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Small nerve fibre quantification in the diagnosis of diabetic sensorimotor polyneuropathy: comparing corneal confocal microscopy with intraepidermal nerve fibre density

Chen, Xin; Graham, Jim; Dabbah, Mohammad; Petropoulos, Ioannis N.; Ponirakis, Georgis; Asghar, Omar; Alam, Uazman; Marshall, Andrew; Fadavi, Hassan; Ferdousi, Maryam; Azmi, Shazli; Tavakoli, Mitra; Efron, Nathan; Jeziorska, Maria; Malik, Rayaz A.

Authors

XIN CHEN XIN.CHEN@NOTTINGHAM.AC.UK
Assistant Professor

Jim Graham

Mohammad Dabbah

Ioannis N. Petropoulos

Georgis Ponirakis

Omar Asghar

Uazman Alam

Andrew Marshall

Hassan Fadavi

Maryam Ferdousi

Shazli Azmi

Mitra Tavakoli

Nathan Efron

Maria Jeziorska

Rayaz A. Malik



Abstract

OBJECTIVE: Quantitative assessment of small fiber damage is key to the early diagnosis and assessment of progression or regression of diabetic sensorimotor polyneuropathy (DSPN). Intraepidermal nerve fiber density (IENFD) is the current gold standard, but corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, has the potential to be a noninvasive and objective image biomarker for identifying small fiber damage. The purpose of this study was to determine the diagnostic performance of CCM and IENFD by using the current guidelines as the reference standard.

RESEARCH DESIGN AND METHODS: Eighty-nine subjects (26 control subjects and 63 patients with type 1 diabetes), with and without DSPN, underwent a detailed assessment of neuropathy, including CCM and skin biopsy.

RESULTS: Manual and automated corneal nerve fiber density (CNFD) (P < 0.0001), branch density (CNBD) (P < 0.0001) and length (CNFL) (P < 0.0001), and IENFD (P < 0.001) were significantly reduced in patients with diabetes with DSPN compared with control subjects. The area under the receiver operating characteristic curve for identifying DSPN was 0.82 for manual CNFD, 0.80 for automated CNFD, and 0.66 for IENFD, which did not differ significantly (P = 0.14).

CONCLUSIONS: This study shows comparable diagnostic efficiency between CCM and IENFD, providing further support for the clinical utility of CCM as a surrogate end point for DSPN.

Journal Article Type Article
Publication Date Jun 5, 2015
Journal Diabetes Care
Print ISSN 0149-5992
Electronic ISSN 1935-5548
Publisher American Diabetes Association
Peer Reviewed Peer Reviewed
Volume 38
Issue 6
Pages 1138-1144
APA6 Citation Chen, X., Graham, J., Dabbah, M., Petropoulos, I. N., Ponirakis, G., Asghar, O., …Malik, R. A. (2015). Small nerve fibre quantification in the diagnosis of diabetic sensorimotor polyneuropathy: comparing corneal confocal microscopy with intraepidermal nerve fibre density. Diabetes Care, 38(6), 1138-1144. doi:10.2337/dc14-2422
DOI https://doi.org/10.2337/dc14-2422
Publisher URL http://care.diabetesjournals.org/content/38/6/1138
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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