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dc.contributor.authorDhage, Shaishav
dc.contributor.authorFerdousi, M.
dc.contributor.authorAdam, Safwaan
dc.contributor.authorHo, Jan Hoong
dc.contributor.authorKalteniece, A.
dc.contributor.authorAzmi, S.
dc.contributor.authorAlam, U.
dc.contributor.authorPonirakis, G.
dc.contributor.authorPetropoulos, I.
dc.contributor.authorAtkinson, A. J.
dc.contributor.authorMarshall, A.
dc.contributor.authorJeziorska, M.
dc.contributor.authorSoran, H.
dc.contributor.authorMalik, R. A.
dc.date.accessioned2021-03-08T06:18:45Z
dc.date.available2021-03-08T06:18:45Z
dc.date.issued2021en
dc.identifier.citationDhage 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.en
dc.identifier.pmid33479291en
dc.identifier.doi10.1038/s41598-021-81302-8en
dc.identifier.urihttp://hdl.handle.net/10541/623778
dc.description.abstractAccurately 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.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.1038/s41598-021-81302-8en
dc.titleCorneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathyen
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, Manchester University NHS Foundation Trust, Manchester, UK.en
dc.identifier.journalScientific Reportsen
dc.description.noteen]
refterms.dateFOA2021-03-08T13:21:04Z


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