Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta‐analysis

Gad, Hoda; Petropoulos, Ioannis N.; Khan, Adnan; Ponirakis, Georgios; MacDonald, Ross; Alam, Uazman; Malik, Rayaz A.

doi:10.1111/jdi.13643

“…However, the nerve density values for those with T1D were significantly lower than for the controls at each time point associated consistently with moderately severe peripheral neuropathy. 27 A similar result was reported in a recent study of 19 patients with T1D followed up for a period 2 years; however, the patients were not compared with a control cohort, so the study lacked a direct aging comparison. 5 Our study has similarities to a previous longitudinal study that observed the progression of SBN density in healthy subjects and in those with T1D.…”

Section: Discussionsupporting

confidence: 67%

Corneal Confocal Microscopy in Type 1 Diabetes Mellitus: A Six-Year Longitudinal Study

Slater¹,

Misra²,

Braatvedt

³

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose The current study describes corneal nerve morphology using in vivo confocal microscopy (IVCM) in patients with type 1 diabetes (T1D) who were followed up for 6 years, and it examines the relationship between corneal parameters and metabolic control of glucose and peripheral neuropathy. Methods Sixty-two participants (37 with T1D and 25 control participants) were assessed in 2011 and 2017. Participants with bilateral cataract surgery or controls who developed diabetes were excluded. All underwent HbA1c, IVCM, and central corneal sensitivity measurements at both time points in the eye previously examined. A modified total neuropathy score was obtained. Results Participants were age and sex matched. The mean duration of diabetes was 32.1 ± 12.0 years at the follow-up visit. The sub-basal nerve density in participants with T1D was lower than that of the controls and did not change (mean ± SD, 11.07 ± 4.0 to 11.41 ± 4.1 mm/mm 2 ; P = 0.71), but it showed a marginal change in controls (19.5 ± 3.7 to 21.63 ± 4.03 mm/mm 2 ; P = 0.06). The corneal sensitivity in T1D did not change (1.3 ± 1.5 to 1.4 ± 1.0 mbar; P = 0.8), and it declined in the controls (0.2 ± 0.3 to 0.6 ± 0.3 mbar; P < 0.001). There were no significant changes in HbA 1c (60.5 ± 12.5 to 61.6 ± 13.7 mmol/mol) or in modified total neuropathy scores (2.4 ± 3.2 to 3.4 ± 3.8; P = 0.2). Conclusions The corneal nerve damage and poorer corneal sensitivity reported in the patients with T1D did not change and displayed improvement with good glycemic control. Translational Relevance The corneal nerve changes may be of more value in those with a shorter duration of diabetes for the timely prediction of at-risk individuals likely to develop peripheral neuropathy, particularly in type 1 diabetes.

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“…A second limitation is the clinical diagnosis of DSPN. Indeed, we did not use more sophisticated modalities, such as nerve conduction velocity, intraepidermal nerve fibre density via skin biopsy, or corneal confocal microscopy, which may enable earlier diagnosis of subclinical DSPN [ 1 , 2 , 29 ]. Moreover, subjects were included in a tertiary care centre, and so results may not be directly applicable to primary care and/or the general T2DM population.…”

Section: Discussionmentioning

confidence: 99%

Skin Advanced Glycation End Products among Subjects with Type 2 Diabetes Mellitus with or without Distal Sensorimotor Polyneuropathy

Papachristou

¹

,

Pafili

²

,

Trypsianis

³

et al. 2021

Journal of Diabetes Research

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Aim of the Study. To examine the correlation between skin AGEs and parameters of distal sensorimotor polyneuropathy (DSPN) in type 2 diabetes mellitus (T2DM). Materials and Methods. We included 132 subjects (88 men) with a mean age of 64.57 years and median T2DM duration of 14.5 years. Skin AGEs were measured with AGE reader mu connect (Diagnoptics) on the dominant arm. The device enables single and automated triplicate measurements: both of these were performed. DSPN was diagnosed through the neuropathy disability score (NDS). Small nerve fibre function was assessed by temperature and pinprick sensation on the foot. Bilateral measurement of the vibration perception threshold (VPT) on the hallux was carried out by using a neurothesiometer (Horwell Scientific Laboratory Supplies). Results. Single and triplicate AGE measurements were positively correlated with each other (Pearson’s correlation coefficient r = 0.991 , 95 % CI = 0.987 -0.994, p < 0.001 ). AGEs were higher among subjects with vs. those without DSPN ( p < 0.001 ). Furthermore, they were higher among subjects with reduced vs. normal temperature sensation ( p < 0.001 ), among subjects with reduced vs. normal pinprick sensation ( p = 0.002 ), among those with abnormal vs. normal monofilament examination ( p < 0.001 ), and among those with abnormal vs. normal VPT ( p < 0.001 ). AGEs were correlated with NDS, VPT, and monofilament score. Conclusions. In T2DM, skin AGEs are increased in the presence of DSPN. This holds true both for large and for small nerve function impairment. Moreover, AGEs are correlated with DSPN severity.

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“…There are numerous alternative methods that have been used to assess DPN such as corneal confocal microscopy and quantification of intraepidermal nerve fibre density; however, these tests are not commonly utilized in clinical practice. 19 , 20 …”

Section: Reviewmentioning

confidence: 99%

Diabetes: how to manage diabetic peripheral neuropathy

Gandhi¹,

Fargo²,

Prasad-Reddy³

et al. 2022

DIC

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Diabetic peripheral neuropathy (DPN) is a major complication of diabetes mellitus. Tight glycaemic management focused on lowering haemoglobin A1C and increasing time in the target glucose range along with metabolic risk factor management form the cornerstone of DPN prevention. However, there is limited evidence supporting the efficacy of glycaemic and metabolic control in reducing the symptoms and complications of DPN, including pain once painful DPN develops. DPN treatments include pharmacological agents and non-pharmacological interventions such as foot care and lifestyle modifications. Pharmacological agents primarily address pain symptoms, which affect 25–35% of people with DPN. First-line agents include the anticonvulsants pregabalin and gabapentin, the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine, and secondary amine tricyclic antidepressants, including nortriptyline and desipramine. All agents have unique pharmacological, safety and clinical profiles, and agent selection should be guided by the presence of comorbidities, potential for adverse effects, drug interactions and costs. Even with the current treatment options, people are commonly prescribed less than the recommended dose of medications, leading to poor management of DPN symptoms and treatment discontinuation. By keeping up with the latest therapy algorithms and treatment options, healthcare professionals can improve the care for people with DPN.

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Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta‐analysis

Cited by 28 publications

References 67 publications

Corneal Confocal Microscopy in Type 1 Diabetes Mellitus: A Six-Year Longitudinal Study

Corneal Confocal Microscopy in Type 1 Diabetes Mellitus: A Six-Year Longitudinal Study

Skin Advanced Glycation End Products among Subjects with Type 2 Diabetes Mellitus with or without Distal Sensorimotor Polyneuropathy

Diabetes: how to manage diabetic peripheral neuropathy

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