Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study

Maryam Ferdousi; Alise Kalteniece; Shazli Azmi; Ioannis N Petropoulos; Georgios Ponirakis; Uazman Alam; Omar Asghar; Andrew Marshall; Catherine Fullwood; Maria Jeziorska; Caroline Abbott; Giuseppe Lauria; Catharina G Faber; Handrean Soran; Nathan Efron; Andrew J M Boulton; Rayaz A Malik

doi:10.2337/dc20-1482

Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study

Maryam Ferdousi, Alise Kalteniece, Shazli Azmi, Ioannis N Petropoulos, Georgios Ponirakis, Uazman Alam, Omar Asghar, Andrew Marshall, Catherine Fullwood, Maria Jeziorska, Caroline Abbott, Giuseppe Lauria, Catharina G Faber, Handrean Soran, Nathan Efron, Andrew J M Boulton, Rayaz A Malik

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	150-156
Number of pages	7
Journal	Diabetes Care
Volume	44
Issue number	1
DOIs	https://doi.org/10.2337/dc20-1482
Publication status	Published - Jan 2021

Keywords

Cornea/diagnostic imaging
Diabetes Mellitus, Type 2/complications
Diabetic Neuropathies/diagnostic imaging
Humans
Microscopy, Confocal
Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2337/dc20-1482

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Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Ponirakis, G., Alam, U., Asghar, O., Marshall, A., Fullwood, C., Jeziorska, M., Abbott, C., Lauria, G., Faber, C. G., Soran, H., Efron, N., Boulton, A. J. M., & Malik, R. A. (2021). Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study. Diabetes Care, 44(1), 150-156. https://doi.org/10.2337/dc20-1482

@article{0d8ed4542e95455b86dc67727389f499,

title = "Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study",

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.",

keywords = "Cornea/diagnostic imaging, Diabetes Mellitus, Type 2/complications, Diabetic Neuropathies/diagnostic imaging, Humans, Microscopy, Confocal, Risk Factors",

author = "Maryam Ferdousi and Alise Kalteniece and Shazli Azmi and Petropoulos, \{Ioannis N\} and Georgios Ponirakis and Uazman Alam and Omar Asghar and Andrew Marshall and Catherine Fullwood and Maria Jeziorska and Caroline Abbott and Giuseppe Lauria and Faber, \{Catharina G\} and Handrean Soran and Nathan Efron and Boulton, \{Andrew J M\} and Malik, \{Rayaz A\}",

note = "{\textcopyright} 2020 by the American Diabetes Association.",

year = "2021",

month = jan,

doi = "10.2337/dc20-1482",

language = "English",

volume = "44",

pages = "150--156",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "1",

}

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 2021, 'Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study', Diabetes Care, vol. 44, no. 1, pp. 150-156. https://doi.org/10.2337/dc20-1482

TY - JOUR

T1 - Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes

T2 - A Corneal Confocal Microscopy Study

AU - Ferdousi, Maryam

AU - Kalteniece, Alise

AU - Azmi, Shazli

AU - Petropoulos, Ioannis N

AU - Ponirakis, Georgios

AU - Alam, Uazman

AU - Asghar, Omar

AU - Marshall, Andrew

AU - Fullwood, Catherine

AU - Jeziorska, Maria

AU - Abbott, Caroline

AU - Lauria, Giuseppe

AU - Faber, Catharina G

AU - Soran, Handrean

AU - Efron, Nathan

AU - Boulton, Andrew J M

AU - Malik, Rayaz A

PY - 2021/1

Y1 - 2021/1

N2 - 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.

AB - 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.

KW - Cornea/diagnostic imaging

KW - Diabetes Mellitus, Type 2/complications

KW - Diabetic Neuropathies/diagnostic imaging

KW - Humans

KW - Microscopy, Confocal

KW - Risk Factors

U2 - 10.2337/dc20-1482

DO - 10.2337/dc20-1482

M3 - Article

C2 - 33144353

SN - 0149-5992

VL - 44

SP - 150

EP - 156

JO - Diabetes Care

JF - Diabetes Care

IS - 1

ER -

Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study

Abstract

Keywords

UN SDGs

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