RT Journal Article
SR Electronic
T1 Surrogate Markers of Small Fiber Damage in Human Diabetic Neuropathy
JF Diabetes
JO Diabetes
FD American Diabetes Association
SP 2148
OP 2154
DO 10.2337/db07-0285
VO 56
IS 8
A1 Quattrini, Cristian
A1 Tavakoli, Mitra
A1 Jeziorska, Maria
A1 Kallinikos, Panagiotis
A1 Tesfaye, Solomon
A1 Finnigan, Joanne
A1 Marshall, Andrew
A1 Boulton, Andrew J.M.
A1 Efron, Nathan
A1 Malik, Rayaz A.
YR 2007
UL http://diabetes.diabetesjournals.org/content/56/8/2148.abstract
AB Surrogate markers of diabetic neuropathy are being actively sought to facilitate the diagnosis, measure the progression, and assess the benefits of therapeutic intervention in patients with diabetic neuropathy. We have quantified small nerve fiber pathological changes using the technique of intraepidermal nerve fiber (IENF) assessment and the novel in vivo technique of corneal confocal microscopy (CCM). Fifty-four diabetic patients stratified for neuropathy, using neurological evaluation, neurophysiology, and quantitative sensory testing, and 15 control subjects were studied. They underwent a punch skin biopsy to quantify IENFs and CCM to quantify corneal nerve fibers. IENF density (IENFD), branch density, and branch length showed a progressive reduction with increasing severity of neuropathy, which was significant in patients with mild, moderate, and severe neuropathy. CCM also showed a progressive reduction in corneal nerve fiber density (CNFD) and branch density, but the latter was significantly reduced even in diabetic patients without neuropathy. Both IENFD and CNFD correlated significantly with cold detection and heat as pain thresholds. Intraepidermal and corneal nerve fiber lengths were reduced in patients with painful compared with painless diabetic neuropathy. Both IENF and CCM assessment accurately quantify small nerve fiber damage in diabetic patients. However, CCM quantifies small fiber damage rapidly and noninvasively and detects earlier stages of nerve damage compared with IENF pathology. This may make it an ideal technique to accurately diagnose and assess progression of human diabetic neuropathy.