Prevalence and patterns of cardiac autonomic dysfunction in male patients with type 2 diabetes mellitus and chronic Charcot's neuroarthropathy: a cross-sectional study from South India

Aims Our study aimed to look at the prevalence and patterns of cardiac autonomic neuropathy related dysfunction in male patients of type 2 diabetes mellitus with chronic Charcot's foot. Methods A total of 74 male patients with type 2 diabetes mellitus were included in this study. Three groups of patients were selected: Group 1 included patients with chronic Charcot's foot (n =24), group 2 included patients with diabetic peripheral neuropathy without chronic Charcot's foot (n =22) and group 3 included patients without peripheral neuropathy or chronic Charcot's foot (n =28). The autonomic functions were tested using a personal computer-based cardiac autonomic neuropathy (CANS-504) analyser. Results The combined sympathetic (SNS) and parasympathetic autonomic function (PNS) abnormalities were detected in about 70.8% in the chronic Charcot's group, 55.6% in the peripheral neuropathy group and 35.7% in the non-neuropathic group. In patients with chronic Charcot's foot (n =24), 29.2% had normal, 20.8% had borderline and 50% had abnormal PNS functions, while 4.2% had normal, 16.7% had borderline and 79.2% had abnormal SNS functions. The Meary's angle (183.1873.83 vs 157.98 +/- 14.11; p <0.196) and Calcaneal pitch (7.07 +/- 3.30 vs 8.5 +/- 1.88; p <0.219) were greater in the subjects with combined autonomic neuropathy, suggesting more structural deformity in them. Conclusion Cardiac autonomic neuropathy-related dysfunction was found to be more common in type 2 diabetes patients with chronic Charcot's foot. This study has highlighted that patients with diabetic mellitus and chronic Charcot's foot should be screened comprehensively in order to prevent complications related to cardiac autonomic dysfunction.