JDRF operating grant 17-2013-312.

Corneal nerve fiber length (CNFL) represents a biomarker for diabetic distal symmetric polyneuropathy (DSP). We aimed to determine the reference distribution of annual CNFL change, the prevalence of abnormal change in diabetes, and its associated clinical variables. RESEARCH DESIGN AND METHODSWe examined 590 participants with diabetes (399 with type 1 diabetes [T1D] and 191 with type 2 diabetes [T2D]) and 204 control patients without diabetes with at least 1 year of follow-up and classified them according to rapid corneal nerve fiber loss (RCNFL) if CNFL change was below the 5th percentile of the control patients without diabetes. RESULTSControl patients without diabetes were 37.9 6 19.8 years old, had median follow-up of three visits over 3.0 years, and mean annual change in CNFL was 20.1% (90% CI 25.9% to 5.0%). RCNFL was defined by values exceeding the 5th percentile of 6% loss. Participants with T1D were 39.9 6 18.7 years old, had median follow-up of three visits over 4.4 years, and mean annual change in CNFL was 20.8% (90% CI 214.0% to 9.9%). Participants with T2D were 60.4 6 8.2 years old, had median follow-up of three visits over 5.3 years, and mean annual change in CNFL was 20.2% (90% CI 214.1% to 14.3%). RCNFL prevalence was 17% overall and was similar by diabetes type (64 T1D [16.0%], 37 T2D [19.4%], P 5 0.31). RNCFL was more common in those with baseline DSP (47% vs. 30% in those without baseline DSP, P 5 0.001), which was associated with lower peroneal conduction velocity but not with baseline HbA 1c or its change over follow-up. CONCLUSIONSAn abnormally rapid loss of CNFL of 6% per year or more occurs in 17% of diabetes patients. RCNFL may identify patients at highest risk for the development and progression of DSP.Diabetic distal symmetric polyneuropathy (DSP) is one of the most prevalent and pervasive diabetes complications that is associated with morbidity and the frequent use of health care resources (1). The natural history of DSP begins with diffuse injury to small unmyelinated sensory nerves (Ad and C fibers) that include autonomic nerves and those that innervate the skin for conveying pain and temperature sensation. It is generally believed that nerve injury first occurs asymptomatically to small nerve fibers before progressing to involve large nerve fibers (2). While nerve conductions studies

Background In the current study, we aimed to determine normative values for muscle thickness and fasciculation prevalence in healthy subjects. Methods We performed a prospective study from October to December 2018 in 65 healthy subjects. All subjects underwent quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in the following 8 muscles: Biceps brachii, abductor pollicis brevis, first dorsal interosseous, abductor digiti minimi, quadriceps, tibialis anterior, extensor digitorum brevis, and abductor hallucis brevis. Results Subject ages ranged from 21 to 82 years, with 63% women. Normative values for muscle thickness were determined using the fifth percentile. Multivariate regression analysis showed that sex, age, body mass index, and hand dominance affected muscle thickness. Fasciculations were observed frequently only in distal muscles. Conclusions Normal values for muscle thickness were determined, and may enhance neuromuscular ultrasound sensitivity and serve as a basis for future studies. Larger series are needed to confirm these values.