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Comparison of Heart Rate Variability in People With Diabetes-Related Neuropathic Foot to Their Counterparts Without a

Murong Wu1, Shuang Lin1, Yan Liu2

  • 1Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Journal of Diabetes Research
|June 9, 2025
PubMed

Insights

Diabetic foot ulceration (DFU) is linked to worse cardiac autonomic function in Type 2 diabetes mellitus (T2DM) patients. Even without peripheral artery disease, DFU patients show significantly impaired heart rate variability (HRV), indicating higher cardiovascular risk.

Area of Science:

  • Cardiology
  • Diabetology
  • Autonomic Neuroscience

Background:

  • Diabetic foot ulceration (DFU) is associated with increased cardiovascular mortality in Type 2 diabetes mellitus (T2DM).
  • The underlying mechanisms, particularly concerning cardiac autonomic function, remain unclear.
  • This study investigates cardiac autonomic function differences between T2DM patients with and without DFU.

Purpose of the Study:

  • To compare cardiac autonomic function between T2DM patients with neuropathic DFU and those without DFU.
  • To assess heart rate variability (HRV) indices as indicators of cardiac autonomic modulation.
  • To identify associations between DFU and impaired cardiac autonomic function.

Main Methods:

  • 362 T2DM participants (181 with DFU, 181 without DFU), matched for propensity scores and free of peripheral artery disease (PAD), were analyzed.
  • 24-hour ECG Holter monitoring was performed to collect heart rate variability (HRV) data.
  • Key HRV indices including SDNN, rMSSD, SDANN, PNN50, LF, HF, and LF/HF ratio were measured.

Main Results:

  • Individuals with DFU exhibited significantly lower levels of all assessed HRV indices (SDNN, rMSSD, SDANN, PNN50, LF, HF, LF/HF ratio) compared to those without DFU (p < 0.05).
  • Severe impairment of cardiac autonomic modulation (SDNN < 50 ms) was 2.5 times more prevalent in the DFU group (21.6% vs. 8.8%, p < 0.001).
  • DFU was independently and negatively associated with all measured HRV parameters (p < 0.05).

Conclusions:

  • Diabetic foot ulceration significantly impairs cardiac autonomic function in T2DM patients, even in the absence of PAD.
  • Reduced heart rate variability in DFU patients suggests a heightened cardiovascular risk.
  • These findings highlight the importance of assessing cardiac autonomic function in T2DM patients with DFU.

Keywords:
cardiac autonomic functiondiabetic foot ulcerationheart rate variabilitypropensity score matching

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