Key result
Diabetic foot ulceration was associated with a 2.5-fold increase in severe impairment of cardiac autonomic modulation compared to T2DM without DFU (21.6% vs. 8.8%, p < 0.001).
Why the study?
The reasons why individuals with diabetic foot ulceration have higher cardiovascular mortality than those with T2DM without foot ulcers remain controversial.
Does the presence of neuropathic diabetic foot ulceration correlate with worse cardiac autonomic function in patients with Type 2 diabetes mellitus?
Observational (n=362)
Does the presence of neuropathic diabetic foot ulceration correlate with worse cardiac autonomic function in patients with Type 2 diabetes mellitus?
Effect estimate: 2.5-fold increase
Absolute Event Rate: 21.6% vs 8.8%
p-value: p=<0.001
Patients with Type 2 diabetes and neuropathic foot ulcers have significantly more impaired cardiac autonomic function compared to matched diabetic patients without ulcers, which may contribute to their higher cardiovascular mortality.
DFU was associated with worse cardiac autonomic modulation in T2DM; hypothesis-generating for its contribution to CV risk, pending prospective studies.
Background: The reasons that individuals with diabetic foot ulceration (DFU) have higher cardiovascular mortality than those with Type 2 diabetes mellitus (T2DM) but without DFU remain controversial. We aimed to compare the differences in cardiac autonomic function between individuals with neuropathic DFU and their counterparts without DFU. Methods: Three hundred and sixty‐two participants with T2DM (181 with DFU and 181 without DFU) who were free of peripheral artery disease (PAD) were included in the final analysis after propensity score matching (PSM). All individuals underwent a 24‐h ECG Holter and used the following indices of heart rate variability (HRV) to assess cardiac autonomic function: the standard deviation of the normal sinus interval (SDNN), the root mean square of successive RR interval differences (rMSSD), the standard deviation of the 5‐min average RR intervals (SDANN), the percentage of normal adjacent RR interval difference > 50 ms (PNN50), the low‐frequency power (LF), the high‐frequency power (HF), and the LF/HF ratio. Results: Individuals with DFU had lower SDNN, LF/HF, PNN50, rMSSD, HF, SDANN, and LF than their counterparts without DFU (all p < 0.05). Individuals with DFU had a 2.5‐fold increase in severe impairment of cardiac autonomic modulation (i.e., SDNN < 50 ms) compared to those without DFU (21.6% vs. 8.8%, p < 0.001). DFU was independently and negatively associated with all the abovementioned HRV measures (all p < 0.05). Conclusion: Among people with neuropathic diabetic foot only, cardiac autonomic function was still more severely impaired in individuals with DFU than in their counterparts without DFU. Trial Registration: CHiCTR2300076628
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Lin et al. (2025) conducted an observational in Type 2 diabetes mellitus with and without diabetic foot ulceration (n=362). Diabetic foot ulceration vs. Type 2 diabetes mellitus without diabetic foot ulceration was evaluated on Severe impairment of cardiac autonomic modulation (SDNN < 50 ms) (2.5-fold increase, p=<0.001). Diabetic foot ulceration was associated with a 2.5-fold increase in severe impairment of cardiac autonomic modulation compared to T2DM without DFU (21.6% vs. 8.8%, p < 0.001).
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