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Ponirakis G, Al-Janahi I, Elgassim E, Homssi M, Petropoulos IN, Gad H, Khan A, Zaghloul HB, Ali H, Siddique MA, Mohamed FFS, Ahmed LHM, Dakroury Y, El Shewehy AMM, Saeid R, Mahjoub F, Al-Thani SN, Ahmed F, Hussein R, Mahmoud S, Hadid NH, Al Obaidan A, Salivon I, Mahfoud ZR, Zirie MA, Al-Ansari Y, Atkin SL, Malik RA. Sustained corneal nerve loss predicts the development of diabetic neuropathy in type 2 diabetes. Front Neurosci 2024; 18:1393105. [PMID: 39015377 PMCID: PMC11249546 DOI: 10.3389/fnins.2024.1393105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/05/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction This study was undertaken to investigate whether sustained rather than a single measure of corneal nerve loss was associated with the onset of diabetic peripheral neuropathy (DPN) and the progression of neuropathic symptoms and deficits in individuals with type 2 diabetes (T2D). Methods Participants underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function, and corneal confocal microscopy (CCM) at baseline, 1, 2, and 4-7 years. Sustained corneal nerve loss was defined as abnormal corneal nerve fiber density (CNFD, <24 fibers/mm2), corneal nerve branch density (CNBD, <21 branches/mm2), and corneal nerve fiber length (CNFL, <16 mm/mm2) persisting for ≥50% of the study duration. Results A total of 107 participants with a mean duration of T2D of 13.3 ± 7.3 years, aged 54.8 ± 8.5 years, underwent baseline and follow-up assessments over a median duration of 4 years, ranging from 1 to 7 years. The DPN prevalence at baseline was 18/107 (16.8%), and of the 89 participants without DPN at baseline, 13 (14.6%) developed DPN during follow-up. Approximately half of the cohort had sustained corneal nerve damage, and corneal nerve measures were significantly lower in this group than those without sustained damage (p < 0.0001). Sustained corneal nerve damage was associated with the development of DPN (p < 0.0001), a progressive loss of vibration perception (p ≤ 0.05), an increased incidence of burning pain, numbness, or a combination of both (p = 0.01-0.001), and a borderline association with progressive sudomotor dysfunction (p = 0.07). Sustained abnormal CNFL effectively distinguished between participants who developed DPN and those who did not (AUC: 76.3, 95% CI: 65.9-86.8%, p < 0.0001), while baseline and other sustained measures did not predict DPN onset. Conclusion Sustained abnormal CCM is associated with more severe corneal nerve damage, DPN development, and the progression of neuropathic symptoms and deficits. Regular CCM monitoring may enable the identification of those at greater risk of developing and worsening DPN who may benefit from more aggressive risk factor reduction.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ibrahim Al-Janahi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Einas Elgassim
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Moayad Homssi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hadeel B. Zaghloul
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hamda Ali
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood A. Siddique
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima F. S. Mohamed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Lina H. M. Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Youssra Dakroury
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Ruba Saeid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Fadwa Mahjoub
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Shaikha N. Al-Thani
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Farheen Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Rawan Hussein
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Salah Mahmoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Nebras H. Hadid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Aisha Al Obaidan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Iuliia Salivon
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R. Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Mahmoud A. Zirie
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf Al-Ansari
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
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Chen Y, Xu Z, Liang A, Chen R, Wang Z, Chen X, Zheng K, Lu P, Liang H, Cao D, Zhang L. Comprehensive assessment of ocular parameters for identifying diagnostic indicators of diabetic peripheral neuropathy. Acta Diabetol 2024:10.1007/s00592-024-02299-w. [PMID: 38780614 DOI: 10.1007/s00592-024-02299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To explore variations in systemic and ocular parameters among patients with diabetes, both with and without diabetic peripheral neuropathy (DPN) and to identify sensitive indicators for DPN diagnosis. METHODS Ninty-five patients with type 2 diabetes mellitus (T2DM) were involved in this cross-sectional study, including 49 without DPN and 46 with DPN. Ocular parameters were obtained using optical coherence tomography angiography (OCTA) and corneal confocal microscopy (CCM). RESULT Patients with DPN presented with significantly higher HbA1c (p < 0.05) and glycated albumin (GA, p < 0.01) levels, increased prevalence of diabetic retinopathy (DR, p < 0.05), and lower serum albumin (ALB, p < 0.01) and red blood cell (RBC, p < 0.05) levels. Ocular assessments revealed reduced corneal nerve fiber length (CNFL, p < 0.001) and enlarged foveal avascular zone (FAZ) area (p < 0.05) in DPN group. Logistic regression analysis indicated a significant association of presence of DR, RBC, GA, ALB, CNFL and DPN (p < 0.05, respectively). In the binary logistic regression for DPN risk, all three models including the presence of DR and CNFL exhibited the area under the curve (AUC) exceeding 0.8. CONCLUSION The study establishes a strong correlation between ocular parameters and DPN, highlighting CCM's role in early diagnosis. Combining systemic and ocular indicators improves DPN risk assessment and early management.
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Affiliation(s)
- Yesheng Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China
| | - Zhicong Xu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China
| | - Anyi Liang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China
| | - Ruoyu Chen
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China
| | - Zicheng Wang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China
- School of Medicine, South China University of Technology, Guangzhou, 510000, China
| | - Xiaojun Chen
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China
| | - Kangyan Zheng
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China
- Shantou University Medical College, Shantou, 515000, China
| | - Peiyao Lu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China
| | - Huilin Liang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China
| | - Dan Cao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China.
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China.
| | - Liang Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China.
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China.
- School of Medicine, South China University of Technology, Guangzhou, 510000, China.
- Shantou University Medical College, Shantou, 515000, China.
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Guo Y, Lu J, Zhu L, Hao X, Huang K. Association between hyperglycemia during pregnancy and offspring's refractive error: A focused review. Eur J Ophthalmol 2024:11206721241238389. [PMID: 38523364 DOI: 10.1177/11206721241238389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
This review article explores the relationship between hyperglycemia during pregnancy and the visual development of offspring, specifically focusing on refractive error. The authors conducted a comprehensive search for relevant articles in various databases and assessed the methodological quality of the included studies. The findings consistently indicate that hyperglycemia during pregnancy can have a detrimental impact on the structural and functional aspects of visual development in offspring. The intrauterine hyperglycemic environment appears to negatively affect the retina and lens, leading to refractive errors. In conclusion, there is likely an association between hyperglycemia during pregnancy and the development of refractive errors in offspring.
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Affiliation(s)
- Yufan Guo
- School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Courset, Hefei, Anhui, China
| | - Jingru Lu
- School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Courset, Hefei, Anhui, China
| | - Linlin Zhu
- School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Courset, Hefei, Anhui, China
| | - Xuemei Hao
- School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Courset, Hefei, Anhui, China
| | - Kun Huang
- School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Courset, Hefei, Anhui, China
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Schicht M, Farger J, Wedel S, Sisignano M, Scholich K, Geisslinger G, Perumal N, Grus FH, Singh S, Sahin A, Paulsen F, Lütjen-Drecoll E. Ocular surface changes in mice with streptozotocin-induced diabetes and diabetic polyneuropathy. Ocul Surf 2024; 31:43-55. [PMID: 38141818 DOI: 10.1016/j.jtos.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE Diabetes mellitus (DM) is a leading risk factor for corneal neuropathy and dry eye disease (DED). Another common consequence of DM is diabetic peripheral polyneuropathy (DPN). Both complications affect around 50 % of the DM patients but the relationship between DM, DED and DPN remains unclear. METHODS In this study, we examined mice with early onset of DM and PN after streptozotocin (STZ)-induced diabetes (DPN). We compared the early morphological changes of the sciatic nerve, dorsal root and trigeminal ganglia with the changes in the ocular surface, including tear proteomic and we also investigated respective changes in the gene expressions and morphological alterations in the eye tissues involved in tear production. RESULTS The lacrimal gland, conjunctival goblet cells and cornea showed morphological changes along with alterations in tear proteins without any obvious signs of ocular surface inflammation. The gene expression for respectively altered tear proteins i.e., of Clusterin in cornea, Car6, Adh3a1, and Eef1a1 in eyelids, and Pigr in the lacrimal gland also showed significant changes compared to control mice. In the trigeminal ganglia like in the dorsal root ganglia neuronal cells showed swollen mitochondria and, in the latter, there was a significant increase of NADPH oxidases and MMP9 suggestive of oxidative and neuronal stress. In the dorsal root ganglia and the sciatic nerve, there was an upregulation of a number of pro-inflammatory cytokines and pain-mediating chemokines. CONCLUSION The early ocular changes in DM Mice only affect the lacrimal gland. Which, is reflected in the tear film composition of DPN mice. Due to the high protein concentration in tear fluid in humans, proteomic analysis in addition to noninvasive investigation of goblet cells and cornea can serve as a tools for the early diagnosis of DPN, DED in clinical practice. Early treatment could delay or even prevent the ocular complications of DM such as DED and PN.
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Affiliation(s)
- Martin Schicht
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Jessica Farger
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Saskia Wedel
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Marco Sisignano
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Frankfurt am Main, Department of Experimental and Translational Ophthalmology, Germany
| | - Klaus Scholich
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Frankfurt am Main, Department of Experimental and Translational Ophthalmology, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Frankfurt am Main, Department of Experimental and Translational Ophthalmology, Germany
| | - Natarajan Perumal
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Franz H Grus
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Swati Singh
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkey
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Elke Lütjen-Drecoll
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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5
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Bjørnkaer A, Gaist LM, Holbech JV, Gaist D, Wirenfeldt M, Sindrup SH, Krøigård T. Corneal confocal microscopy in small and mixed fiber neuropathy-Comparison with skin biopsy and cold detection in a large prospective cohort. J Peripher Nerv Syst 2023; 28:664-676. [PMID: 37651181 DOI: 10.1111/jns.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS The diagnosis of small fiber neuropathy (SFN) is supported by reduced intraepidermal nerve fiber density (IENFD). The noninvasive method corneal confocal microscopy (CCM) has the potential to be a practical alternative. We aimed to estimate the diagnostic accuracy of CCM compared with IENFD and cold detection thresholds (CDT) in SFN and mixed fiber neuropathy (MFN). METHODS CCM was performed in an unselected prospective cohort of patients with a clinical suspicion of polyneuropathy. Predefined criteria were used to classify SFN and MFN. Neuropathy scores, including the Utah early neuropathy scale (UENS), were used to describe severity. Patients with established other diagnoses were used for diagnostic specificity calculations. RESULTS Data were taken from 680 patients, of which 244 had SFN or MFN. There was no significant difference in sensitivities [95%CI] of CCM (0.44 [0.38-0.51]), IEFND (0.43 [0.36-0.49]), and CDT (0.34 [0.29-0.41]). CCM specificity (0.75 [0.69-0.81]) was lower (p = .044) than for IENFD (0.99 [0.96-1.00]) but not than for CDT (0.81 [0.75-0.86]). The AUCs of the ROC curves of 0.63, 0.63 and 0.74 respectively, was lower for corneal nerve fiber density (p = .0012) and corneal nerve fiber length (p = .0015) compared with IENFD. While UENS correlated significantly with IENFD (p = .0016; R2 = .041) and CDT (p = .0002; R2 = .056), it did not correlate with CCM measures. INTERPRETATION The diagnostic utility of CCM in SNF and MFN is limited by the low specificity compared with skin biopsy. Further, CCM is less suitable than skin biopsy and CDT as a marker for neuropathy severity.
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Affiliation(s)
- Asger Bjørnkaer
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Laura M Gaist
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jakob V Holbech
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - David Gaist
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Martin Wirenfeldt
- University of Southern Denmark, Odense, Denmark
- Pathology Research Unit, Odense University Hospital, Odense, Denmark
| | - Søren H Sindrup
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Thomas Krøigård
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Siegel AP, Avanaki K. The power of light and sound: optoacoustic skin imaging for diabetes progression monitoring. LIGHT, SCIENCE & APPLICATIONS 2023; 12:283. [PMID: 37996426 PMCID: PMC10667326 DOI: 10.1038/s41377-023-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Diabetes progression is marked by damage to vascular and neural networks. Raster-scan optoacoustic mesoscopy holds the potential to measure extent of diabetes progression by analyzing changes in skin vasculature.
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Affiliation(s)
- Amanda P Siegel
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Kamran Avanaki
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
- Section of Neonatology, Department of Pediatrics, UI Health Children's Hospital of the University of Illinois at Chicago, Chicago, IL, USA.
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA.
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Sune MP, Sune M, Sune P, Dhok A. Prevalence of Retinopathy in Prediabetic Populations: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49602. [PMID: 38161917 PMCID: PMC10755086 DOI: 10.7759/cureus.49602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Among the leading causes of vision impairment and blindness globally, diabetic retinopathy (DR) is one of the most important causes. There is increasing evidence of DR prevalence in the prediabetic population. This systematic review presents collective data on retinopathy in the prediabetic population. This review article aimed to estimate the reported prevalence of retinopathy in prediabetes, impaired glucose tolerance test (GTT) without diabetes mellitus, and the risk factors involved and to summarize it. Literature searches were done using the Web of Science, CINAHL, Google Scholar, Cochrane, EMBASE, and PubMed databases from inception to April 2023. Our search included the words prediabetes, DR, and risk factors. All searches were looked at for methodological quality and evidence. Thirty-one studies were included after the screening. Population-based data were used in 23 studies (82.1%). The prediabetic population screened was 10,539. The prevalence of retinopathy ranged between 0.3% and 20.9%, showing a median of 8.1% with an interquartile range (IQR) of 4.2-11%, showing great variance in estimates due to the use of different screening methods, methods used for retinopathy grading, and study populations. Several studies compared the population with normal GTT with impaired glucose tolerance (IGT) and inferred that there was a lower prevalence of retinopathy in the normal GTT population (3.0%, IQR 0.3-7.4%) than prediabetes (6.7%, IQR 1.9-10.1%). According to this data, a greater retinopathy prevalence was found in prediabetic populations.
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Affiliation(s)
- Manjiri P Sune
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mona Sune
- Ophthalmology, Sune Eye Hospital, Wardha, IND
| | | | - Archana Dhok
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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8
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Malik RA. Is the 10 g monofilament fit for purpose for diagnosing DPN? BMJ Open Diabetes Res Care 2023; 11:e003773. [PMID: 37989348 PMCID: PMC10660155 DOI: 10.1136/bmjdrc-2023-003773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Rayaz A Malik
- Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Division of Cardiovascular Sciences, University of Manchester-The Victoria University of Manchester Campus, Manchester, UK
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He H, Fasoula NA, Karlas A, Omar M, Aguirre J, Lutz J, Kallmayer M, Füchtenbusch M, Eckstein HH, Ziegler A, Ntziachristos V. Opening a window to skin biomarkers for diabetes stage with optoacoustic mesoscopy. LIGHT, SCIENCE & APPLICATIONS 2023; 12:231. [PMID: 37718348 PMCID: PMC10505608 DOI: 10.1038/s41377-023-01275-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
Being the largest and most accessible organ of the human body, the skin could offer a window to diabetes-related complications on the microvasculature. However, skin microvasculature is typically assessed by histological analysis, which is not suited for applications to large populations or longitudinal studies. We introduce ultra-wideband raster-scan optoacoustic mesoscopy (RSOM) for precise, non-invasive assessment of diabetes-related changes in the dermal microvasculature and skin micro-anatomy, resolved with unprecedented sensitivity and detail without the need for contrast agents. Providing unique imaging contrast, we explored a possible role for RSOM as an investigational tool in diabetes healthcare and offer the first comprehensive study investigating the relationship between different diabetes complications and microvascular features in vivo. We applied RSOM to scan the pretibial area of 95 participants with diabetes mellitus and 48 age-matched volunteers without diabetes, grouped according to disease complications, and extracted six label-free optoacoustic biomarkers of human skin, including dermal microvasculature density and epidermal parameters, based on a novel image-processing pipeline. We then correlated these biomarkers to disease severity and found statistically significant effects on microvasculature parameters as a function of diabetes complications. We discuss how label-free RSOM biomarkers can lead to a quantitative assessment of the systemic effects of diabetes and its complications, complementing the qualitative assessment allowed by current clinical metrics, possibly leading to a precise scoring system that captures the gradual evolution of the disease.
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Affiliation(s)
- Hailong He
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Murad Omar
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Juan Aguirre
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Jessica Lutz
- Diabetes Center at Marienplatz, Munich, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Martin Füchtenbusch
- Diabetes Center at Marienplatz, Munich, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Annette Ziegler
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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10
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Chan ACY, Kumar S, Tan G, Wong HY, Ong JJY, Chandra B, Huang H, Sharma VK, Lai PS. Expanding the genetic causes of small-fiber neuropathy: SCN genes and beyond. Muscle Nerve 2023; 67:259-271. [PMID: 36448457 DOI: 10.1002/mus.27752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 12/05/2022]
Abstract
Small-fiber neuropathy (SFN) is a disorder that exclusively affects the small nerve fibers, sparing the large nerve fibers. Thinly myelinated Aδ-fibers and unmyelinated C-fibers are damaged, leading to development of neuropathic pain, thermal dysfunction, sensory symptoms, and autonomic disturbances. Although many SFNs are secondary and due to immunological causes or metabolic disturbances, the etiology is unknown in up to half of the patients. Over the years, this proportion of "idiopathic SFN" has decreased, as familial and genetic causes have been discovered, thus shifting a proportion of once "idiopathic" cases to the genetic category. After the discovery of SCN9A-gene variants in 2012, SCN10A and SCN11A variants have been found to be pathogenic in SFN. With improved accessibility of SFN diagnostic tools and genetic tests, many non-SCN variants and genetically inherited systemic diseases involving the small nerve fibers have also been described, but only scattered throughout the literature. There are 80 SCN variants described as causing SFN, 8 genes causing hereditary sensory autonomic neuropathies (HSAN) described with pure SFN, and at least 7 genes involved in genetically inherited systemic diseases associated with SFN. This systematic review aims to consolidate and provide an updated overview on the genetic variants of SFN to date---SCN genes and beyond. Awareness of these genetic causes of SFN is imperative for providing treatment directions, prognostication, and management of expectations for patients and their health-care providers.
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Affiliation(s)
- Amanda C Y Chan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shivaram Kumar
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace Tan
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hiu Yi Wong
- Division of Life Science, State Key Laboratory of Molecular Neuroscience, Hong Kong University of Science and Technology, Hong Kong, China
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong Science Park, Hong Kong, China
| | - Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bharatendu Chandra
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Medical Genetics, University of Iowa, Iowa City, Iowa, USA
| | - Hua Huang
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vijay Kumar Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Poh San Lai
- Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
- Adjunct Faculty, Genome Institute of Singapore, Singapore, Singapore
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11
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Kirthi V, Reed KI, Alattar K, Zuckerman BP, Bunce C, Nderitu P, Alam U, Clarke B, Hau S, Al-Shibani F, Petropoulos IN, Malik RA, Pissas T, Bergeles C, Vas P, Hopkins D, Jackson TL. Multimodal testing reveals subclinical neurovascular dysfunction in prediabetes, challenging the diagnostic threshold of diabetes. Diabet Med 2023; 40:e14952. [PMID: 36054221 PMCID: PMC10087038 DOI: 10.1111/dme.14952] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore if novel non-invasive diagnostic technologies identify early small nerve fibre and retinal neurovascular pathology in prediabetes. METHODS Participants with normoglycaemia, prediabetes or type 2 diabetes underwent an exploratory cross-sectional analysis with optical coherence tomography angiography (OCT-A), handheld electroretinography (ERG), corneal confocal microscopy (CCM) and evaluation of electrochemical skin conductance (ESC). RESULTS Seventy-five participants with normoglycaemia (n = 20), prediabetes (n = 29) and type 2 diabetes (n = 26) were studied. Compared with normoglycaemia, mean peak ERG amplitudes of retinal responses at low (16-Td·s: 4.05 μV, 95% confidence interval [95% CI] 0.96-7.13) and high (32-Td·s: 5·20 μV, 95% CI 1.54-8.86) retinal illuminance were lower in prediabetes, as were OCT-A parafoveal vessel densities in superficial (0.051 pixels/mm2 , 95% CI 0.005-0.095) and deep (0.048 pixels/mm2 , 95% CI 0.003-0.093) retinal layers. There were no differences in CCM or ESC measurements between these two groups. Correlations between HbA1c and peak ERG amplitude at 32-Td·s (r = -0.256, p = 0.028), implicit time at 32-Td·s (r = 0.422, p < 0.001) and 16-Td·s (r = 0.327, p = 0.005), OCT parafoveal vessel density in the superficial (r = -0.238, p = 0.049) and deep (r = -0.3, p = 0.017) retinal layers, corneal nerve fibre length (CNFL) (r = -0.293, p = 0.017), and ESC-hands (r = -0.244, p = 0.035) were observed. HOMA-IR was a predictor of CNFD (β = -0.94, 95% CI -1.66 to -0.21, p = 0.012) and CNBD (β = -5.02, 95% CI -10.01 to -0.05, p = 0.048). CONCLUSIONS The glucose threshold for the diagnosis of diabetes is based on emergent retinopathy on fundus examination. We show that both abnormal retinal neurovascular structure (OCT-A) and function (ERG) may precede retinopathy in prediabetes, which require confirmation in larger, adequately powered studies.
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Affiliation(s)
- Varo Kirthi
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Kate I Reed
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Catey Bunce
- Biomedical Research Centre, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Paul Nderitu
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Uazman Alam
- University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Bronagh Clarke
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Scott Hau
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London, London, UK
| | | | | | - Rayaz A Malik
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Division of Research, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Theodoros Pissas
- King's College London, London, UK
- University College London, London, UK
| | | | - Prashanth Vas
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - David Hopkins
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy L Jackson
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
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12
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Gottwald-Hostalek U, Gwilt M. Vascular complications in prediabetes and type 2 diabetes: a continuous process arising from a common pathology. Curr Med Res Opin 2022; 38:1841-1851. [PMID: 35833523 DOI: 10.1080/03007995.2022.2101805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The term, "prediabetes", describes a state of hyperglycaemia that is intermediate between true normoglycaemia and the diagnostic cut-offs for indices of glycaemia that are used to diagnose type 2 diabetes. The presence of prediabetes markedly increases the risk of developing type 2 diabetes. Numerous randomized, controlled evaluations of various agents have demonstrated significant prevention or delay of the onset of type 2 diabetes in subjects with prediabetes. Intensive lifestyle interventions and metformin have been studied most widely, with the lifestyle intervention being more effective in the majority of subjects. The application of therapeutic interventions at the time of prediabetes to preserve long-term outcomes has been controversial, however, due to a lack of evidence relating to the pathogenic effects of prediabetes and the effectiveness of interventions to produce a long-term clinical benefit. Recent studies have confirmed that prediabetes, however defined, is associated with a significantly increased risk of macrovascular and microvascular complications essentially identical to those of diabetes, and also with subclinical derangements of the function of microvasculature and neurons that likely signify increased risk of compilations in future. Normoglycaemia, prediabetes and type 2 diabetes appear to be part of a continuum of increased risk of adverse outcomes. Long-term (25-30 years) post-trial follow up of two major diabetes prevention trials have shown that short-term interventions to prevent diabetes lead to long-term reductions in the risk of complications. These findings support the concept of therapeutic intervention to preserve long-term health in people with prediabetes before type 2 diabetes becomes established.
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13
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Matuszewska-Iwanicka A, Stratmann B, Stachs O, Allgeier S, Bartschat A, Winter K, Guthoff R, Tschoepe D, Hettlich HJ. Mosaic vs. Single Image Analysis with Confocal Microscopy of the Corneal Nerve Plexus for Diagnosis of Early Diabetic Peripheral Neuropathy. Ophthalmol Ther 2022; 11:2211-2223. [PMID: 36184730 DOI: 10.1007/s40123-022-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The assessment of the corneal nerve fibre plexus with corneal confocal microscopy (CCM) is an upcoming but still experimental method in the diagnosis of early stage diabetic peripheral neuropathy (DPN). Using an innovative imaging technique-Heidelberg Retina Tomograph equipped with the Rostock Cornea Module (HRT-RCM) and EyeGuidance module (EG)-we were able to look at greater areas of subbasal nerve plexus (SNP) in order to increase the diagnostic accuracy. The aim of our study was to evaluate the usefulness of EG instead of single image analysis in diagnosis of early stage DPN. METHODS This prospective study was performed on 60 patients with type 2 diabetes mellitus, classified equally into two subgroups based on neuropathy deficient score (NDS): patients without DPN (group 1) or with mild DPN (group 2). The following parameters were analysed in the two subgroups: corneal nerve fibre length (CNFL; mm/mm2), corneal nerve fibre density (CNFD; no./mm2), corneal nerve branch density (CNBD; no./mm2). Furthermore, we compared the data calculated with the novel mosaic, EG-based method with those received from single image analysis using different quantification tools. RESULTS Using EG we did not find a significant difference between group 1 and group 2: CNFL (16.81 ± 5.87 mm/mm2 vs. 17.19 ± 7.19 mm/mm2, p = 0.895), CNFD (254.05 ± 115.36 no./mm2 vs. 265.91 ± 161.63 no./mm2, p = 0.732) and CNBD (102.68 ± 62.28 no./mm2 vs. 115.38 ± 96.91 no./mm2, p = 0.541). No significant difference between the EG method of analysing the SNP and the single image analysis of 10 images per patient was detected. CONCLUSION On the basis of our results it was not possible to differentiate between early stages of large nerve fibre DPN in patients with type 2 diabetes mellitus via SNP analysis. To improve sensitivity and specificity of this method newer technologies are under current evaluation. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05326958.
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Affiliation(s)
- Aleksandra Matuszewska-Iwanicka
- Eye Clinic Johannes Wesling Hospital, Ruhr Universität Bochum, Augen-Praxisklinik Minden, Königstraße 120, 32427, Minden, Germany.
| | - Bernd Stratmann
- Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Diethelm Tschoepe
- Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
- Stiftung DHD (Der herzkranke Diabetiker) Stiftung in der Deutschen Diabetes-Stiftung, Bad Oeynhausen, Germany
| | - Hans-Joachim Hettlich
- Eye Clinic Johannes Wesling Hospital, Ruhr Universität Bochum, Augen-Praxisklinik Minden, Königstraße 120, 32427, Minden, Germany
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14
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So WZ, Qi Wong NS, Tan HC, Yu Lin MT, Yu Lee IX, Mehta JS, Liu YC. Diabetic corneal neuropathy as a surrogate marker for diabetic peripheral neuropathy. Neural Regen Res 2022; 17:2172-2178. [PMID: 35259825 PMCID: PMC9083173 DOI: 10.4103/1673-5374.327364] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus, affecting nerves in all parts of the body including corneal nerves and peripheral nervous system, leading to diabetic corneal neuropathy and diabetic peripheral neuropathy, respectively. Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies, clinical scoring, and skin biopsies. However, these diagnostic methods have limited sensitivity in detecting small-fiber disease, hence they do not accurately reflect the status of diabetic neuropathy. More recently, analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy. In this review, we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy, elaborating on the foundational aspects of each: pathogenesis, clinical presentation, evaluation, and management. We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy, particularly early diabetic peripheral neuropathy; the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy; and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.
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Affiliation(s)
- Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore
| | - Natalie Shi Qi Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Jodhbir S Mehta
- Singapore Eye Research Institute; Department of Cornea and External Eye Disease, Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Yu-Chi Liu
- Singapore Eye Research Institute; Department of Cornea and External Eye Disease, Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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15
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Pasha R, Azmi S, Ferdousi M, Kalteniece A, Bashir B, Gouni-Berthold I, Malik RA, Soran H. Lipids, Lipid-Lowering Therapy, and Neuropathy: A Narrative Review. Clin Ther 2022; 44:1012-1025. [PMID: 35810030 DOI: 10.1016/j.clinthera.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
Abstract
Statins, or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, are the mainstay of treatment for hypercholesterolemia as they effectively reduce LDL-C levels and risk of atherosclerotic cardiovascular disease. Apart from hyperglycemia, dyslipidemia and HDL dysfunction are known risk factors for neuropathy in people with obesity and diabetes. Although there are case reports of statin-induced neuropathy, ad hoc analyses of clinical trials and observational studies have shown that statins may improve peripheral neuropathy. However, large randomized controlled trials and meta-analyses of cardiovascular outcome trials with statins and other lipid-lowering drugs have not reported on neuropathy outcomes. Because neuropathy was not a prespecified outcome in major cardiovascular trials, one cannot conclude whether statins or other lipid-lowering therapies increase or decrease the risk of neuropathy. The aim of this review was to assess if statins have beneficial or detrimental effects on neuropathy and whether there is a need for large well-powered interventional studies using objective neuropathy end points.
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Affiliation(s)
- Raabya Pasha
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Shazli Azmi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Maryam Ferdousi
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Alise Kalteniece
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Bilal Bashir
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes, and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom.
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16
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Performance Analysis of Conventional Machine Learning Algorithms for Diabetic Sensorimotor Polyneuropathy Severity Classification Using Nerve Conduction Studies. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9690940. [PMID: 35510061 PMCID: PMC9061035 DOI: 10.1155/2022/9690940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/14/2022] [Accepted: 03/18/2022] [Indexed: 02/06/2023]
Abstract
Background Diabetic sensorimotor polyneuropathy (DSPN) is a major form of complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is very common and well-established in the field of research, its application in DSPN diagnosis using nerve conduction studies (NCS), is very limited in the existing literature. Method In this study, the NCS data were collected from the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. The NCS variables are median motor velocity (m/sec), median motor amplitude (mV), median motor F-wave (msec), median sensory velocity (m/sec), median sensory amplitude (μV), Peroneal Motor Velocity (m/sec), peroneal motor amplitude (mv), peroneal motor F-wave (msec), sural sensory velocity (m/sec), and sural sensory amplitude (μV). Three different feature ranking techniques were used to analyze the performance of eight different conventional classifiers. Results The ensemble classifier outperformed other classifiers for the NCS data ranked when all the NCS features were used and provided an accuracy of 93.40%, sensitivity of 91.77%, and specificity of 98.44%. The random forest model exhibited the second-best performance using all the ten features with an accuracy of 93.26%, sensitivity of 91.95%, and specificity of 98.95%. Both ensemble and random forest showed the kappa value 0.82, which indicates that the models are in good agreement with the data and the variables used and are accurate to identify DSPN using these ML models. Conclusion This study suggests that the ensemble classifier using all the ten NCS variables can predict the DSPN severity which can enhance the management of DSPN patients.
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17
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Bu Y, Shih KC, Tong L. The ocular surface and diabetes, the other 21st Century epidemic. Exp Eye Res 2022; 220:109099. [DOI: 10.1016/j.exer.2022.109099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
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18
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Corneal Confocal Microscopy Identifies Small Nerve Fibre Damage in Patients with Hypertriglyceridemia. J Clin Lipidol 2022; 16:463-471. [DOI: 10.1016/j.jacl.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/01/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
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19
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Kirthi V, Nderitu P, Alam U, Evans JR, Nevitt S, Malik RA, Hopkins D, Jackson TL. The prevalence of retinopathy in prediabetes: A systematic review. Surv Ophthalmol 2022; 67:1332-1345. [DOI: 10.1016/j.survophthal.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/21/2022]
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Abstract
Diabetes polyneuropathy is an important complication of diabetes polyneuropathy, and its notable sequelae of foot ulceration, autonomic dysfunction, and neuropathic pain are associated with significant morbidity and mortality. Despite the major impact on quality of life and health economic costs, it remains underdiagnosed until late in its natural history, and there is lack of any intervention that can reverse its clinical progress. Assessment of small fiber neuropathy (SFN) in diabetes offers an opportunity to detect abnormalities at an early stage so that both interventional studies and preventative measures can be enacted to prevent progression to the devastating complications of foot ulceration and cardiac dysautonomic death. Over the last two decades, significant advances have been made in understanding the pathophysiology of diabetes neuropathy and its assessment. In this review, we discuss limitations of the screening methods recommended in current clinical guidelines which are based on large nerve fiber assessments. Thereafter, we discuss in detail the various methods currently available to assess small fiber structure and function and examine their individual strength and limitations. Finally, we discuss the reasons why despite the considerable body of evidence available, legislators and global experts have yet to incorporate the assessment of SFN as routine clinical surveillance in diabetes management. We hope that these insights will stimulate further discussion and be instrumental in the early adoption of these methods so as to reduce the burden of complications arising due to diabetes polyneuropathy.
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Affiliation(s)
- Sanjeev Sharma
- Diabetes Trails unit, Ipswich Hospital
(ESNEFT), Ipswich, UK
| | - Prashanth Vas
- Department of Diabetes, Kings College
Hospital, London, UK
| | - Gerry Rayman
- Diabetes Trails unit, Ipswich Hospital
(ESNEFT), Ipswich, UK
- Gerry Rayman, MD, Diabetes Trials Unit,
Department of Diabetes & Endocrinology, Ipswich Hospital, ESNEFT, Heath
Road, Ipswich, Suffolk IP4 5RH, UK.
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21
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ASSOCIATIONS BETWEEN DYSGLYCEMIA, RETINAL NEURODEGENERATION, AND MICROALBUMINURIA IN PREDIABETES AND TYPE 2 DIABETES. Retina 2022; 42:442-449. [PMID: 35188489 DOI: 10.1097/iae.0000000000003337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the association between retinal neurodegeneration and metabolic parameters in progressive dysglycemia. METHOD A cross-sectional study was performed on 68 participants: normal glucose tolerance (n = 23), prediabetes (n = 25), and Type 2 diabetes without diabetic retinopathy (n = 20). Anthropometric assessment and laboratory sampling for HbA1c, fasting glucose, insulin, c-peptide, lipid profile, renal function, and albumin-to-creatinine ratio were conducted. Central and pericentral macular thicknesses on spectral domain optical coherence tomography were compared with systemic parameters. RESULTS Baseline demographic characteristics were similar across all groups. Cuzick's trend test revealed progressive full-thickness macular thinning with increasing dysglycemia across all three groups (P = 0.015). The urinary albumin-to-creatinine ratio was significantly correlated with full-thickness superior (R = -0.435; P = 0.0002), inferior (R = -0.409; P = 0.0005), temporal (R = -0.429; P = 0.003), and nasal (R = -0.493; P < 0.0001) pericentral macular thinning, after post hoc Bonferroni adjustment. There was no association between macular thinning and waist circumference, body mass index, blood pressure, lipid profile, or insulin resistance. CONCLUSION Progressive dysglycemia is associated with macular thinning before the onset of visible retinopathy and occurs alongside microalbuminuria. Retinal neurodegenerative changes may help identify those most at risk from dysglycemic end-organ damage.
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22
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Newlin Lew K, Arnold T, Cantelmo C, Jacque F, Posada-Quintero H, Luthra P, Chon KH. Diabetes Distal Peripheral Neuropathy: Subtypes and Diagnostic and Screening Technologies. J Diabetes Sci Technol 2022; 16:295-320. [PMID: 34994241 PMCID: PMC8861801 DOI: 10.1177/19322968211035375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes distal symmetrical peripheral neuropathy (DSPN) is the most prevalent form of neuropathy in industrialized countries, substantially increasing risk for morbidity and pre-mature mortality. DSPN may manifest with small-fiber disease, large-fiber disease, or a combination of both. This review summarizes: (1) DSPN subtypes (small- and large-fiber disease) with attention to clinical signs and patient symptoms; and (2) technological diagnosis and screening for large- and small-fiber disease with inclusion of a comprehensive literature review of published studies from 2015-present (N = 66). Review findings, informed by the most up-to-date research, advance critical understanding of DSPN large- and small-fiber screening technologies, including those designed for point-of-care use in primary care and endocrinology practices.
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Affiliation(s)
- Kelley Newlin Lew
- School of Nursing, University of
Connecticut (UConn), Storrs, CT, USA
- Kelley Newlin Lew, School of Nursing,
University of Connecticut (UConn), 231 Glenbrook Road, Storrs, CT 06269, USA.
| | - Tracey Arnold
- School of Nursing, University of
Connecticut (UConn), Storrs, CT, USA
| | | | - Francky Jacque
- Hispanic Alliance of Southeastern
Connecticut, New London, CT, USA
| | - Hugo Posada-Quintero
- Biomedical Engineering Department,
University of Connecticut (UConn), Storrs, CT, USA
| | - Pooja Luthra
- Division of Endocrinology and
Metabolism, UConn Health, Farmington, CT, USA
| | - Ki H. Chon
- Biomedical Engineering Department,
University of Connecticut (UConn), Storrs, CT, USA
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Corneal Confocal Microscopy in the Diagnosis of Small Fiber Neuropathy: Faster, Easier, and More Efficient Than Skin Biopsy? PATHOPHYSIOLOGY 2021; 29:1-8. [PMID: 35366285 PMCID: PMC8954271 DOI: 10.3390/pathophysiology29010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic pain may affect 30–50% of the world’s population and an important cause is small fiber neuropathy (SFN). Recent research suggests that autoimmune diseases may be one of the most common causes of small nerve fiber damage. There is low awareness of SFN among patients and clinicians and it is difficult to diagnose as routine electrophysiological methods only detect large fiber abnormalities, and specialized small fiber tests, like skin biopsy and quantitative sensory testing, are not routinely available. Corneal confocal microscopy (CCM) is a rapid, non-invasive, reproducible method for quantifying small nerve fiber degeneration and regeneration, and could be an important tool for diagnosing SFN. This review considers the advantages and disadvantages of CCM and highlights the evolution of this technique from a research tool to a diagnostic test for small fiber damage, which can be a valuable contribution to the study and management of autoimmune disease.
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Jin Y, Wang W, Chen W, Guo S, Li C, Zhu D, Bi Y. Corneal confocal microscopy: A useful tool for diagnosis of small fiber neuropathy in type 2 diabetes. J Diabetes Investig 2021; 12:2183-2189. [PMID: 34134175 PMCID: PMC8668068 DOI: 10.1111/jdi.13616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
AIM To investigate the diagnostic utility of corneal confocal microscopy (CCM) for small fiber neuropathy in type 2 diabetes. MATERIALS AND METHODS There were 186 participants with type 2 diabetes enrolled in this cross-sectional research. Pure small fiber neuropathy and mixed fiber neuropathy were defined using clinical examination, electromyography, and quantitative sensory testing. Demographics and clinical data, corneal confocal microscopy parameters, and other neuropathy measures were compared among the groups. The diagnostic utility of corneal confocal microscopy for small fiber neuropathy was assessed by the receiver operating curve. RESULTS Of the 186 patients, 24.7% had a pure small fiber neuropathy and 17.2% of patients were diagnosed with mixed fiber neuropathy. The corneal nerve fiber density (CNFD), corneal nerve fiber branch density (CNBD), and corneal nerve fiber length (CNFL) were significantly lower in subjects with pure small fiber neuropathy compared with those without diabetic peripheral neuropathy (all P < 0.05). The receiver operating curve analysis for corneal confocal microscopy diagnosing small fiber neuropathy demonstrated the area under the curve for CNFD of 0.791, CNFL of 0.778, CNBD of 0.710. CONCLUSIONS Patients with type 2 diabetes with pure small fiber neuropathy showed more corneal nerve loss compared with those without diabetic peripheral neuropathy. It was revealed that corneal confocal microscopy can be a reasonable marker in the diagnosis of small fiber neuropathy in type 2 diabetes.
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Affiliation(s)
- Yu Jin
- Department of EndocrinologyNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingChina
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
- Department of OsteoporosisLianyungang Clinical College of Nanjing Medical UniversityLianyungangChina
| | - Weimin Wang
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Wei Chen
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Simin Guo
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Chenxi Li
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Dalong Zhu
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Yan Bi
- Department of EndocrinologyNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingChina
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
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25
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Kalteniece A, Ferdousi M, Azmi S, Khan SU, Worthington A, Marshall A, Faber CG, Lauria G, Boulton AJM, Soran H, Malik RA. Corneal nerve loss is related to the severity of painful diabetic neuropathy. Eur J Neurol 2021; 29:286-294. [PMID: 34570924 PMCID: PMC9292015 DOI: 10.1111/ene.15129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
Background and purpose Previously it has been shown that patients with painful diabetic neuropathy (PDN) have greater corneal nerve loss compared to patients with painless diabetic neuropathy. This study investigated if the severity of corneal nerve loss was related to the severity of PDN. Methods Participants with diabetic neuropathy (n = 118) and healthy controls (n = 38) underwent clinical and neurological evaluation, quantitative sensory testing, nerve conduction testing and corneal confocal microscopy and were categorized into those with no (n = 43), mild (n = 34) and moderate‐to‐severe (n = 41) neuropathic pain. Results Corneal nerve fibre density (p = 0.003), corneal nerve fibre length (p < 0.0001) and cold perception threshold (p < 0.0001) were lower and warm perception threshold was higher (p = 0.002) in patients with more severe pain, but there was no significant difference in the neuropathy disability score (p = 0.5), vibration perception threshold (p = 0.5), sural nerve conduction velocity (p = 0.3) and amplitude (p = 0.7), corneal nerve branch density (p = 0.06) and deep breathing heart rate variability (p = 0.08) between patients with differing severity of PDN. The visual analogue scale correlated significantly with corneal nerve fibre density (r = −0.3, p = 0.0002), corneal nerve branch density (r = −0.3, p = 0.001) and corneal nerve fibre length (r = −0.4, p < 0.0001). Receiver operating curve analysis showed that corneal nerve fibre density had an area under the curve of 0.78 with a sensitivity of 0.73 and specificity of 0.72 for the diagnosis of PDN. Conclusions Corneal confocal microscopy reveals increasing corneal nerve fibre loss with increasing severity of neuropathic pain and a good diagnostic outcome for identifying patients with PDN.
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Affiliation(s)
- Alise Kalteniece
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Saif Ullah Khan
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Anne Worthington
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Catharina G Faber
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Giuseppe Lauria
- Neuroalgology Unit and Skin Biopsy, Peripheral Neuropathy and Neuropathic Pain Centre, IRCCS Foundation 'Carlo Besta' Neurological Institute, Milan, Italy
| | - Andrew J M Boulton
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Handrean Soran
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.,Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, Qatar
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26
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Al-Janahi E, Ponirakis G, Al Hamad H, Vattoth S, Elsotouhy A, Petropoulos IN, Khan A, Gad H, Chandran M, Sankaranarayanan A, Ramadan M, Elorrabi M, Gadelseed M, Tosino R, Gawhale PV, Arasn A, Alobaidi M, Khan S, Manikoth P, Hamdi Y, Osman S, Nadukkandiyil N, AlSulaiti E, Thodi N, Almuhannadi H, Mahfoud ZR, Own A, Shuaib A, Malik RA. Corneal Nerve and Brain Imaging in Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2021; 77:1533-1543. [PMID: 32925064 PMCID: PMC7683060 DOI: 10.3233/jad-200678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Visual rating of medial temporal lobe atrophy (MTA) is an accepted structural neuroimaging marker of Alzheimer’s disease. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic technique that detects neuronal loss in peripheral and central neurodegenerative disorders. Objective: To determine the diagnostic accuracy of CCM for mild cognitive impairment (MCI) and dementia compared to medial temporal lobe atrophy (MTA) rating on MRI. Methods: Subjects aged 60–85 with no cognitive impairment (NCI), MCI, and dementia based on the ICD-10 criteria were recruited. Subjects underwent cognitive screening, CCM, and MTA rating on MRI. Results: 182 subjects with NCI (n = 36), MCI (n = 80), and dementia (n = 66), including AD (n = 19, 28.8%), VaD (n = 13, 19.7%), and mixed AD (n = 34, 51.5%) were studied. CCM showed a progressive reduction in corneal nerve fiber density (CNFD, fibers/mm2) (32.0±7.5 versus 24.5±9.6 and 20.8±9.3, p < 0.0001), branch density (CNBD, branches/mm2) (90.9±46.5 versus 59.3±35.7 and 53.9±38.7, p < 0.0001), and fiber length (CNFL, mm/mm2) (22.9±6.1 versus 17.2±6.5 and 15.8±7.4, p < 0.0001) in subjects with MCI and dementia compared to NCI. The area under the ROC curve (95% CI) for the diagnostic accuracy of CNFD, CNBD, CNFL compared to MTA-right and MTA-left for MCI was 78% (67–90%), 82% (72–92%), 86% (77–95%) versus 53% (36–69%) and 40% (25–55%), respectively, and for dementia it was 85% (76–94%), 84% (75–93%), 85% (76–94%) versus 86% (76–96%) and 82% (72–92%), respectively. Conclusion: The diagnostic accuracy of CCM, a non-invasive ophthalmic biomarker of neurodegeneration, was high and comparable with MTA rating for dementia but was superior to MTA rating for MCI.
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Affiliation(s)
- Eiman Al-Janahi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Manchester Metropolitan University, Faculty of Science and Engineering, Manchester, UK
| | - Hanadi Al Hamad
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Surjith Vattoth
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elsotouhy
- Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mani Chandran
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Marwan Ramadan
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Marwa Elorrabi
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Masharig Gadelseed
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rhia Tosino
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Priya V Gawhale
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anjum Arasn
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maryam Alobaidi
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shafi Khan
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Pravija Manikoth
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yasmin Hamdi
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Susan Osman
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Navas Nadukkandiyil
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Essa AlSulaiti
- Geriatric & Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Noushad Thodi
- MRI Unit, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Almuhannadi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ahmed Own
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Manchester Metropolitan University, Faculty of Science and Engineering, Manchester, UK.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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27
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Ponirakis G, Abdul‐Ghani MA, Jayyousi A, Zirie MA, Qazi M, Almuhannadi H, Petropoulos IN, Khan A, Gad H, Migahid O, Megahed A, Al‐Mohannadi S, AlMarri F, Al‐Khayat F, Mahfoud Z, Al Hamad H, Ramadan M, DeFronzo R, Malik RA. Painful diabetic neuropathy is associated with increased nerve regeneration in patients with type 2 diabetes undergoing intensive glycemic control. J Diabetes Investig 2021; 12:1642-1650. [PMID: 33714226 PMCID: PMC8409832 DOI: 10.1111/jdi.13544] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS/INTRODUCTION Painful diabetic peripheral neuropathy (pDPN) is associated with small nerve fiber degeneration and regeneration. This study investigated whether the presence of pDPN might influence nerve regeneration in patients with type 2 diabetes undergoing intensive glycemic control. MATERIALS AND METHODS This exploratory substudy of an open-label randomized controlled trial undertook the Douleur Neuropathique en 4 questionnaire and assessment of electrochemical skin conductance, vibration perception threshold and corneal nerve morphology using corneal confocal microscopy in participants with and without pDPN treated with exenatide and pioglitazone or basal-bolus insulin at baseline and 1-year follow up, and 18 controls at baseline only. RESULTS Participants with type 2 diabetes, with (n = 13) and without (n = 28) pDPN had comparable corneal nerve fiber measures, electrochemical skin conductance and vibration perception threshold at baseline, and pDPN was not associated with the severity of DPN. There was a significant glycated hemoglobin reduction (P < 0.0001) and weight gain (P < 0.005), irrespective of therapy. Participants with pDPN showed a significant increase in corneal nerve fiber density (P < 0.05), length (P < 0.0001) and branch density (P < 0.005), and a decrease in the Douleur Neuropathique en 4 score (P < 0.01), but no change in electrochemical skin conductance or vibration perception threshold. Participants without pDPN showed a significant increase in corneal nerve branch density (P < 0.01) and no change in any other neuropathy measures. A change in the severity of painful symptoms was not associated with corneal nerve regeneration and medication for pain. CONCLUSIONS This study showed that intensive glycemic control is associated with greater corneal nerve regeneration and an improvement in the severity of pain in patients with painful diabetic neuropathy.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Muhammad A Abdul‐Ghani
- National Diabetes CenterHamad General HospitalHamad Medical CorporationDohaQatar
- Division of DiabetesUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Amin Jayyousi
- National Diabetes CenterHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mahmoud A Zirie
- National Diabetes CenterHamad General HospitalHamad Medical CorporationDohaQatar
| | - Murtaza Qazi
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | | | | | - Adnan Khan
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Hoda Gad
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Osama Migahid
- National Diabetes CenterHamad General HospitalHamad Medical CorporationDohaQatar
- Division of DiabetesUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Ayman Megahed
- National Diabetes CenterHamad General HospitalHamad Medical CorporationDohaQatar
| | | | - Fatema AlMarri
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Fatima Al‐Khayat
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Ziyad Mahfoud
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | | | | | - Ralph DeFronzo
- Division of DiabetesUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Rayaz A Malik
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
- National Diabetes CenterHamad General HospitalHamad Medical CorporationDohaQatar
- Institute of Cardiovascular ScienceUniversity of ManchesterManchesterUK
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Abstract
SUMMARY The autonomic nervous system is a complex neural network that controls several organ systems. Its assessment includes a detailed history of autonomic functions, clinical examination, and autonomic tests. Most widely used is a battery of tests that assess cardiovascular reflex autonomic and sudomotor tests, which include deep breathing (assesses parasympathetic function), Valsalva maneuver, tilt test (both assess parasympathetic and adrenergic functions), and sudomotor testing for the evaluation of postganglionic sudomotor fibers. These basic tests represent a foundation of autonomic testing. Nevertheless, the autonomic nervous system also controls organ systems not directly assessed by basic tests. This review describes a number of auxiliary autonomic tests that can be used in addition to basic autonomic tests or can be used independently to explore particular autonomic functions or to answer a specific clinical question. The auxiliary tests described in this review evaluate cardiovascular, thermoregulatory, gastrointestinal, genitourinary, eye, and exocrine functions. These tests are cold pressor test, sustained handgrip maneuver, reverse tilt test, venoarteriolar reflex, laser Doppler flare imaging, microneurography, neck suction, lower body negative pressure, venous occlusion plethysmography, pharmacologic assessment of postganglionic sympathetic outflow, plasma norepinephrine, sympathetic skin response, video cinefluoroscopic swallowing test, esophageal manometry test, small bowel manometry test, wireless motility capsule test, urodynamic studies, penile plethysmography, intracavernosal papaverine injection, infrared video pupillography, corneal confocal microscopy, pupillary response to dilute pilocarpine and hydroxyamphetamine, Schirmer test, tear osmolarity test, and salivary secretion test. The protocol of each test is described in detail. This review can be used as a quick reference for the auxiliary autonomic tests.
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Affiliation(s)
- Rodrigo C Quispe
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; and
| | - Peter Novak
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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29
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Azmi S, Ferdousi M, Liu Y, Adam S, Siahmansur T, Ponirakis G, Marshall A, Petropoulos IN, Ho JH, Syed AA, Gibson JM, Ammori BJ, Durrington PN, Malik RA, Soran H. The role of abnormalities of lipoproteins and HDL functionality in small fibre dysfunction in people with severe obesity. Sci Rep 2021; 11:12573. [PMID: 34131170 PMCID: PMC8206256 DOI: 10.1038/s41598-021-90346-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity and associated dyslipidemia may contribute to increased cardiovascular disease. Obesity has also been associated with neuropathy. We have investigated presence of peripheral nerve damage in patients with severe obesity without type 2 diabetes and the status of metabolic syndrome and lipoprotein abnormalities. 47participants with severe obesity and 30 age-matched healthy controls underwent detailed phenotyping of neuropathy and an assessment of lipoproteins and HDL-functionality. Participants with severe obesity had a higher neuropathy symptom profile, lower sural and peroneal nerve amplitudes, abnormal thermal thresholds, heart rate variability with deep breathing and corneal nerve parameters compared to healthy controls. Circulating apolipoprotein A1 (P = 0.009), HDL cholesterol (HDL-C) (P < 0.0001), cholesterol efflux (P = 0.002) and paroxonase-1 (PON-1) activity (P < 0.0001) were lower, and serum amyloid A (SAA) (P < 0.0001) was higher in participants with obesity compared to controls. Obese participants with small nerve fibre damage had higher serum triglycerides (P = 0.02), lower PON-1 activity (P = 0.002) and higher prevalence of metabolic syndrome (58% vs. 23%, P = 0.02) compared to those without. However, HDL-C (P = 0.8), cholesterol efflux (P = 0.08), apoA1 (P = 0.8) and SAA (P = 0.8) did not differ significantly between obese participants with and without small nerve fibre damage. Small nerve fibre damage occurs in people with severe obesity. Patients with obesity have deranged lipoproteins and compromised HDL functionality compared to controls. Obese patients with evidence of small nerve fibre damage, compared to those without, had significantly higher serum triglycerides, lower PON-1 activity and a higher prevalence of metabolic syndrome.
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Affiliation(s)
- Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Diabetes, Endocrine and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Yifen Liu
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Safwaan Adam
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospitals, Manchester, M13 9WL, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Tarza Siahmansur
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Jan Hoong Ho
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospitals, Manchester, M13 9WL, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Akheel A Syed
- Department of Diabetes and Endocrinology, Salford Royal Trust NHS Foundation Trust, Salford, UK
| | - John M Gibson
- Department of Diabetes and Endocrinology, Salford Royal Trust NHS Foundation Trust, Salford, UK
| | - Basil J Ammori
- Department Surgery, Salford Royal Trust NHS Foundation Trust, Salford, UK
| | - Paul N Durrington
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. .,Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospitals, Manchester, M13 9WL, UK.
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30
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Iqbal Z, Kalteniece A, Ferdousi M, Adam S, D'Onofrio L, Ho JH, Rao AP, Dhage S, Azmi S, Liu Y, Donn R, Malik RA, Soran H. Corneal Keratocyte Density and Corneal Nerves Are Reduced in Patients With Severe Obesity and Improve After Bariatric Surgery. Invest Ophthalmol Vis Sci 2021; 62:20. [PMID: 33475689 PMCID: PMC7817877 DOI: 10.1167/iovs.62.1.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Obesity is associated with peripheral neuropathy, which bariatric surgery may ameliorate. The aim of this study was to assess whether corneal confocal microscopy can show a change in corneal nerve morphology and keratocyte density in subjects with severe obesity after bariatric surgery. Methods Twenty obese patients with diabetes (n = 13) and without diabetes (n = 7) underwent assessment of hemoglobin A1c (HbA1c), lipids, IL-6, highly sensitive C-reactive protein (hsCRP), and corneal confocal microscopy before and 12 months after bariatric surgery. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and keratocyte density (KD) from the anterior, middle, and posterior stroma were quantified. Twenty-two controls underwent assessment at baseline only. Results CNFL (P < 0.001), CNBD (P < 0.05), and anterior (P < 0.001), middle (P < 0.001), and posterior (P < 0.001) keratocyte densities were significantly lower in obese patients compared to controls, and anterior keratocyte density (AKD) correlated with CNFL. Twelve months after bariatric surgery, there were significant improvements in body mass index (BMI; P < 0.001), HDL cholesterol (P < 0.05), hsCRP (P < 0.001), and IL-6 (P < 0.01). There were significant increases in CNFD (P < 0.05), CNBD (P < 0.05), CNFL (P < 0.05), and anterior (P < 0.05) and middle (P < 0.001) keratocyte densities. The increase in AKD correlated with a decrease in BMI (r = -0.55, P < 0.05) and triglycerides (r = -0.85, P < 0.001). There were no significant correlations between the change in keratocyte densities and corneal nerve fiber or other neuropathy measures. Conclusions Corneal confocal microscopy demonstrates early small fiber damage and reduced keratocyte density in obese patients. Bariatric surgery leads to weight reduction and improvement in lipids and inflammation and an improvement in keratocyte density and corneal nerve regeneration.
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Affiliation(s)
- Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Jan H Ho
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Anoop Prasanna Rao
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Shaishav Dhage
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Shazli Azmi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Yifen Liu
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rachelle Donn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Ferdousi M, Azmi S, Kalteniece A, Khan SU, Petropoulos IN, Ponirakis G, Alam U, Asghar O, Marshall A, Soran H, Boulton AJM, Augustine T, Malik RA. No evidence of improvement in neuropathy after renal transplantation in patients with end stage kidney disease. J Peripher Nerv Syst 2021; 26:269-275. [PMID: 34085731 DOI: 10.1111/jns.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
To assess the impact of renal transplantation on peripheral nerve damage in patients with chronic kidney disease (CKD). Fifteen patients with CKD (eGFR <15 mL/min/1.73 m2 ) underwent longitudinal assessment after renal transplantation (age: 56.88 ± 2.53 years, eGFR: 46.82 ± 4.86) and were compared with 15 age-matched controls (age: 58.25 ± 2.18 years, eGFR: 86.0 ± 2.0). The neuropathy symptom profile (NSP), neuropathy disability score (NDS), vibration perception threshold (VPT), cold and warm sensation threshold (CST and WST), cold and heat induced pain (CIP and HIP), deep breathing heart rate variability (DB-HRV), nerve conduction studies and corneal confocal microscopy (CCM) to quantify small nerve fibre pathology, were undertaken within 1-month of renal transplantation (baseline) and at 6, 12 and 24 months of follow up. There was no significant difference in NSP (P = .1), NDS (P = .3), VPT (P = .6), CST (P = .2), CIP (P = .08), HIP (P = .1), DB-HRV (P = .9) and sural (P = .4) and peroneal (P = .1) nerve amplitude between patients with CKD and controls at baseline. However, sural (P = .04), peroneal (P = .002) and tibial (P = .007) nerve conduction velocity and tibial nerve amplitude (P = .03) were significantly lower, WST (P = .02) was significantly higher and corneal nerve fibre density (P = .004) was significantly lower in patients with CKD compared with controls. There was no significant change in NSP, NDS, quantitative sensory testing, DB-HRV, nerve conduction or CCM parameters 24 months after renal transplantation. There is evidence of small and large fibre neuropathy in patients with CKD, but no change up to 24 months after successful renal transplantation.
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Affiliation(s)
- Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Saif Ullah Khan
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Doha, Qatar
| | - Uazman Alam
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Omar Asghar
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Andrew Marshall
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Handrean Soran
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Andrew J M Boulton
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Titus Augustine
- Department of Transplant and Endocrine Surgery, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.,Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Doha, Qatar
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Takahashi K, Mizukami H, Osonoi S, Ogasawara S, Hara Y, Kudoh K, Takeuchi Y, Sasaki T, Daimon M, Yagihashi S. Inhibitory effects of xanthine oxidase inhibitor, topiroxostat, on development of neuropathy in db/db mice. Neurobiol Dis 2021; 155:105392. [PMID: 34000416 DOI: 10.1016/j.nbd.2021.105392] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Inflammation and oxidative stress contribute to the pathophysiology of diabetic neuropathy. According to recent evidence, the modulation of macrophage polarization in peripheral nerves represents a potential therapeutic target for diabetic neuropathy. Xanthine oxidase, which is a form of xanthin oxidoreductase, is the rate-limiting enzyme that catalyzes the degradation of hypoxanthine and xanthine into uric acid. Activation of xanthine oxidase promotes oxidative stress and macrophage activation. A preclinical study reported the beneficial effects of xanthine oxidase inhibitors on peripheral nerve dysfunction in experimental models of diabetes. However, the detailed mechanisms remain unknown. In this study, we examined the effect of the xanthine oxidase inhibitor topiroxostat on macrophage polarization and peripheral neuropathy in an obese diabetic model, db/db mice. First, the effects of xanthine oxidase inhibitors on cultured macrophages and dorsal root ganglion neurons exposed to xanthine oxidase were assessed. Furthermore, five-week-old db/db mice were administered the xanthine oxidase inhibitors topiroxostat [1 mg/kg/day (dbT1) or 2 mg/kg/day (dbT2)] or febuxostat [1 mg/kg (dbF)]. Glucose metabolism and body weight were evaluated during the experimental period. At 4 and 8 weeks of treatment, peripheral nerve functions such as nerve conduction velocities, thermal thresholds and pathology of skin and sciatic nerves were evaluated. The mRNA expression of molecules related to inflammation and oxidative stress was also measured in sciatic nerves. Untreated db/db mice and the nondiabetic db strain (db/m) were studied for comparison. An in vitro study showed that topiroxostat suppressed macrophage activation and proinflammatory but not anti-inflammatory polarization, and prevented the reduction in neurite outgrowth from neurons exposed to xanthine oxidase. Neuropathic changes exemplified by delayed nerve conduction and reduced intraepidermal nerve fiber density developed in db/db mice. These deficits were significantly prevented in the treated group, most potently in dbT2. Protective effects were associated with the suppression of macrophage infiltration, cytokine expression, and oxidative stress in the sciatic nerve and decreased plasma xanthine oxidoreductase activity. Our results revealed the beneficial effects of the xanthine oxidase inhibitor topiroxostat on neuropathy development in a mouse model of type 2 diabetes. The suppression of proinflammatory macrophage activation and oxidative stress-induced damage were suggested to be involved in this process.
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Affiliation(s)
- Kazuhisa Takahashi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Hiroki Mizukami
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.
| | - Sho Osonoi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Saori Ogasawara
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Yutaro Hara
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Department of Gastroenterological Surgery and Pediatric Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Kazuhiro Kudoh
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Yuki Takeuchi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Takanori Sasaki
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Makoto Daimon
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Soroku Yagihashi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
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Petropoulos IN, Ponirakis G, Ferdousi M, Azmi S, Kalteniece A, Khan A, Gad H, Bashir B, Marshall A, Boulton AJM, Soran H, Malik RA. Corneal Confocal Microscopy: A Biomarker for Diabetic Peripheral Neuropathy. Clin Ther 2021; 43:1457-1475. [PMID: 33965237 DOI: 10.1016/j.clinthera.2021.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Diagnosing early diabetic peripheral neuropathy remains a challenge due to deficiencies in currently advocated end points. The cornea is densely innervated with small sensory fibers, which are structurally and functionally comparable to intraepidermal nerve fibers. Corneal confocal microscopy is a method for rapid, noninvasive scanning of the living cornea with high resolution and magnification. METHODS This narrative review presents the framework for the development of biomarkers and the literature on the use and adoption of corneal confocal microscopy as an objective, diagnostic biomarker in experimental and clinical studies of diabetic peripheral neuropathy. A search was performed on PubMed and Google Scholar based on the terms "corneal confocal microscopy," "diabetic neuropathy," "corneal sensitivity," and "clinical trials." FINDINGS A substantial body of evidence underpins the thesis that corneal nerve loss predicts incident neuropathy and progresses with the severity of diabetic peripheral neuropathy. Corneal confocal microscopy also identifies early corneal nerve regeneration, strongly arguing for its inclusion as a surrogate end point in clinical trials of disease-modifying therapies. IMPLICATIONS There are sufficient diagnostic and prospective validation studies to fulfill the US Food and Drug Administration criteria for a biomarker to support the inclusion of corneal confocal microscopy as a primary end point in clinical trials of disease-modifying therapies in diabetic neuropathy.
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Affiliation(s)
| | | | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Shazli Azmi
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Adnan Khan
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hoda Gad
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Bilal Bashir
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Clinical Neurophysiology, The Walton Centre, Liverpool, United Kingdom; Division of Neuroscience and Experimental Psychology, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew J M Boulton
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar; Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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34
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D'Onofrio L, Kalteniece A, Ferdousi M, Azmi S, Petropoulos IN, Ponirakis G, Alam U, Asghar O, Marshall A, Boulton AJM, Efron N, Buzzetti R, Soran H, Malik RA. Small Nerve Fiber Damage and Langerhans Cells in Type 1 and Type 2 Diabetes and LADA Measured by Corneal Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 33944892 PMCID: PMC8107645 DOI: 10.1167/iovs.62.6.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Increased corneal and epidermal Langerhans cells (LCs) have been reported in patients with diabetic neuropathy. The aim of this study was to quantify the density of LCs in relation to corneal nerve morphology and the presence of diabetic neuropathy and to determine if this differed in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and latent autoimmune diabetes of adults (LADA). Methods Patients with T1DM (n = 25), T2DM (n = 36), or LADA (n = 23) and control subjects (n = 23) underwent detailed assessment of peripheral neuropathy and corneal confocal microscopy. Corneal nerve fiber density (CNFD), branch density (CNBD), length (CNFL) and total, immature and mature LC densities were quantified. Results Lower CNFD (P < 0.001), CNBD (P < 0.0001), and CNFL (P < 0.0001) and higher LC density (P = 0.03) were detected in patients with T1DM, T2DM, and LADA compared to controls. CNBD was inversely correlated with mature (r = -0.5; P = 0.008), immature (r = -0.4; P = 0.02) and total (r = -0.5; P = 0.01) LC density, and CNFL was inversely correlated with immature LC density (r = -0.4; P = 0.03) in patients with T1DM but not in patients with T2DM and LADA. Conclusions This study shows significant corneal nerve loss and an increase in LC density in patients with T1DM, T2DM, and LADA. Furthermore, increased LC density correlated with corneal nerve loss in patients with T1DM.
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Affiliation(s)
- Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Ioannis N. Petropoulos
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Uazman Alam
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Omar Asghar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andrew J M. Boulton
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Nathan Efron
- Queensland University of Technology, School of Optometry and Vision Science, Brisbane, Australia
| | | | - Handrean Soran
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Rayaz A. Malik
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
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35
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Kirthi V, Perumbalath A, Brown E, Nevitt S, Petropoulos IN, Burgess J, Roylance R, Cuthbertson DJ, Jackson TL, Malik RA, Alam U. Prevalence of peripheral neuropathy in pre-diabetes: a systematic review. BMJ Open Diabetes Res Care 2021; 9:9/1/e002040. [PMID: 34006607 PMCID: PMC8137250 DOI: 10.1136/bmjdrc-2020-002040] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
There is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive electronic bibliographic search was performed in MEDLINE, EMBASE, PubMed, Web of Science and the Cochrane Central Register of Controlled Trials from inception to June 1, 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. An evaluation was undertaken by method of neuropathy assessment. After screening 1784 abstracts and reviewing 84 full-text records, 29 studies (9351 participants) were included. There was a wide range of prevalence estimates (2%-77%, IQR: 6%-34%), but the majority of studies (n=21, 72%) reported a prevalence ≥10%. The three highest prevalence estimates of 77% (95% CI: 54% to 100%), 71% (95% CI: 55% to 88%) and 66% (95% CI: 53% to 78%) were reported using plantar thermography, multimodal quantitative sensory testing and nerve conduction tests, respectively. In general, studies evaluating small nerve fiber parameters yielded a higher prevalence of peripheral neuropathy. Due to a variety of study populations and methods of assessing neuropathy, there was marked heterogeneity in the prevalence estimates. Most studies reported a higher prevalence of peripheral neuropathy in pre-diabetes, primarily of a small nerve fiber origin, than would be expected in the background population. Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.
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Affiliation(s)
- Varo Kirthi
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anugraha Perumbalath
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Emily Brown
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | - Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rebecca Roylance
- Edge Hill University Library, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine, Doha, Qatar
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Division of Endocrinology, Diabetes & Gastroenterology, University of Manchester, Manchester, UK
- Pain Research Institute, University of Liverpool, Liverpool, UK
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36
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Marshall A, Alam U, Themistocleous A, Calcutt N, Marshall A. Novel and Emerging Electrophysiological Biomarkers of Diabetic Neuropathy and Painful Diabetic Neuropathy. Clin Ther 2021; 43:1441-1456. [PMID: 33906790 DOI: 10.1016/j.clinthera.2021.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes. Small and large peripheral nerve fibers can be involved in DPN. Large nerve fiber damage causes paresthesia, sensory loss, and muscle weakness, and small nerve fiber damage is associated with pain, anesthesia, foot ulcer, and autonomic symptoms. Treatments for DPN and painful DPN (pDPN) pose considerable challenges due to the lack of effective therapies. To meet these challenges, there is a major need to develop biomarkers that can reliably diagnose and monitor progression of nerve damage and, for pDPN, facilitate personalized treatment based on underlying pain mechanisms. METHODS This study involved a comprehensive literature review, incorporating article searches in electronic databases (Google Scholar, PubMed, and OVID) and reference lists of relevant articles with the authors' substantial expertise in DPN. This review considered seminal and novel research and summarizes emerging biomarkers of DPN and pDPN that are based on neurophysiological methods. FINDINGS From the evidence gathered from 145 papers, this submission describes emerging clinical neurophysiological methods with potential to act as biomarkers for the diagnosis and monitoring of DPN as well as putative future roles as predictors of response to antineuropathic pain medication in pDPN. Nerve conduction studies only detect large fiber damage and do not capture pathology or dysfunction of small fibers. Because small nerve fiber damage is prominent in DPN, additional biomarkers of small nerve fiber function are needed. Activation of peripheral nociceptor fibers using laser, heat, or targeted electrical stimuli can generate pain-related evoked potentials, which are an objective neurophysiological measure of damage along the small fiber pathways. Assessment of nerve excitability, which provides a surrogate of axonal properties, may detect alterations in function before abnormalities are detected by nerve conduction studies. Microneurography and rate-dependent depression of the Hoffmann-reflex can be used to dissect underlying pain-generating mechanisms arising from the periphery and spinal cord, respectively. Their role in informing mechanistic-based treatment of pDPN as well as facilitating clinical trials design is discussed. IMPLICATIONS The neurophysiological methods discussed, although currently not practical for use in busy outpatient settings, detect small fiber and early large fiber damage in DPN as well as disclosing dominant pain mechanisms in pDPN. They are suited as diagnostic and predictive biomarkers as well as end points in mechanistic clinical trials of DPN and pDPN.
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Affiliation(s)
- Anne Marshall
- Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Uazman Alam
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andreas Themistocleous
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Calcutt
- Department of Pathology, University of California, San Diego, La Jolla, California
| | - Andrew Marshall
- Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Clinical Neurophysiology, The Walton Centre, Liverpool, United Kingdom; Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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Adam S, Azmi S, Ho JH, Liu Y, Ferdousi M, Siahmansur T, Kalteniece A, Marshall A, Dhage SS, Iqbal Z, D'Souza Y, Natha S, Kalra PA, Donn R, Ammori BJ, Syed AA, Durrington PN, Malik RA, Soran H. Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study. Obes Surg 2021; 31:554-563. [PMID: 33104989 PMCID: PMC7847862 DOI: 10.1007/s11695-020-05052-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE There are limited data on the impact of bariatric surgery on microvascular complications of type 2 diabetes (T2D), particularly diabetic neuropathy. We assessed microvascular complications (especially neuropathy) in obese patients with T2D before and 12 months after bariatric surgery. MATERIALS AND METHODS This was a prospective observational cohort study. Measurements of neuropathy symptom profile (NSP), neuropathy disability score (NDS), vibration (VPT), cold (CPT) and warm (WPT) perception thresholds, nerve conduction studies (NCS) and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), branch density (CNBD) and fibre length (CNFL); urinary albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFRcyst-creat) and retinal grading were taken. RESULTS Twenty-six (62% female; median age 52 years) obese patients with T2D were recruited. Body mass index (BMI) (47.2 to 34.5 kg/m2; p < 0.001) decreased post-operatively. There were improvements in CNFD (27.1 to 29.2/mm2; p = 0.005), CNBD (63.4 to 77.8/mm2; p = 0.008), CNFL (20.0 to 20.2/mm2; p = 0.001), NSP (3 to 0/38; p < 0.001) and eGFRcyst-creat (128 to 120 ml/min; p = 0.015) post-bariatric surgery. Changes in (Δ) triglycerides were independently associated with ΔCNFL (β = - 0.53; p = 0.024) and Δsystolic blood pressure (β = 0.62;p = 0.017), and %excess BMI loss (β = - 0.004; p = 0.018) were associated with ΔeGFRcyst-creat. There was no significant change in NDS, VPT, CPT, WPT, NCS, uACR or retinopathy status. Glomerular hyperfiltration resolved in 42% of the 12 patients with this condition pre-operatively. CONCLUSION Bariatric surgery results in improvements in small nerve fibres and glomerular hyperfiltration in obese people with T2D, which were associated with weight loss, triglycerides and systolic blood pressure, but with no change in retinopathy or uACR at 12 months.
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Affiliation(s)
- Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Shazli Azmi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jan H Ho
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Yifen Liu
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Tarza Siahmansur
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alise Kalteniece
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Marshall
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Shaishav S Dhage
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Yvonne D'Souza
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Salim Natha
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Philip A Kalra
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Rachelle Donn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Basil J Ammori
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Akheel A Syed
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Paul N Durrington
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Manchester University NHS Foundation Trust, Manchester, UK.
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Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics (Basel) 2021; 11:diagnostics11020165. [PMID: 33498918 PMCID: PMC7911433 DOI: 10.3390/diagnostics11020165] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.
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Chiang JCB, Goldstein D, Trinh T, Au K, Mizrahi D, Muhlmann M, Crowe P, O'Neill S, Edwards K, Park SB, Krishnan AV, Markoulli M. A Cross-Sectional Study of Sub-Basal Corneal Nerve Reduction Following Neurotoxic Chemotherapy. Transl Vis Sci Technol 2021; 10:24. [PMID: 33510963 PMCID: PMC7804570 DOI: 10.1167/tvst.10.1.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Sub-basal corneal nerves have been shown to change during neurotoxic chemotherapy treatment. This cross-sectional study investigated corneal nerve morphology in patients who have completed neurotoxic chemotherapy well after treatment cessation and its association with peripheral nerve function. Methods Central corneal nerve fiber length (CNFL) and inferior whorl length (IWL), average nerve fiber length (ANFL), corneal nerve fiber density (CNFD) and corneal nerve branch density (CNBD), and nerve fiber area (CNFA) were examined using in vivo corneal confocal microscopy in patients with cancer who had completed treatment with either paclitaxel or oxaliplatin between 3 and 24 months prior to assessment in comparison with 2 separate groups of healthy controls. Neurological assessments were conducted including clinician- and patient-reported outcomes, and neurological grading scales. Results Both paclitaxel- (n = 40) and oxaliplatin-treated (n = 30) groups had reduced IWL and ANFL compared to the respective healthy control groups (n = 15 in each group) (paclitaxel: IWL = P = 0.02, ANFL = P = 0.009; and oxaliplatin: IWL = P = 0.008, ANFL P = 0.02). CNFL and CNFD reduction were observed only in the paclitaxel-treated group compared with healthy controls (P = 0.008 and P = 0.02, respectively), whereas CNFA was reduced in the oxaliplatin-treated group (P = 0.04). IWL reduction correlated with worse fine hand dexterity in chemotherapy-treated patients (r = −0.33, P = 0.007). Conclusions There is evidence of corneal nerve loss in patients with cancer who have been treated with paclitaxel and oxaliplatin well after treatment cessation associated with worse upper limb function. Translational Relevance Sub-basal corneal nerve reduction is evident even after cessation of neurotoxic treatment. In vivo corneal confocal microscopy may be useful in the monitoring of nerve function in patients receiving chemotherapy.
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Affiliation(s)
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kimberley Au
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - David Mizrahi
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Mark Muhlmann
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Philip Crowe
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Siobhan O'Neill
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Maria Markoulli
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
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Kirthi V, Nderitu P, Alam U, Evans J, Nevitt S, Malik RA, Jackson TL. Prevalence of retinopathy in prediabetes: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e040997. [PMID: 33414145 PMCID: PMC7797244 DOI: 10.1136/bmjopen-2020-040997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There is growing evidence of a higher than expected prevalence of retinopathy in prediabetes. This paper presents the protocol of a systematic review and meta-analysis of retinopathy in prediabetes. The aim of the review is to estimate the prevalence of retinopathy in prediabetes and to summarise the current data. METHODS AND ANALYSIS This protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive electronic bibliographic search will be conducted in MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and the Cochrane Library. Eligible studies will report prevalence data for retinopathy on fundus photography in adults with prediabetes. No time restrictions will be placed on the date of publication. Screening for eligible studies and data extraction will be conducted by two reviewers independently, using predefined inclusion criteria and prepiloted data extraction forms. Disagreements between the reviewers will be resolved by discussion, and if required, a third (senior) reviewer will arbitrate.The primary outcome is the prevalence of any standard features of diabetic retinopathy (DR) on fundus photography, as per International Clinical Diabetic Retinopathy Severity Scale (ICDRSS) classification. Secondary outcomes are the prevalence of (1) any retinal microvascular abnormalities on fundus photography that are not standard features of DR as per ICDRSS classification and (2) any macular microvascular abnormalities on fundus photography, including but not limited to the presence of macular exudates, microaneurysms and haemorrhages. Risk of bias for included studies will be assessed using a validated risk of bias tool for prevalence studies. Pooled estimates for the prespecified outcomes of interest will be calculated using random effects meta-analytic techniques. Heterogeneity will be assessed using the I2 statistic. ETHICS AND DISSEMINATION Ethical approval is not required as this is a protocol for a systematic review and no primary data are to be collected. Findings will be disseminated through peer-reviewed publications and presentations at national and international meetings including Diabetes UK, European Association for the Study of Diabetes, American Diabetes Association and International Diabetes Federation conferences. PROSPERO REGISTRATION NUMBER CRD42020184820.
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Affiliation(s)
- Varo Kirthi
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Ophthalmology Research Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul Nderitu
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Ophthalmology Research Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Uazman Alam
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
- Pain Research Institute and Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Department of Diabetes and Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jennifer Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Ophthalmology Research Unit, King's College Hospital NHS Foundation Trust, London, UK
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Ferdousi M, Kalteniece A, Azmi S, Petropoulos IN, Ponirakis G, Alam U, Asghar O, Marshall A, Fullwood C, Jeziorska M, Abbott C, Lauria G, Faber CG, Soran H, Efron N, Boulton AJM, Malik RA. Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study. Diabetes Care 2021; 44:150-156. [PMID: 33144353 PMCID: PMC7783929 DOI: 10.2337/dc20-1482] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the diagnostic utility of corneal confocal microscopy (CCM) for diabetic peripheral neuropathy (DPN) and the risk factors for corneal nerve loss. RESEARCH DESIGN AND METHODS A total of 490 participants, including 72 healthy control subjects, 149 with type 1 diabetes, and 269 with type 2 diabetes, underwent detailed assessment of peripheral neuropathy and CCM in relation to risk factors. RESULTS Corneal nerve fiber density (CNFD) (P < 0.0001 and P < 0.0001), corneal nerve fiber branch density (CNBD) (P < 0.0001 and P < 0.0001), and corneal nerve fiber length (CNFL) (P < 0.0001 and P = 0.02) were significantly lower in patients with type 1 and type 2 diabetes compared with control subjects. CNFD (P < 0.0001), CNBD (P < 0.0001), and CNFL (P < 0.0001) were lower in type 1 diabetes compared with type 2 diabetes. Receiver operating characteristic curve analysis for the diagnosis of DPN demonstrated a good area under the curve for CNFD of 0.81, CNBD of 0.74, and CNFL of 0.73. Multivariable regression analysis showed a significant association among reduced CNFL with age (β = -0.27, P = 0.007), HbA1c (β = -1.1; P = 0.01), and weight (β = -0.14; P = 0.03) in patients with type 2 diabetes and with duration of diabetes (β = -0.13; P = 0.02), LDL cholesterol (β = 1.8, P = 0.04), and triglycerides (β = -2.87; P = 0.009) in patients with type 1 diabetes. CONCLUSIONS CCM identifies more severe corneal nerve loss in patients with type 1 diabetes compared with type 2 diabetes and shows good diagnostic accuracy for DPN. Furthermore, the risk factors for a reduction in corneal nerve fiber length differ between type 1 and type 2 diabetes.
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Affiliation(s)
- Maryam Ferdousi
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Alise Kalteniece
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Shazli Azmi
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Ioannis N Petropoulos
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Georgios Ponirakis
- Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, U.K
| | - Omar Asghar
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Andrew Marshall
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Catherine Fullwood
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K.,Research and Innovation, Manchester University NHS Foundation Trust, Manchester, U.K.,Manchester Academic Health Science Centre, Manchester, U.K
| | - Maria Jeziorska
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Caroline Abbott
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K
| | - Giuseppe Lauria
- IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Catharina G Faber
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Handrean Soran
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Nathan Efron
- Queensland University of Technology, School of Optometry and Vision Science, Brisbane, Queensland, Australia
| | - Andrew J M Boulton
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K
| | - Rayaz A Malik
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, The University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, U.K. .,Research Division, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
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Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in Screening, Early Diagnosis and Accurate Staging of Diabetic Neuropathy. Front Endocrinol (Lausanne) 2021; 12:671257. [PMID: 34122344 PMCID: PMC8188984 DOI: 10.3389/fendo.2021.671257] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Abstract
The incidence of both type 1 and type 2 diabetes is increasing worldwide. Diabetic peripheral neuropathy (DPN) is among the most distressing and costly of all the chronic complications of diabetes and is a cause of significant disability and poor quality of life. This incurs a significant burden on health care costs and society, especially as these young people enter their peak working and earning capacity at the time when diabetes-related complications most often first occur. DPN is often asymptomatic during the early stages; however, once symptoms and overt deficits have developed, it cannot be reversed. Therefore, early diagnosis and timely intervention are essential to prevent the development and progression of diabetic neuropathy. The diagnosis of DPN, the determination of the global prevalence, and incidence rates of DPN remain challenging. The opinions vary about the effectiveness of the expansion of screenings to enable early diagnosis and treatment initiation before disease onset and progression. Although research has evolved over the years, DPN still represents an enormous burden for clinicians and health systems worldwide due to its difficult diagnosis, high costs related to treatment, and the multidisciplinary approach required for effective management. Therefore, there is an unmet need for reliable surrogate biomarkers to monitor the onset and progression of early neuropathic changes in DPN and facilitate drug discovery. In this review paper, the aim was to assess the currently available tests for DPN's sensitivity and performance.
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Affiliation(s)
- Josie Carmichael
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
| | - Hassan Fadavi
- Peripheral Neuropathy Group, Imperial College, London, United Kingdom
| | - Fukashi Ishibashi
- Internal Medicine, Ishibashi Medical and Diabetes Centre, Hiroshima, Japan
| | - Angela C Shore
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
| | - Mitra Tavakoli
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
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Mansoor H, Tan HC, Lin MTY, Mehta JS, Liu YC. Diabetic Corneal Neuropathy. J Clin Med 2020; 9:jcm9123956. [PMID: 33291308 PMCID: PMC7762152 DOI: 10.3390/jcm9123956] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
Diabetic keratopathy (DK) is a common, but underdiagnosed, ocular complication of diabetes mellitus (DM) that has a significant economic burden. It is characterised by progressive damage of corneal nerves, due to DM-induced chronic hyperglycaemia and its associated metabolic changes. With advances in corneal nerve imaging and quantitative analytic tools, studies have shown that the severity of diabetic corneal neuropathy correlates with the status of diabetic peripheral neuropathy. The corneal nerve plexus is, therefore, considered as an important surrogate marker of diabetic peripheral neuropathy and helps in the evaluation of interventional efficacy in the management of DM. The clinical manifestations of DK depend on the disease severity and vary from decreased corneal sensitivity to sight-threatening corneal infections and neurotrophic ulcers. The severity of diabetic corneal neuropathy and resultant DK determines its management plan, and a step-wise approach is generally suggested. Future work would focus on the exploration of biomarkers for diabetic corneal neuropathy, the development of new treatment for corneal nerve protection, and the improvement in the clinical assessment, as well as current imaging technique and analysis, to help clinicians detect diabetic corneal neuropathy earlier and monitor the sub-clinical progression more reliably.
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Affiliation(s)
- Hassan Mansoor
- Al Shifa Trust Eye Hospital, Rawalpindi 44000, Pakistan;
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Molly Tzu-Yu Lin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore 168751, Singapore
- Eye-Academic Clinical Program, Duke-National University Singapore Graduate Medical School, Singapore 169857, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore 168751, Singapore
- Eye-Academic Clinical Program, Duke-National University Singapore Graduate Medical School, Singapore 169857, Singapore
- Correspondence: ; Tel.: +65-65-767-246; Fax: +65-62-277-290
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Ferdousi M, Kalteniece A, Azmi S, Petropoulos IN, Worthington A, D'Onofrio L, Dhage S, Ponirakis G, Alam U, Marshall A, Faber CG, Lauria G, Soran H, Malik RA. Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ Open Diabetes Res Care 2020; 8:8/2/e001801. [PMID: 33355206 PMCID: PMC7754626 DOI: 10.1136/bmjdrc-2020-001801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 11/21/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Diabetic neuropathy can be diagnosed and assessed using a number of techniques including corneal confocal microscopy (CCM). RESEARCH DESIGN AND METHODS We have undertaken quantitative sensory testing, nerve conduction studies and CCM in 143 patients with type 1 and type 2 diabetes without neuropathy (n=51), mild neuropathy (n=47) and moderate to severe neuropathy (n=45) and age-matched controls (n=30). RESULTS Vibration perception threshold (p<0.0001), warm perception threshold (WPT) (p<0.001), sural nerve conduction velocity (SNCV) (p<0.001), corneal nerve fiber density (CNFD) (p<0.0001), corneal nerve branch density (CNBD) (p<0.0001), corneal nerve fiber length (CNFL) (p=0.002), inferior whorl length (IWL) (p=0.0001) and average nerve fiber length (ANFL) (p=0.0001) showed a progressive abnormality with increasing severity of diabetic neuropathy. Receiver operating characteristic curve analysis for the diagnosis of diabetic neuropathy showed comparable performance in relation to the area under the curve (AUC) but differing sensitivities and specificities for vibration perception threshold (AUC 0.79, sensitivity 55%, specificity 90%), WPT (AUC 0.67, sensitivity 50%, specificity 76%), cold perception threshold (AUC 0.64, sensitivity 80%, specificity 47%), SNCV (AUC 0.70, sensitivity 76%, specificity 54%), CNFD (AUC 0.71, sensitivity 58%, specificity 83%), CNBD (AUC 0.70, sensitivity 69%, specificity 65%), CNFL (AUC 0.68, sensitivity 64%, specificity 67%), IWL (AUC 0.72, sensitivity 70%, specificity 65%) and ANFL (AUC 0.72, sensitivity 71%, specificity 66%). CONCLUSION This study shows that CCM identifies early and progressive corneal nerve loss at the inferior whorl and central cornea and has comparable utility with quantitative sensory testing and nerve conduction in the diagnosis of diabetic neuropathy.
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Affiliation(s)
- Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Anne Worthington
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Luca D'Onofrio
- Department of Experimental Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Shaishav Dhage
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Uazman Alam
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Andrew Marshall
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Catharina G Faber
- Department of Neurology, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Giuseppe Lauria
- Department of Clinical Neurosciences, Università di Milano - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Handrean Soran
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Research Division, Weill Cornell Medical College in Qatar, Doha, Qatar
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45
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Jiao H, Lim AS, Fazio Coles TE, McQuade RM, Furness JB, Chinnery HR. The effect of high-fat diet-induced metabolic disturbance on corneal neuroimmune features. Exp Eye Res 2020; 201:108298. [PMID: 33069696 DOI: 10.1016/j.exer.2020.108298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The highly innervated cornea is susceptible to nerve loss secondary to systemic diseases such as diabetes and metabolic disturbances caused by high-fat diet. In this study, we characterize the effect of high-fat diet on the mouse corneal neuroimmune phenotype, including changes to corneal nerve density and resident immune cells, alongside the clinical assessment of corneal thickness and endothelial cell density. METHODS Male C57Bl6/J mice, aged 10 weeks, were fed a high-fat diet (60 kcal% fat, 5.2 kcal/g) or control diet (10 kcal%, 3.8 kcal/g) for 16 weeks. At the study endpoint, metabolic parameters (HbA1c, weight, fasting glucose, body fat) were measured to confirm metabolic disturbance. Clinical imaging of the anterior segment was performed using optical coherence tomography to measure the corneal epithelial and stromal thickness. Corneal sensory nerves were visualized using flatmount immunostaining and confocal microscopy. The topographical distribution and density of sensory nerves (BIII-tubulin+), intraepithelial CD45+ and MHC- II+ cells, stromal macrophages (IBA1+CD206+) and endothelial cells (ZO-1+) were analysed using FIJI. RESULTS High-fat diet mice had significantly higher blood HbA1c, higher body weight, a higher percentage of body fat and elevated fasting glucose compared to the control diet mice. Corneal epithelial and stromal thickness was similar in both groups. The sum length of the basal nerve plexus was lower in the central and peripheral cornea of mice fed a high-fat diet. In contrast, the sum length of superficial nerve terminals was similar between groups. Epithelial immune cell density was two-fold higher in the central corneas of high-fat diet mice compared to control diet mice. IBA1+CD206+ macrophage density was similar in the anterior stroma of both groups but was significantly higher in the posterior stroma of the peripheral cornea in the high-fat diet mice compared to controls. The percentage of nerve-associated MHC-II+ cells in the epithelium and stroma was higher in HFD mice compared to controls. Endothelial cell density was similar in the corneas of high-fat diet mice compared to controls. CONCLUSION Together with corneal neuropathy, corneal immune cells in mice fed a high-fat diet were differentially affected depending on their topographical distribution and location within cornea, and appeared in closer proximity to epithelial and stromal nerves, suggesting a local neuroimmune disruption induced by systemic metabolic disturbance.
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Affiliation(s)
- Haihan Jiao
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia Sl Lim
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Therese E Fazio Coles
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia
| | - Rachel M McQuade
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Medicine, Western Health, Melbourne University, Sunshine, Victoria, Australia
| | - John B Furness
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Holly R Chinnery
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
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Baranowska-Jurkun A, Matuszewski W, Bandurska-Stankiewicz E. Chronic Microvascular Complications in Prediabetic States-An Overview. J Clin Med 2020; 9:E3289. [PMID: 33066307 PMCID: PMC7602111 DOI: 10.3390/jcm9103289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes.
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Affiliation(s)
- Angelika Baranowska-Jurkun
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland; (W.M.); (E.B.-S.)
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Chao C, Wang R, Jones M, Karson N, Jussel A, Smith J, Richdale K, Harrison W. The Relationship Between Corneal Nerve Density and Hemoglobin A1c in Patients With Prediabetes and Type 2 Diabetes. Invest Ophthalmol Vis Sci 2020; 61:26. [PMID: 33112943 PMCID: PMC7594598 DOI: 10.1167/iovs.61.12.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/15/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose Decreased corneal nerve fiber density and higher corneal epithelial dendritic cells have been reported in established patients with type 2 diabetes; however, alterations in the subbasal nerve plexus in prediabetes with healthy subjects or subjects with diabetes is limited. The study aimed to determine corneal nerve fiber density and morphology and dendritic cell density between healthy subjects and those with prediabetes or type 2 diabetes. Methods Fifty-two subjects (aged 30-70 years) were recruited. Blood samples and body metrics were taken. Subjects were grouped as: healthy controls (hemoglobin A1c [HbA1c] < 5.7%), prediabetes (5.7-6.4%), and type 2 diabetes (> 6.4% or physician diagnosis). Central corneal subbasal nerve plexus was imaged using in vivo confocal microscopy. Corneal nerve fiber density and morphology, including interconnections and tortuosity, and dendritic cell density were assessed. Kruskal-Wallis tests were carried out to compare differences in the examined variables between groups. Spearman correlations were carried out to examine the associations between body metrics with HbA1c and corneal findings. Results Seventeen healthy controls, 20 subjects with prediabetes, and 15 subjects with type 2 diabetes completed this study. Central corneal nerve fiber density was significantly lower in type 2 diabetes compared to prediabetes (P = 0.045) and healthy controls (P = 0.001). No differences were found in central corneal nerve fiber interconnections, tortuosity, or dendritic cell density between groups. There was a significant association between HbA1c and corneal nerve fiber density (rho = -0.45, P = 0.001) and body mass index (BMI; rho = -0.30, P = 0.04). Conclusions Increased HbA1c values are associated with decreased corneal nerve fiber density across the spectrum of type 2 diabetes.
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Affiliation(s)
- Cecilia Chao
- University of Houston, College of Optometry, Houston, Texas, United States
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rachel Wang
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Morgan Jones
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Nicole Karson
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Allison Jussel
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Jennyffer Smith
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Kathryn Richdale
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Wendy Harrison
- University of Houston, College of Optometry, Houston, Texas, United States
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Kudoh K, Mizukami H, Itabashi C, Fuke N, Osonoi S, Takeuchi Y, Wada K, Igawa A, Ogasawara S, Ishibashi Y, Hakamada K, Yagihashi S, Nakaji S. Lipopolysaccharide-binding protein is a distinctive biomarker of abnormal pain threshold in the general Japanese population. BMJ Open Diabetes Res Care 2020; 8:8/1/e001739. [PMID: 33099510 PMCID: PMC7590358 DOI: 10.1136/bmjdrc-2020-001739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Small fiber neuropathy (SFN) is an early manifestation in diabetic polyneuropathy (DPN); however, the mechanisms are not fully understood. In diabetes, SFN is presumed to be common in individuals with overt DPN, enhancing activation of polyol pathway, oxidative stress, advanced glycation end products (AGEs), and inflammation. We explored the relationship between clinicohematological factors related to DPN and pain sensation in the Japanese population. RESEARCH DESIGN AND METHODS We conducted a population-based study, recruiting 1030 individuals (average age 54.4±0.5 years), in 2017, to participate in our Iwaki project. After initial screening by fasting blood glucose and glycohemoglobin A1c (HbA1c) measurements, the subjects were categorized into control (n=894), type 2 diabetes (n=81), and impaired fasting glucose (n=55) groups. Clinical data were gathered, and relationships between pain threshold from intraepidermal electrical stimulation (PINT) and DPN were examined by analysis of variance, post hoc test, and χ2 tests to study correlations among and between groups of the clinical data and DPN. RESULTS Univariate linear regression analyses showed significant correlations between PINT and serum lipopolysaccharide-binding protein (LBP) level (ß=0.1025, p=0.001). Adjustments for the clinical measurements confirmed a positive correlation (ß=0.070, p=0.034). Logistic regression analysis revealed high LBP value (>6.7 mg/dL) as a significant risk factor toward abnormal PINT (≥0.35 mA). LBP significantly correlated with the high-sensitivity C reactive protein, inflammation marker, elevated similarly in both pre-diabetic and overt-diabetic groups, compared with controls, but it did not correlate with a decreased Achilles tendon reflex. In contrast, urine 8-hydroxy-2'-deoxyguanosine, oxidative stress marker, and pentosidine, AGEs, markedly increased in individuals with type 2 diabetes with high HbA1c. CONCLUSIONS Individuals with high LBP exhibited an elevated PINT in the Japanese population. Low level of inflammation evoked by metabolic endotoxemia is possibly implicated in the pathophysiology of SFN from pre-diabetic stage.
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Affiliation(s)
- Kazuhiro Kudoh
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroki Mizukami
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chieko Itabashi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Nobuo Fuke
- Innovation Division, KAGOME Co, Ltd, Tochigi, Japan
| | - Sho Osonoi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Takeuchi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akiko Igawa
- Department of Gastrointestinal Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Saori Ogasawara
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichi Hakamada
- Department of Gastrointestinal Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Soroku Yagihashi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Wang M, Zhang C, Zuo A, Li L, Chen L, Hou X. Diagnostic utility of corneal confocal microscopy in type 2 diabetic peripheral neuropathy. J Diabetes Investig 2020; 12:574-582. [PMID: 32745370 PMCID: PMC8015829 DOI: 10.1111/jdi.13381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
Aims/Introduction The early pathological changes of diabetic peripheral neuropathy (DPN) are mainly small nerve fiber injuries. Corneal confocal microscopy (CCM) is an easy, rapid, non‐invasive and repeatable technique to detect the damage of small nerve fibers. The purpose of this study was to explore the application of CCM in DPN and other chronic complications of type 2 diabetes mellitus. Materials and Methods A total of 220 individuals (48 normal healthy control participants and 172 patients with type 2 diabetes mellitus) were included in the study. All participants were assessed and scored for neurological symptoms and neurological deficits, quantitative sensory test, neuroelectrophysiological test, and CCM. Results Corneal nerve fiber density, corneal nerve fiber length and corneal nerve branch density were significantly reduced in patients with type 2 diabetes mellitus compared with normal healthy control subjects (P < 0.001, P < 0.001 and P < 0.001, respectively). In the DPN group, corneal nerve fiber density, corneal nerve branch density and corneal nerve fiber length were significantly lower than for patients without DPN (P < 0.001, P < 0.001 and P < 0.001, respectively). Receiver operating characteristic analysis showed that the optimal cut‐off values were 24.68, 39 and 15.315, respectively, in which corneal nerve fiber density and corneal nerve fiber length had moderate sensitivity and specificity. Conclusion This study provides more support for the clinical use of CCM to diagnose type 2 diabetes mellitus‐related complications, especially DPN.
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Affiliation(s)
- Meijian Wang
- Department of Endocrinology, Qilu Hospital, Shandong University, Qingdao, Shandong, China
| | - Cong Zhang
- Department of School of Biological & Chemical Engineering, Qingdao Technical College, Qingdao, Shandong, China
| | - Anju Zuo
- Department of Endocrinology, Qilu Hospital, Shandong University, Ji'nan, Shandong, China
| | - Lili Li
- Department of Ultrasound, Qilu Hospital, Shandong University, Qingdao, Shandong, China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital, Shandong University, Ji'nan, Shandong, China
| | - Xinguo Hou
- Department of Endocrinology, Qilu Hospital, Shandong University, Ji'nan, Shandong, China
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Corneal nerves in diabetes-The role of the in vivo corneal confocal microscopy of the subbasal nerve plexus in the assessment of peripheral small fiber neuropathy. Surv Ophthalmol 2020; 66:493-513. [PMID: 32961210 DOI: 10.1016/j.survophthal.2020.09.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
The cornea's intense innervation is responsible for corneal trophism and ocular surface hemostasis maintenance. Corneal diabetic neuropathy affects subbasal nerve plexus, with progressive alteration of nerves' morphology and density. The quantitative analysis of nerve fibers can be performed with in vivo corneal confocal microscopy considering the main parameters such as corneal nerve fibers length, corneal nerve fibers density, corneal nerve branching density, tortuosity coefficient, and beadings frequency. As the nerve examination permits the detection of early changes occurring in diabetes, the invivo corneal confocal microscopy becomes, over time, an important tool for diabetic polyneuropathy assessment and follow-up. In this review, we summarize the actual evidence about corneal nerve changes in diabetes and the relationship between the grade of alterations and the duration and severity of the disease. We aim at understanding how diabetes impacts corneal nerves and how it correlates with sensorimotor peripheral polyneuropathy and retinal complications. We also attempt to analyze the safety of the most common surgical procedures such as cataract and refractive surgery in diabetic patients and to highlight the specific risk factors. We believe that information about the corneal nerve fibers' condition obtained from the in vivo subbasal nerve plexus investigation may be crucial in monitoring peripheral small fiber polyneuropathy and that it will help with decision-making in ophthalmic surgery in diabetic patients.
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