Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy

Abstract Accurately quantifying the progression of diabetic peripheral neuropathy is key to identify individuals who will progress to foot ulceration and to power clinical intervention trials. We have undertaken detailed neuropathy phenotyping to assess the longitudinal utility of different measures...

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Autores principales:	Shaishav Dhage, Maryam Ferdousi, Safwaan Adam, Jan Hoong Ho, Alise Kalteniece, Shazli Azmi, Uazman Alam, Georgios Ponirakis, Ioannis Petropoulos, Andrew J. Atkinson, Andrew Marshall, Maria Jeziorska, Handrean Soran, Rayaz A. Malik
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6e4fe82f035548e3b5afb9e01bf828a9
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spelling	oai:doaj.org-article:6e4fe82f035548e3b5afb9e01bf828a92021-12-02T13:57:12ZCorneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy10.1038/s41598-021-81302-82045-2322https://doaj.org/article/6e4fe82f035548e3b5afb9e01bf828a92021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-81302-8https://doaj.org/toc/2045-2322Abstract Accurately quantifying the progression of diabetic peripheral neuropathy is key to identify individuals who will progress to foot ulceration and to power clinical intervention trials. We have undertaken detailed neuropathy phenotyping to assess the longitudinal utility of different measures of neuropathy in patients with diabetes. Nineteen patients with diabetes (age 52.5 ± 14.7 years, duration of diabetes 26.0 ± 13.8 years) and 19 healthy controls underwent assessment of symptoms and signs of neuropathy, quantitative sensory testing, autonomic nerve function, neurophysiology, intra-epidermal nerve fibre density (IENFD) and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), branch density (CNBD) and fibre length (CNFL). Mean follow-up was 6.5 years. Glycated haemoglobin (p = 0.04), low-density lipoprotein-cholesterol (LDL-C) (p = 0.0009) and urinary albumin creatinine ratio (p < 0.0001) improved. Neuropathy symptom profile (p = 0.03), neuropathy disability score (p = 0.04), vibration perception threshold (p = 0.02), cold perception threshold (p = 0.006), CNFD (p = 0.03), CNBD (p < 0.0001), CNFL (p < 0.0001), IENFD (p = 0.04), sural (p = 0.02) and peroneal motor nerve conduction velocity (p = 0.03) deteriorated significantly. Change (∆) in CNFL correlated with ∆CPT (p = 0.006) and ∆Expiration/Inspiration ratio (p = 0.002) and ∆IENFD correlated with ∆CNFD (p = 0.005), ∆CNBD (p = 0.02) and ∆CNFL (p = 0.01). This study shows worsening of diabetic neuropathy across a range of neuropathy measures, especially CCM, despite an improvement in HbA1c and LDL-C. It further supports the utility of CCM as a rapid, non-invasive surrogate measure of diabetic neuropathy.Shaishav DhageMaryam FerdousiSafwaan AdamJan Hoong HoAlise KaltenieceShazli AzmiUazman AlamGeorgios PonirakisIoannis PetropoulosAndrew J. AtkinsonAndrew MarshallMaria JeziorskaHandrean SoranRayaz A. MalikNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Shaishav Dhage Maryam Ferdousi Safwaan Adam Jan Hoong Ho Alise Kalteniece Shazli Azmi Uazman Alam Georgios Ponirakis Ioannis Petropoulos Andrew J. Atkinson Andrew Marshall Maria Jeziorska Handrean Soran Rayaz A. Malik Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
description	Abstract Accurately quantifying the progression of diabetic peripheral neuropathy is key to identify individuals who will progress to foot ulceration and to power clinical intervention trials. We have undertaken detailed neuropathy phenotyping to assess the longitudinal utility of different measures of neuropathy in patients with diabetes. Nineteen patients with diabetes (age 52.5 ± 14.7 years, duration of diabetes 26.0 ± 13.8 years) and 19 healthy controls underwent assessment of symptoms and signs of neuropathy, quantitative sensory testing, autonomic nerve function, neurophysiology, intra-epidermal nerve fibre density (IENFD) and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), branch density (CNBD) and fibre length (CNFL). Mean follow-up was 6.5 years. Glycated haemoglobin (p = 0.04), low-density lipoprotein-cholesterol (LDL-C) (p = 0.0009) and urinary albumin creatinine ratio (p < 0.0001) improved. Neuropathy symptom profile (p = 0.03), neuropathy disability score (p = 0.04), vibration perception threshold (p = 0.02), cold perception threshold (p = 0.006), CNFD (p = 0.03), CNBD (p < 0.0001), CNFL (p < 0.0001), IENFD (p = 0.04), sural (p = 0.02) and peroneal motor nerve conduction velocity (p = 0.03) deteriorated significantly. Change (∆) in CNFL correlated with ∆CPT (p = 0.006) and ∆Expiration/Inspiration ratio (p = 0.002) and ∆IENFD correlated with ∆CNFD (p = 0.005), ∆CNBD (p = 0.02) and ∆CNFL (p = 0.01). This study shows worsening of diabetic neuropathy across a range of neuropathy measures, especially CCM, despite an improvement in HbA1c and LDL-C. It further supports the utility of CCM as a rapid, non-invasive surrogate measure of diabetic neuropathy.
format	article
author	Shaishav Dhage Maryam Ferdousi Safwaan Adam Jan Hoong Ho Alise Kalteniece Shazli Azmi Uazman Alam Georgios Ponirakis Ioannis Petropoulos Andrew J. Atkinson Andrew Marshall Maria Jeziorska Handrean Soran Rayaz A. Malik
author_facet	Shaishav Dhage Maryam Ferdousi Safwaan Adam Jan Hoong Ho Alise Kalteniece Shazli Azmi Uazman Alam Georgios Ponirakis Ioannis Petropoulos Andrew J. Atkinson Andrew Marshall Maria Jeziorska Handrean Soran Rayaz A. Malik
author_sort	Shaishav Dhage
title	Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
title_short	Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
title_full	Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
title_fullStr	Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
title_full_unstemmed	Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
title_sort	corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/6e4fe82f035548e3b5afb9e01bf828a9
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Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy

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