 背景 在患有外周动脉疾病(PAD)的患者中，糖尿病(DM)的存在与较高的发病率和死亡率相关。由于为改善DM患者的医疗保健(包括慢性病项目)付出了巨大努力，本研究旨在调查15年观察期内DM对PAD患者临床负担的时间趋势。 方法 我们分析了2005年至2019年间德国根据DM分层的所有因PAD住院的患者。 结果 共有2,654,871 例 PAD住院患者(865,823 例DM)纳入分析。基于PAD的住院人数从 2005 年的 142,778 人增加到 2019 年的 190,135 人(β 3956/年 95%CI 3034‐4878，P<0.001)，同时 PAD 合并 DM 患者的住院人数增加(2005 年:41,609 人(29.1%)vs. 2019 年:65,302 (34.3%), β 2019/年 95%CI 1593‐2446，P<0.001)。截肢率(β ‐0.42 95%CI ‐0.44 to ‐0.40, P<0.001)以及住院病死率(2005:4.7%，2019:2.8%, β ‐0.64 95%CI ‐0.69 to ‐0.59, P<0.001) 在观察期间糖尿病 PAD 患者降低。尽管在观察期的最后几年发病率和死亡率有所改善，但与非糖尿病PAD 患者相比，糖尿病患者在观察期内的发病率和死亡率风险仍然增加。 结论 尽管DM治疗取得了进展，但DM仍然与不良的患者临床状况相关，并且仍然是 2005年至 2019 年间德国住院的 PAD 合并 DM 患者发病率和死亡率的重要危险因素。 Highlights Annual numbers of hospitalizations of patients with peripheral artery disease (PAD) in coprevalence with diabetes mellitus (DM) increased significantly during the observational period from 2005 to 2019. Age and comorbidity‐burden of PAD patients with DM aggravated over time, whereas major adverse cardiac and cerebrovascular events and in‐hospital mortality of PAD patients with DM decreased from 2005 to 2019. The proportion of female PAD patients with DM decreased from 2005 to 2019. Annual numbers of amputation surgeries decreased from 2005 to 2019 driven by declining numbers of major amputations. Compared to nondiabetic persons, presence of DM was associated with poor in‐hospital outcome, which was widely unchanged over time.