scholarly journals Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 165
Author(s):  
Jamie Burgess ◽  
Bernhard Frank ◽  
Andrew Marshall ◽  
Rashaad S. Khalil ◽  
Georgios Ponirakis ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Nerve Fibre ◽  
Diabetic Peripheral Neuropathy ◽  
Point Of Care ◽  
Unmet Need ◽  
Screening Tools ◽  
Nerve Fibres ◽  
Diagnostic Laboratory ◽  
Corneal Confocal Microscopy ◽  
Small Nerve

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.

scholarly journals Using corneal confocal microscopy to compare Mecobalamin intramuscular injections vs oral tablets in treating diabetic peripheral neuropathy: a RCT

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuanjin Zhang ◽  
Dongsheng Fan ◽  
Yixuan Zhang ◽  
Shuo Zhang ◽  
Haikun Wang ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Nerve Fibre ◽  
Diabetic Peripheral Neuropathy ◽  
Controlled Study ◽  
Oral Tablet ◽  
Injection Treatment ◽  
Intramuscular Injections ◽  
Corneal Confocal Microscopy ◽  
Corneal Nerve

AbstractThis randomized controlled study used corneal confocal microscopy (CCM) to compare the efficacy of Mecobalamin intramuscular injections vs oral tablets in treating mild to moderate diabetic peripheral neuropathy (DPN) by detecting early nerve fiber repair. Enrolled patients were randomized approximately 1:1 to receive Mecobalamin intramuscular injections (0.5 mg/day, 3 times/week) or Mecobalamin oral tablets (1.5 mg/day) for 8 weeks. Primary outcome was change of inferior whorl length (IWL) from baseline. Secondary outcomes included changes of corneal nerve fibre length (CNFL), corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD) and the Survey of Autonomic Symptoms (SAS). 15 (93.75%) patients in the injection group and 17 (89.47%) patients in the tablet group completed the study. The injection treatment significantly improved patients’ IWL from baseline (21.64 ± 3.00 mm/mm2 vs 17.64 ± 4.83 mm/mm2, P < 0.01) while the tablet treatment didn’t. Additionally, the injection treatment led to significantly improved CNFL, CNBD and SAS from baseline (all P < 0.05) while the tablet treatment did not. No patient experienced any adverse events. In conclusion, CCM is sensitive enough to detect the superior efficacy of 8-week Mecobalamin intramuscular injection treatment for DPN compared to the oral tablet treatment.ClinicalTrials.gov registration number: NCT04372316 (30/04/2020).

Retinal nerve fibre layer thinning associated with diabetic peripheral neuropathy

2012 ◽  
Vol 29 (7) ◽  
pp. e106-e111 ◽  
Author(s):  
A. M. Shahidi ◽  
G. P. Sampson ◽  
N. Pritchard ◽  
K. Edwards ◽  
D. Vagenas ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Nerve Fibre ◽  
Diabetic Peripheral Neuropathy ◽  
Retinal Nerve Fibre Layer ◽  
Fibre Layer ◽  
Nerve Fibre Layer

scholarly journals Artificial Intelligence–Based Classification of Diabetic Peripheral Neuropathy From Corneal Confocal Microscopy Images

Diabetes Care ◽  
2021 ◽  
pp. dc202012
Author(s):  
Tooba Salahouddin ◽  
Ioannis N. Petropoulos ◽  
Maryam Ferdousi ◽  
Georgios Ponirakis ◽  
Omar Asghar ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Diabetic Peripheral Neuropathy ◽  
Corneal Confocal Microscopy ◽  
Microscopy Images

scholarly journals Rapid Automated Diagnosis of Diabetic Peripheral Neuropathy With In Vivo Corneal Confocal Microscopy

2014 ◽  
Vol 55 (4) ◽  
pp. 2071 ◽  
Author(s):  
Ioannis N. Petropoulos ◽  
Uazman Alam ◽  
Hassan Fadavi ◽  
Andrew Marshall ◽  
Omar Asghar ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Diabetic Peripheral Neuropathy ◽  
Automated Diagnosis ◽  
Corneal Confocal Microscopy

scholarly journals The Association between Serum Cytokines and Damage to Large and Small Nerve Fibers in Diabetic Peripheral Neuropathy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Francesca Magrinelli ◽  
Chiara Briani ◽  
Marcello Romano ◽  
Susanna Ruggero ◽  
Elisabetta Toffanin ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Nerve Fiber ◽  
Diabetic Peripheral Neuropathy ◽  
Motor Nerve ◽  
Serum Levels ◽  
Nerve Fibers ◽  
Fiber Damage ◽  
Serum Cytokines ◽  
Small Nerve

Diabetic peripheral neuropathy (DPN) is a frequent complication of type 2 diabetes mellitus (DM) and may involve small and large peripheral nerve fibers. Recent evidence suggests a role of cytokines in DPN. The paper is aimed at exploring whether the serum concentration of cytokines is associated with small and large nerve fiber function and with neuropathic pain (NP). We recruited a group of 32 type 2 DM patients who underwent serum cytokines (TNF-α, IL-2, IL-4, IL-6, and IL-10) dosage as well as electrodiagnostic and quantitative sensory testing (QST) assessment to explore damage to large and small nerve fibers. Raised serum levels of IL-6 and IL-10 correlated with markers of large nerve fiber sensory and motor axonal damage. Raised IL-10 serum level was associated with signs of motor nerve demyelination. No differences were found in pain characteristics and electrodiagnostic and QST markers of small nerve fiber function in relation to cytokines serum levels. IL-6 and IL-10 serum levels were associated with large nerve fiber damage but not to small fibers function or NP. IL-6 and IL-10 cytokines might play a role in the pathogenesis of nerve fiber damage or represent a compensatory or neuroprotective mechanism.

scholarly journals Corneal Confocal Microscopy – A Novel, Noninvasive Method to Assess Diabetic Peripheral Neuropathy

2014 ◽  
Vol 21 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Georgeta Inceu ◽  
Horea Demea ◽  
Ioan Andrei Veresiu
Keyword(s):  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Diabetic Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Diabetic Patients ◽  
Noninvasive Method ◽  
Anthropometric Parameters ◽  
Perception Threshold ◽  
Peripheral Diabetic Neuropathy ◽  
Corneal Confocal Microscopy

AbstractBackground and aims. This article aims to compare corneal confocal microscopy (CCM) with acknowledged tests of diabetic peripheral neuropathy (DPN), to assess corneal nerve morphology using CCM in diabetic patients, and to underline possible correlations between clinical and biological parameters, diabetes duration and DPN severity. Material and methods. A total of 90 patients with type 2 diabetes were included in the study for whom we measured anthropometric parameters and we performed laboratory measurements (tests). The patients were assessed for diabetic peripheral neuropathy using Semmes-Weinstein Monofilament Testing (SWMT), Rapid-Current Perception Threshold (R-CPT) measurements using the Neurometer®, and CCM. We stratified the patients according to DPN severity, based on four parameters extracted after image analysis. Results. A higher percentage of patients were diagnosed with DPN using CCM (88.8%), compared with SWMT and R-CPT measurement (17.8% and 40% respectively). The incidence of DPN detected with CCM was considerable in patients with normal protective sensation and with normal R-CPT values. Conclusions. Our study showed that corneal confocal microscopy is a useful noninvasive method for diabetic neuropathy assessement in early stages. It was proven to directly quantify small fiber pathology, and to stratify neuropathic severity, and therefore can be used as a new, reliable tool in the diagnosis, clinical evaluation, and follow-up of peripheral diabetic neuropathy.

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