Corneal Confocal Microscopy Detects Early Nerve Regeneration in Diabetic Neuropathy After Simultaneous Pancreas and Kidney Transplantation
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Open Access
- 13 December 2012
- journal article
- Published by American Diabetes Association in Diabetes
- Vol. 62 (1), 254-260
- https://doi.org/10.2337/db12-0574
Abstract
Diabetic neuropathy is associated with increased morbidity and mortality. To date, limited data in subjects with impaired glucose tolerance and diabetes demonstrate nerve fiber repair after intervention. This may reflect a lack of efficacy of the interventions but may also reflect difficulty of the tests currently deployed to adequately assess nerve fiber repair, particularly in short-term studies. Corneal confocal microscopy (CCM) represents a novel noninvasive means to quantify nerve fiber damage and repair. Fifteen type 1 diabetic patients undergoing simultaneous pancreas–kidney transplantation (SPK) underwent detailed assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal sensitivity, and CCM at baseline and at 6 and 12 months after successful SPK. At baseline, diabetic patients had a significant neuropathy compared with control subjects. After successful SPK there was no significant change in neurologic impairment, neurophysiology, QST, corneal sensitivity, and intraepidermal nerve fiber density (IENFD). However, CCM demonstrated significant improvements in corneal nerve fiber density, branch density, and length at 12 months. Normalization of glycemia after SPK shows no significant improvement in neuropathy assessed by the neurologic deficits, QST, electrophysiology, and IENFD. However, CCM shows a significant improvement in nerve morphology, providing a novel noninvasive means to establish early nerve repair that is missed by currently advocated assessment techniques.Keywords
This publication has 54 references indexed in Scilit:
- Mapping the Nerve Architecture of Diabetic Human CorneasOphthalmology, 2012
- Prevalence and Characteristics of Painful Diabetic Neuropathy in a Large Community-Based Diabetic Population in the U.K.Diabetes Care, 2011
- Efficacy and Safety of Antioxidant Treatment With α-Lipoic Acid Over 4 Years in Diabetic PolyneuropathyDiabetes Care, 2011
- Corneal confocal microscopy detects improvement in corneal nerve morphology with an improvement in risk factors for diabetic neuropathyDiabetic Medicine, 2011
- Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trialMuscle & Nerve, 2010
- Corneal confocal microscopy: A novel means to detect nerve fibre damage in idiopathic small fibre neuropathyExperimental Neurology, 2010
- Corneal Confocal MicroscopyDiabetes Care, 2010
- Effect of Prior Intensive Insulin Treatment During the Diabetes Control and Complications Trial (DCCT) on Peripheral Neuropathy in Type 1 Diabetes During the Epidemiology of Diabetes Interventions and Complications (EDIC) StudyDiabetes Care, 2010
- Epidermal Innervation in Type 1 Diabetic PatientsDiabetes Care, 2008
- Effect of a Multifactorial Intervention on Mortality in Type 2 DiabetesNew England Journal of Medicine, 2008