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

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    Authors
    Dhage, Shaishav
    Ferdousi, M.
    Adam, Safwaan
    Ho, Jan Hoong
    Kalteniece, A.
    Azmi, S.
    Alam, U.
    Ponirakis, G.
    Petropoulos, I.
    Atkinson, A. J.
    Marshall, A.
    Jeziorska, M.
    Soran, H.
    Malik, R. A.
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    Affiliation
    Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK.
    Issue Date
    2021
    
    Metadata
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    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.
    Citation
    Dhage S, Ferdousi M, Adam S, Ho JH, Kalteniece A, Azmi S, et al. Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy. Sci Rep. 2021;11(1):1859.
    Journal
    Scientific Reports
    URI
    http://hdl.handle.net/10541/623778
    DOI
    10.1038/s41598-021-81302-8
    PubMed ID
    33479291
    Additional Links
    https://dx.doi.org/10.1038/s41598-021-81302-8
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1038/s41598-021-81302-8
    Scopus Count
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