title: Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy.
abstract: We investigated the factors that might influence the development of diabetic foot ulcers (DFUs) in type 2 diabetes patients without diabetic polyneuropathy (DPN).From January 2000 to December 2005, a total of 595 patients who had type 2 diabetes without DPN between the ages of 25 and 75 years, and had no prior history of DFUs were consecutively enrolled in the study. A cardiovascular autonomic function test was performed to diagnose cardiovascular autonomic neuropathy (CAN) using heart rate variability parameters.The median follow-up time was 13.3 years. Among the 449 (75.4%) patients who completed the follow-up evaluation, 22 (4.9%) patients developed new ulcers, and 6 (1.3%) patients underwent the procedure for lower extremity amputations. The patients in the DFUs group had a longer duration of diabetes, higher baseline HbA1c levels, higher rates of nephropathy, and CAN. A Cox hazard regression analysis results revealed that the development of DFUs was significantly associated with the presence of CAN (normal vs definite CAN; HR, 4.45; 95% confidence interval, 1.29-15.33) after adjusting for possible confounding factors.The development of DFUs was independently associated with CAN in patients with type 2 diabetes without DPN. We suggested the importance of CAN as a predictor of DFUs even in the patients without DPN, and the need to pay attention to patients with definite CAN and type 2 diabetes.
authors.affiliation: From the Division of Endocrinology and Metabolism (J-SY, S-AC, T-SL, Y-BA, S-HK) Division of Cardiology (K-DY), Department of Internal Medicine, and Department of Rehabilitation Medicine (J-SK), St Vincent's Hospital; Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital (E-YL); Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St Mary's Hospital (K-HS), College of Medicine, The Catholic University of Korea, Seoul, Korea; and Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health (Y-MP), Research Triangle Park, NC.
authors.forename: Jae-Seung
authors.initials: JS
authors.lastname: Yun
authors.forename: Seon-Ah
authors.initials: SA
authors.lastname: Cha
authors.forename: Tae-Seok
authors.initials: TS
authors.lastname: Lim
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Lee
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Yu-Bae
authors.initials: YB
authors.lastname: Ahn
authors.forename: Ki-Dong
authors.initials: KD
authors.lastname: Yoo
authors.forename: Joon-Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Yong-Moon
authors.initials: YM
authors.lastname: Park
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017719:Diabetic Foot / Q000175:diagnosis* / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea