Limits...
Corneal confocal microscopy detects neuropathy in patients with type 1 diabetes without retinopathy or microalbuminuria.

Petropoulos IN, Green P, Chan AW, Alam U, Fadavi H, Marshall A, Asghar O, Efron N, Tavakoli M, Malik RA - PLoS ONE (2015)

Bottom Line: SSNCV, corneal nerve fibre (CNFD) and branch (CNBD) density and length (CNFL) were reduced significantly (p<0.001) in diabetic patients without retinopathy compared to control subjects.Furthermore, CNFD, CNBD and CNFL were also significantly (p<0.001) reduced in diabetic patients without microalbuminuria (n=39), compared to control subjects.IVCCM detects early small fibre damage in the absence of retinopathy or microalbuminuria in patients with Type 1 diabetes.

View Article: PubMed Central - PubMed

Affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health System Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Weill Cornell Medical College Qatar, Division of Research, Qatar Foundation, Education City, Doha, Qatar.

ABSTRACT

Objective: Corneal innervation is increasingly used as a surrogate marker of human diabetic peripheral neuropathy (DPN) however its temporal relationship with the other microvascular complications of diabetes is not fully established. In this cross-sectional, observational study we aimed to assess whether neuropathy occurred in patients with type 1 diabetes, without retinopathy or microalbuminuria.

Materials and methods: All participants underwent detailed assessment of peripheral neuropathy [neuropathy disability score (NDS), vibration perception threshold (VPT), peroneal motor nerve conduction velocity (PMNCV), sural sensory nerve conduction velocity (SSNCV) and in vivo corneal confocal microscopy (IVCCM)], retinopathy (digital fundus photography) and albuminuria status [albumin: creatinine ratio (ACR)].

Results: 53 patients with Type 1 diabetes with (n=37) and without retinopathy (n=16) were compared to control subjects (n=27). SSNCV, corneal nerve fibre (CNFD) and branch (CNBD) density and length (CNFL) were reduced significantly (p<0.001) in diabetic patients without retinopathy compared to control subjects. Furthermore, CNFD, CNBD and CNFL were also significantly (p<0.001) reduced in diabetic patients without microalbuminuria (n=39), compared to control subjects. Greater neuropathic severity was associated with established retinopathy and microalbuminuria.

Conclusions: IVCCM detects early small fibre damage in the absence of retinopathy or microalbuminuria in patients with Type 1 diabetes.

No MeSH data available.


Related in: MedlinePlus

Fundus photograph of the central 30° with corresponding IVCCM image of the central subbasal nerves (yellow arrows) for control (non-mydriatic) (CTR) (A) and patients with diabetes and varying stages of DR (B, C and D).From left to right: (A) IVCCM image shows abundant corneal nerve axons for a control without retinopathy, B) significant decrease of subbasal nerves in a patient with diabetes ‘without DR’ (No DR), C) slight progressive loss of subbasal nerves in a patient with diabetes and background DR (BDR) and D) severe axonal loss on IVCCM in a patient with diabetes and pre-proliferative DR (PDR).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4390357&req=5

pone.0123517.g002: Fundus photograph of the central 30° with corresponding IVCCM image of the central subbasal nerves (yellow arrows) for control (non-mydriatic) (CTR) (A) and patients with diabetes and varying stages of DR (B, C and D).From left to right: (A) IVCCM image shows abundant corneal nerve axons for a control without retinopathy, B) significant decrease of subbasal nerves in a patient with diabetes ‘without DR’ (No DR), C) slight progressive loss of subbasal nerves in a patient with diabetes and background DR (BDR) and D) severe axonal loss on IVCCM in a patient with diabetes and pre-proliferative DR (PDR).

Mentions: Patients without DR compared to control subjects showed a significantly lower CNFD (P = 0.0001), CNBD (P<0.0001), CNFL (P<0.0001) and SNCV (P<0.05). There was a further significant reduction in CNFD between patients with and without DR (P = 0.004) (Figs 1 and 2 and Table 2). There was an inverse correlation between the retinopathy grade and CNFD (r = -0.67, P<0.001), CNBD (r = -0.58, P<0.001) and CNFL (r = -0.66, P<0.001).


Corneal confocal microscopy detects neuropathy in patients with type 1 diabetes without retinopathy or microalbuminuria.

Petropoulos IN, Green P, Chan AW, Alam U, Fadavi H, Marshall A, Asghar O, Efron N, Tavakoli M, Malik RA - PLoS ONE (2015)

Fundus photograph of the central 30° with corresponding IVCCM image of the central subbasal nerves (yellow arrows) for control (non-mydriatic) (CTR) (A) and patients with diabetes and varying stages of DR (B, C and D).From left to right: (A) IVCCM image shows abundant corneal nerve axons for a control without retinopathy, B) significant decrease of subbasal nerves in a patient with diabetes ‘without DR’ (No DR), C) slight progressive loss of subbasal nerves in a patient with diabetes and background DR (BDR) and D) severe axonal loss on IVCCM in a patient with diabetes and pre-proliferative DR (PDR).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390357&req=5

pone.0123517.g002: Fundus photograph of the central 30° with corresponding IVCCM image of the central subbasal nerves (yellow arrows) for control (non-mydriatic) (CTR) (A) and patients with diabetes and varying stages of DR (B, C and D).From left to right: (A) IVCCM image shows abundant corneal nerve axons for a control without retinopathy, B) significant decrease of subbasal nerves in a patient with diabetes ‘without DR’ (No DR), C) slight progressive loss of subbasal nerves in a patient with diabetes and background DR (BDR) and D) severe axonal loss on IVCCM in a patient with diabetes and pre-proliferative DR (PDR).
Mentions: Patients without DR compared to control subjects showed a significantly lower CNFD (P = 0.0001), CNBD (P<0.0001), CNFL (P<0.0001) and SNCV (P<0.05). There was a further significant reduction in CNFD between patients with and without DR (P = 0.004) (Figs 1 and 2 and Table 2). There was an inverse correlation between the retinopathy grade and CNFD (r = -0.67, P<0.001), CNBD (r = -0.58, P<0.001) and CNFL (r = -0.66, P<0.001).

Bottom Line: SSNCV, corneal nerve fibre (CNFD) and branch (CNBD) density and length (CNFL) were reduced significantly (p<0.001) in diabetic patients without retinopathy compared to control subjects.Furthermore, CNFD, CNBD and CNFL were also significantly (p<0.001) reduced in diabetic patients without microalbuminuria (n=39), compared to control subjects.IVCCM detects early small fibre damage in the absence of retinopathy or microalbuminuria in patients with Type 1 diabetes.

View Article: PubMed Central - PubMed

Affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health System Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Weill Cornell Medical College Qatar, Division of Research, Qatar Foundation, Education City, Doha, Qatar.

ABSTRACT

Objective: Corneal innervation is increasingly used as a surrogate marker of human diabetic peripheral neuropathy (DPN) however its temporal relationship with the other microvascular complications of diabetes is not fully established. In this cross-sectional, observational study we aimed to assess whether neuropathy occurred in patients with type 1 diabetes, without retinopathy or microalbuminuria.

Materials and methods: All participants underwent detailed assessment of peripheral neuropathy [neuropathy disability score (NDS), vibration perception threshold (VPT), peroneal motor nerve conduction velocity (PMNCV), sural sensory nerve conduction velocity (SSNCV) and in vivo corneal confocal microscopy (IVCCM)], retinopathy (digital fundus photography) and albuminuria status [albumin: creatinine ratio (ACR)].

Results: 53 patients with Type 1 diabetes with (n=37) and without retinopathy (n=16) were compared to control subjects (n=27). SSNCV, corneal nerve fibre (CNFD) and branch (CNBD) density and length (CNFL) were reduced significantly (p<0.001) in diabetic patients without retinopathy compared to control subjects. Furthermore, CNFD, CNBD and CNFL were also significantly (p<0.001) reduced in diabetic patients without microalbuminuria (n=39), compared to control subjects. Greater neuropathic severity was associated with established retinopathy and microalbuminuria.

Conclusions: IVCCM detects early small fibre damage in the absence of retinopathy or microalbuminuria in patients with Type 1 diabetes.

No MeSH data available.


Related in: MedlinePlus