Autonomic and sensory nerve function in diabetic foot ulceration

Area of Science:

• Neurology
• Endocrinology
• Diabetology

Background:

• Diabetic neuropathy, encompassing both sensory and autonomic dysfunction, is implicated in the development of diabetic foot ulcers.
• The specific contribution of sensory versus autonomic nerve dysfunction to ulcer pathogenesis remains unclear.

Purpose of the Study:

• To compare the prevalence and significance of peripheral sensory nerve dysfunction and cardiac autonomic reflex abnormalities in diabetic patients with and without a history of foot ulceration.

Main Methods:

• A comparative study involving 51 diabetic patients with foot ulceration and 480 diabetic control subjects.
• Assessment of peripheral sensory nerve function included ankle reflexes and vibration perception threshold.
• Cardiac autonomic reflex function was evaluated using four standardized tests, summarized into an autonomic score.

Main Results:

• Diabetic patients with foot ulcers exhibited significantly higher rates of impaired ankle reflexes (96.1%) and reduced vibration perception (82.4%) compared to controls (40.8% and 25.8%, respectively; P < 0.001).
• Abnormalities in cardiac autonomic function tests were more frequent in the ulceration group, with 62.8% having an abnormal autonomic score versus 13.5% in controls (P < 0.001).
• Discriminant analysis identified an abnormal autonomic score as the strongest predictor of foot ulceration in diabetic patients.

Conclusions:

• Both sensory and autonomic neuropathy are prevalent in diabetic foot ulceration.
• Autonomic nerve dysfunction, as indicated by cardiac autonomic reflex tests, is a critical and independent predictor of diabetic foot ulceration.