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

• Published in: Diabetes care Vol. 44; no. 1; pp. 150 - 156
• Main Authors: Ferdousi, Maryam, Kalteniece, Alise, Azmi, Shazli, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Fullwood, Catherine, Jeziorska, Maria, Abbott, Caroline, Lauria, Giuseppe, Faber, Catharina G., Soran, Handrean, Efron, Nathan, Boulton, Andrew J.M., Malik, Rayaz A.
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.01.2021
• Subjects: Cholesterol; Confocal microscopy; Cornea; Cornea - diagnostic imaging; Density; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetic Neuropathies - diagnostic imaging; Diagnosis; Diagnostic systems; Humans; Low density lipoprotein; Medical diagnosis; Microscopy; Microscopy, Confocal; Pathophysiology/Complications; Peripheral neuropathy; Regression analysis; Research design; Risk analysis; Risk Factors; Triglycerides
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc20-1482

To assess the diagnostic utility of corneal confocal microscopy (CCM) for diabetic peripheral neuropathy (DPN) and the risk factors for corneal nerve loss. 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. Corneal nerve fiber density (CNFD) ( < 0.0001 and < 0.0001), corneal nerve fiber branch density (CNBD) ( < 0.0001 and < 0.0001), and corneal nerve fiber length (CNFL) ( < 0.0001 and = 0.02) were significantly lower in patients with type 1 and type 2 diabetes compared with control subjects. CNFD ( < 0.0001), CNBD ( < 0.0001), and CNFL ( < 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, = 0.007), HbA (β = -1.1; = 0.01), and weight (β = -0.14; = 0.03) in patients with type 2 diabetes and with duration of diabetes (β = -0.13; = 0.02), LDL cholesterol (β = 1.8, = 0.04), and triglycerides (β = -2.87; = 0.009) in patients with type 1 diabetes. 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.