Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry

• Published in: Diabetic medicine Vol. 32; no. 11; pp. 1470 - 1478
• Main Authors: Lerner, A. G., Bernabé-Ortiz, A., Ticse, R., Hernandez, A., Huaylinos, Y., Pinto, M. E., Málaga, G., Checkley, W., Gilman, R. H., Miranda, J. J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2015; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Autonomic Nervous System Diseases - complications; Autonomic Nervous System Diseases - diagnosis; Autonomic Nervous System Diseases - pathology; Autonomic Nervous System Diseases - physiopathology; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Cardiomyopathies - diagnosis; Diabetic Neuropathies - diagnosis; Diabetic Retinopathy - diagnosis; Early Diagnosis; Female; Humans; Light; Male; Mass Screening; Middle Aged; Peru; Pupil - radiation effects; Reflex, Pupillary - radiation effects; Reproducibility of Results; Sensitivity and Specificity; Peru
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12752

Aim To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy. Methods We conducted a cross‐sectional study with participants drawn from two settings: a hospital and a community site. At the community site, individuals with newly diagnosed diabetes as well as a random sample of control individuals without diabetes, confirmed by oral glucose tolerance test, were selected. Participants underwent an LED light stimulus test and eight pupillometry variables were measured. Outcomes were diabetes, defined by oral glucose tolerance test, and cardiac autonomic dysfunction, determined by a positive readout on two of four diagnostic tests: heart rate response to the Valsalva manoeuvre; orthostatic hypotension; 30:15 ratio; and expiration‐to‐inspiration ratio. The area under the curve, best threshold, sensitivity and specificity of each pupillometry variable was calculated. Results Data from 384 people, 213 with diabetes, were analysed. The mean (±sd) age of the people with diabetes was 58.6 (±8.2) years and in the control subjects it was 56.1 (±8.6) years. When comparing individuals with and without diabetes, the amplitude of the pupil reaction had the highest area under the curve [0.69 (sensitivity: 78%; specificity: 55%)]. Cardiac autonomic neuropathy was present in 51 of the 138 people evaluated (37.0%; 95% CI 28.8–45.1). To diagnose cardiac autonomic neuropathy, two pupillometry variables had the highest area under the curve: baseline pupil radius [area under the curve: 0.71 (sensitivity: 51%; specificity: 84%)], and amplitude of the pupil reaction [area under the curve: 0.70 (sensitivity: 82%; specificity: 55%)]. Conclusions Pupillometry is an inexpensive technique to screen for diabetes and cardiac autonomic neuropathy, but it does not have sufficient accuracy for clinical use as a screening tool. What's new? Rapid, easy‐to‐implement, point‐of‐care, bloodless and laboratory‐free screening tools would advance the field of diabetes. Pupillometry is such a tool and was performed following an automated technique and using a portable computer to minimize measurement error, including operator‐dependent bias. The usefulness of pupillometry as a screening tool for Type 2 diabetes in clinical and community settings has not been previously explored. The results from this study showed that pupillometry was not good enough to recommend its usage as a screening tool. Our results do not exclude the usefulness of pupillometry for neuropathy diagnosis or for monitoring and patient follow‐up at clinical encounters.