Abstract
Purpose
Diabetic foot ulcers (DFUs) and cardiac autonomic neuropathy (CAN) are severe complications
of diabetes mellitus (DM). Both DFU and CAN are associated with increased risk of
major cardiovascular events and mortality. Because of the clinical impact of both
these conditions, it is important to establish what effect the presence of CAN has
on DFU outcomes.
Methods
This is a narrative review of original research articles identified through an electronic
search of PubMed, Scopus, and Google scholar databases until June 2021 exploring CAN
in individuals with DFUs. We explored prevalence, patient outcomes (DFU healing and
amputation), and mortality.
Findings
Evidence suggests that the prevalence of CAN is high, ranging from 43% to 66% among
those with DFUs. The presence of CAN may also increase the odds of developing DFUs.
A single-center, prospective, observational study has suggested that the presence
of CAN significantly reduces DFU healing time. The impact on amputation is indeterminate,
with conflicting reports from studies reporting either no or increased risk. On the
basis of limited evidence, CAN may be associated with increased mortality in individuals
with DFUs.
Implications
The interplay between CAN and DFUs is poorly understood from current literature. Given
the high prevalence of CAN in individuals with DFUs and the potential for suboptimal
outcomes, further high-quality studies are required to determine future management
approaches when both conditions coexist and to establish whether early CAN screening
in individuals with diabetes at high risk of foot ulceration may ultimately improve
their outlook.
Keywords
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Article info
Publication history
Published online: December 30, 2021
Accepted:
December 8,
2021
Identification
Copyright
© 2021 Elsevier Inc.
