Diagnostic utility of corneal confocal microscopy in type 2 diabetic peripheral neuropathy

• Published in: Journal of diabetes investigation Vol. 12; no. 4; pp. 574 - 582
• Main Authors: Wang, Meijian, Zhang, Cong, Zuo, Anju, Li, Lili, Chen, Li, Hou, Xinguo
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.04.2021; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Aged; Blood pressure; Case-Control Studies; Cholesterol; Confocal microscopy; Cornea; Cornea - innervation; Cornea - pathology; Corneal confocal microscopy; Creatinine; Demographics; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetic Neuropathies - diagnosis; Diabetic Neuropathies - etiology; Diabetic Neuropathies - pathology; Diabetic neuropathy; Diabetic peripheral neuropathy; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - etiology; Female; Foot diseases; Humans; Lipoproteins; Male; Microscopy; Microscopy, Confocal; Middle Aged; Neurological diseases; Original; Peripheral neuropathy; Statistical analysis; Triglycerides; Type 2 diabetes mellitus; United Kingdom > UK; Diabetic peripheral neuropathy; Corneal confocal microscopy; Type 2 diabetes mellitus
• ISSN: 2040-1116; 2040-1124; 2040-1124
• DOI: 10.1111/jdi.13381

Aims/Introduction The early pathological changes of diabetic peripheral neuropathy (DPN) are mainly small nerve fiber injuries. Corneal confocal microscopy (CCM) is an easy, rapid, non‐invasive and repeatable technique to detect the damage of small nerve fibers. The purpose of this study was to explore the application of CCM in DPN and other chronic complications of type 2 diabetes mellitus. Materials and Methods A total of 220 individuals (48 normal healthy control participants and 172 patients with type 2 diabetes mellitus) were included in the study. All participants were assessed and scored for neurological symptoms and neurological deficits, quantitative sensory test, neuroelectrophysiological test, and CCM. Results Corneal nerve fiber density, corneal nerve fiber length and corneal nerve branch density were significantly reduced in patients with type 2 diabetes mellitus compared with normal healthy control subjects (P < 0.001, P < 0.001 and P < 0.001, respectively). In the DPN group, corneal nerve fiber density, corneal nerve branch density and corneal nerve fiber length were significantly lower than for patients without DPN (P < 0.001, P < 0.001 and P < 0.001, respectively). Receiver operating characteristic analysis showed that the optimal cut‐off values were 24.68, 39 and 15.315, respectively, in which corneal nerve fiber density and corneal nerve fiber length had moderate sensitivity and specificity. Conclusion This study provides more support for the clinical use of CCM to diagnose type 2 diabetes mellitus‐related complications, especially DPN. The early pathological changes of diabetic peripheral neuropathy are mainly small nerve fiber injuries. Corneal confocal microscopy is a simple, non‐invasive and repeatable technique to detect the damage of small nerve fibers. The purpose of this study was to explore the application of corneal confocal microscopy in diabetic peripheral neuropathy and other chronic complications of type 2 diabetes mellitus.