<i>In vivo</i> corneal confocal microscopy as a novel non‐invasive tool to investigate cardiac autonomic neuropathy in Type 1 diabetes

Maddaloni, Ernesto; Sabatino, Francesco; Toro, Rossella Del; Crugliano, S.; Grande, Stefania; Pantano, Angelo Lauria; Maurizi, Anna Rita; Palermo, Andrea; Bombardieri, Stefano; Pozzilli, Paolo; Manfrini, Silvia

doi:10.1111/dme.12583

Cited by 41 publications

(37 citation statements)

References 23 publications

(27 reference statements)

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“…43, 46, 48, 49, 66, 69, 70, 71, 72, 73 Diabetic peripheral neuropathy, a common complication in up to 54% of diabetic population, is a significant cause of morbidity and poor quality of life in diabetic patients. As such, early detection of high-risk patients can pre-empt the course of the disease with measures such as better foot-care to improve healthcare outcomes.…”

Section: Cornea Neuropathymentioning

confidence: 99%

“…6, 16, 17, 45, 77 Decreases in nerve fiber length in sub-basal nerve plexus have also been found to be associated with subclinical diabetic autonomic neuropathy which may be life-threatening, including cardiovascular complications such as arrhythmias or sudden cardiac deaths. 46, 71, 72 The vagal function is used as a measure of autonomic neurological function, assessed by the change of heart rate in response to breathing and posture.…”

Section: Cornea Neuropathymentioning

confidence: 99%

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A systematic review on the impact of diabetes mellitus on the ocular surface

2017

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Diabetes mellitus is associated with extensive morbidity and mortality in any human community. It is well understood that the burden of diabetes is attributed to chronic progressive damage in major end-organs, but it is underappreciated that the most superficial and transparent organ affected by diabetes is the cornea. Different corneal components (epithelium, nerves, immune cells and endothelium) underpin specific systemic complications of diabetes. Just as diabetic retinopathy is a marker of more generalized microvascular disease, corneal nerve changes can predict peripheral and autonomic neuropathy, providing a window of opportunity for early treatment. In addition, alterations of immune cells in corneas suggest an inflammatory component in diabetic complications. Furthermore, impaired corneal epithelial wound healing may also imply more widespread disease. The non-invasiveness and improvement in imaging technology facilitates the emergence of new screening tools. Systemic control of diabetes can improve ocular surface health, possibly aided by anti-inflammatory and vasoprotective agents.

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Section: Cornea Neuropathymentioning

confidence: 99%

Section: Cornea Neuropathymentioning

confidence: 99%

A systematic review on the impact of diabetes mellitus on the ocular surface

2017

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“…There were progressive and significant reductions in nerve-fiber density, nerve-branch density, and nerve-fiber length in patients with DAN vs healthy control and patients without DAN. Another study showed that CCM could represent a new and noninvasive tool in the diagnosis of CAN in T1DM, as corneal nerve-fiber density was lower in patients with CAN vs without CAN (based on HRV and postural hypotension) 116. This is still an evolving area of research, but could present a new noninvasive method for CAN screening and diagnosis in the future.…”

Section: Diagnosis and Screening Of Canmentioning

confidence: 99%

“…For example, an improvement in the gold standard for DPN – nerve-conduction studies – does not necessarily correlate with an improvement in CAN and vice versa, whereas if CCM, discussed earlier, were used as a measure of DPN, it may lead to a different result. Indeed, following islet-cell transplant, CCM shows improvements in corneal nerves 115,116…”

Section: Treatment Of Canmentioning

confidence: 99%

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Fisher

Tahrani

2017

DMSO

111

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Cardiac autonomic neuropathy (CAN) is a common and often-underdiagnosed complication of diabetes mellitus (DM). CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease, and morbidity in patients with DM, but despite these significant consequences CAN often remains undiagnosed for a prolonged period. This is commonly due to the disease being asymptomatic until the later stages, as well as a lack of easily available screening strategies. In this article, we review the latest developments in the epidemiology, pathogenesis, diagnosis, consequences, and treatments of CAN in patients with DM.

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“…Among patients with type 1 diabetes, CNFD was significantly lower ( P = 0.008) in the presence of CAN, and this difference remained significant after adjustment for age, sex, type 1 diabetes duration, insulin dosage and severity of DSPN. Similarly, CNFL was significantly lower in the presence of CAN ( P = 0.005), and this difference remained significant after adjustment for type 1 diabetes duration, insulin dosage and severity of DSPN, but it lost significance after adjustment for age and sex. Tavakoli et al .…”

Section: Introductionmentioning

confidence: 97%

Corneal confocal microscopy: Recent progress in the evaluation of diabetic neuropathy

Παπάνας

Ziegler

2015

J of Diabetes Invest

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The present brief review discusses recent progress with corneal confocal microscopy for the evaluation of diabetic sensorimotor polyneuropathy. Corneal confocal microscopy is a new, non-invasive and reproducible diagnostic modality, and it can also be easily applied for patient follow up. It enables new perspectives of studying the natural history of diabetic sensorimotor polyneuropathy, severity of nerve fiber pathology and documenting early nerve fiber regeneration after therapeutic intervention. It shows moderate to high sensitivity and specificity for the timely diagnosis of diabetic sensorimotor polyneuropathy. Currently, corneal confocal microscopy is mainly used in specialized centers, but deserves more widespread application for the assessment of diabetic sensorimotor polyneuropathy. Finally, further progress is required in terms of technical improvements for automated nerve fiber quantification and for analysis of larger images.

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In vivo corneal confocal microscopy as a novel non‐invasive tool to investigate cardiac autonomic neuropathy in Type 1 diabetes

Cited by 41 publications

References 23 publications

A systematic review on the impact of diabetes mellitus on the ocular surface

A systematic review on the impact of diabetes mellitus on the ocular surface

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Corneal confocal microscopy: Recent progress in the evaluation of diabetic neuropathy

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