Lens autofluorescence ratio as a noninvasive marker of peripheral diabetic neuropathy

Abstract

INTRODUCTION Diabetes and its complications are the significant cause of morbidity and mortality. Advanced glycation end products play a major role in the pathogenesis of diabetes complications. OBJECTIVES The aim of the study was to investigate the possible use of a biomicroscope (ClearPath DS-120), which shows the age-adjusted lens fluorescence ratio (LFR), for the diagnosis of diabetic peripheral neuropathy (DPN). PATIENTS AND METHODS A total of 160 patients with type 2 diabetes who underwent an LFR measurement were recruited to this study. DPN was defined as the presence of neuropathic pain or feet sensory loss (or both). Neurothesiometer, monofilament test, and DN4 test results were used for the diagnosis of DPN. RESULTS The LFR of 43 patients (27%) was higher than the expected levels. According to the DN4 questionnaire, 35 of 160 patients (21%) had neuropathic pain. Thirty-seven patients (23%) had higher vibration perception thresholds than expected (>25 V). The monofilament test showed that 42 patients (26%) seemed to be affected by DPN. All of the tests, when considered individually, revealed that patients with higher LFR had more problems related to DPN (P <0.05). High LFR had a sensitivity of 50% and a specificity of 81% in the diagnosis of DPN. Although there was no significant difference in fasting blood glucose levels, we observed that HbA 1c levels were higher and diabetes duration was longer in patients with higher LFR (P <0.05). CONCLUSIONS The measurement of LFR may have clinical utility for a noninvasive detection of DPN.

Long-term development of lens fluorescence in a twin cohort: Heritability and effects of age and lifestyle

“…Although there is a continuing interest in the potential of lens fluorescence as a non-invasive diabetes screening modality or indirect marker of diabetic complications [ 35 , 42 – 45 ], it seems that lens fluorescence is too unreliable a marker to be of practical use. The explanation appears to be a ‘black box’ of genes that has a powerful influence on the rate at which fluorophores accumulate in the lens, of which we have found heritability (up to 93%) to be higher than both that of HbA 1c levels (75% [ 46 ]) and type 2 diabetes (up to 80% [ 47 ]).…”

Nursing Management and Integrative/Integrated Applications in Diabetic Neuropathy

“…Diabetic Peripheral Neuropathy (DPN) is the most common complication of diabetes mellitus (5,12). The most important risk factors in the development of neuropathy are the duration of diabetes and poor glycemic control.…”

“…DPN affects autonomic, motor, and sensory nerve functions, and as a result, it may cause foot ulceration and amputation (12,14).…”

“…Autonomic neuropathy is also associated with thermoregulatory dysfunction and abnormal tissue perfusion (35). With the involvement of autonomic nerves, the control of blood flow in arterioles and vasodilation are impaired, and the risk of developing ulcers due to ischemia increases (12). In addition, autonomic neuropathy causes arteriovenous shunts in the subcutaneous vascular network (20).…”

Investigation of the association between lens autofluorescence ratio and diabetes: a cross-sectional study

“…To this end, lens fluorescence ratio (LFR) measured by confocal biomicroscopy was developed as a novel, rapid, and non-invasive technique for the measurement of AGEs. There is accumulating evidence that LFR is augmented in people with diabetes or diabetic peripheral neuropathy [4][5][6][7]. For example, in a comparative study of patients with type 2 diabetes (T2D) (n = 82) and healthy subjects (n = 109), LFR was found to be higher in the T2D patients than in the healthy subjects.…”