Response to Letter to the Editor Concerning: Adam S. et al. Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

Corneal confocal microscopy for the assessment of diabetic neuropathy and beyond in Brazil

“…We have shown that simultaneous pancreas and kidney (SPK) transplantation in patients with type-1 diabetes normalized HbA1c and was associated with corneal nerve regeneration after 6 months, with an improvement in neuropathic symptoms after 24 months and nerve conduction after 36 months. 12 We have also shown evidence of corneal nerve regeneration after bariatric surgery in obese subjects with 13 and without 14 diabetes. In a randomized clinical trial, 15 a weekly glucagon-like peptide-1 (GLP-1) agonist with pioglitazone or basal bolus insulin led to an ∼ 3% improvement in HbA1c and was associated with corneal nerve regeneration over 12 months, but with no change in vibration perception or sudomotor function.…”

GAED Medal Lecture 2022: Challenging the Dogma in Diabetic Neuropathy and Beyond

“…14 We have shown an increase in CNFL at 12 months, followed by an improvement in neuropathic symptoms at 24 months and neurophysiology at 36 months after SPK transplantation. 15 We have also recently shown an improvement in corneal nerve morphology in obese subjects with 90 and without 91 diabetes, after bariatric surgery. A novel first-in-class peptide (ARA290-Cibinetide), which reduces tissue inflammation, improved corneal nerve fiber density and length in patients with sarcoidosis-related neuropathy 92 93 and type 2 diabetes 94 and was paralleled by an improvement in pain scores.…”