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Abstract

Click to add/remove this article to your list of 'My Favorites' Corneal Confocal Microscopy Detects Neuropathy in Subjects with Impaired Glucose Tolerance

Year: 2010

Abstract Number: 414-PP

Authors: IOANNIS N. PETROPOULOS, OMAR ASGHAR, UAZMAN ALAM, HASSAN FADAVI, MOHAMMAD A. DABBAH, ANDY MARSHALL, MITRA TAVAKOLI, ANDREW J. M. BOULTON, RAYAZ A. MALIK

Institutions: Manchester, United Kingdom

Results: Recent studies employing skin biopsies have demonstrated a higher than expected prevalence of Impaired Glucose Tolerance (IGT) in patients with idiopathic small fibre neuropathy leading to the suggestion that IGT may cause neuropathy. However, studies in patients with IGT demonstrate a minimal neuropathy, using neurological assessment and measures of small fibre dysfunction. Corneal confocal microscopy (CCM) is an alternative non-invasive test to detect early nerve damage in patients with diabetic neuropathy. We have assessed the neuropathy symptom profile (NSP), neuropathy disability score (NDS), quantitative sensory testing for vibration perception threshold (VPT), warm and cold thresholds (WT, CT), cold and heat induced pain (CIP, HIP), peripheral sudomotor function (Neuropad) and nerve conduction studies of the sural nerve in 14 subjects with IGT (based on WHO defined 2h post load glucose 7.8-11.1) and 20 healthy controls. In the IGT group age was 60.3 ± 9.6 yrs, weight 85.5 ± 14.8 Kg, BP 126 ± 19.5/83 ± 37, HbA1C 6.4% ± 0.4 and triglyceride 4.3 ± 0.9 mmol/l. The IGT group had a higher NSP (4 vs 0), NDS (2 vs 0), VPT (13.9 ± 9.8 vs 3.4 ± 1.3, P<0.0001) WT (38.8 ± 6.5 vs 36.0 ± 1.8, p=0.01) and percentage colour change of the neuropad (57.8 ± 37.2 vs 100, P=0.0009) with no difference for sural nerve conduction velocity (50.6 ± 1.7 vs 46.5±1.9), amplitude (15.3 ± 2.4 vs 20.3±3.8), CT (27.6 ± 6.2 vs 28.6 ± 2.4, P=0.13), CIP (4.1±6.4 vs 6.4±5.9, P=0.25) and HIP (48.2±3.9 vs 47.1±2.4, P=0.19) compared to controls. However, CCM analysis demonstrated a significant reduction in corneal nerve fibre density (mm2) (29.1 ± 4.2 vs 37.6 ±3.8, P<0.0001), nerve branch density (39.5 ±17.6 vs 56.5 ± 22.5, P=0.03) and nerve fibre length (mm/mm2) (22.3 ± 5.1 vs 27.3 ± 4.1, P=0.003) with an increase in nerve fibre tortuosity (23.7 ± 5.0 vs 15.8 ± 2.6, P<0.0001) in IGT v controls. We demonstrate significant evidence of a small fibre neuropathy in subjects with IGT per se and in particular show that CCM is able to detect early nerve damage which cannot be detected using conventional electrophysiology or QST.

Category: Neuropathy