Key result
The presence of cardiac autonomic neuropathy was associated with a two-fold increase in the likelihood of diabetic foot ulcer healing (HR 2.05; 95% CI 1.01-4.16; p=0.046).
Why the study?
The prevalence of cardiac autonomic neuropathy in people with diabetic foot ulceration is unknown, and whether it influences ulcer healing is unclear.
Does the presence of cardiac autonomic neuropathy predict diabetic foot ulcer healing in patients with diabetes and peripheral neuropathy?
Cohort (n=47)
No
Does the presence of cardiac autonomic neuropathy predict diabetic foot ulcer healing in patients with diabetes and peripheral neuropathy?
Hazard Ratio: 2.05 (95% CI 1.01–4.16)
p-value: p=0.046
Cardiac autonomic neuropathy is highly prevalent in patients with diabetic foot ulcers and is paradoxically associated with improved ulcer healing.
May indicate cardiac autonomic neuropathy predicts better healing; leaves open causality and needs prospective validation.
AIMS: People with diabetes and peripheral neuropathy (DPN) are at high risk of diabetic foot ulceration (DFU). The prevalence of cardiac autonomic neuropathy (CAN) in people with DFU is unknown and if CAN influences DFU healing is unclear. METHODS: We investigated, in a prospective observational single-centre cohort study, if CAN predicts DFU healing in 47 (77% male) people with a DFU and DPN attending a university hospital foot clinic. CAN was diagnosed by 2 or more abnormal Ewing's tests. Baseline DFU severity was evaluated using the site, ischaemia, neuropathy, bacterial infection, area and depth (SINBAD) score. The primary outcome was defined as evidence of DFU healing on clinical examination. Median (interquartile) length of follow-up was 1150 (624-1331) days. RESULTS: The prevalence of CAN was 43%. Of the cohort, 70% had complete healing of their DFU. Participants with CAN had a shorter median (interquartile) duration time to heal compared to those without CAN [91 (44-164) days compared to 302 (135-413) (p=0.047)]. Minor/major amputation and mortality was similar in both groups. The presence of CAN increased DFU healing by two-fold [HR=2.05, 95% CI 1.01-4.16, p=0.046] in multivariable competing risk analyses. CONCLUSIONS: We demonstrate a high prevalence of CAN in a DFU cohort and that CAN is associated with improved DFU healing. The results of this study establish the scientific rationale for further studies to better understand the mechanisms between CAN and DFU outcomes.
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Farrow et al. (2020) conducted a cohort in Diabetic foot ulcer and peripheral neuropathy (n=47). Cardiac autonomic neuropathy (CAN) vs. No cardiac autonomic neuropathy was evaluated on Evidence of DFU healing on clinical examination (HR 2.05, 95% CI 1.01-4.16, p=0.046). The presence of cardiac autonomic neuropathy was associated with a two-fold increase in the likelihood of diabetic foot ulcer healing (HR 2.05; 95% CI 1.01-4.16; p=0.046).
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