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. 2015 Apr;38(4):671-5.
doi: 10.2337/dc14-2114. Epub 2015 Jan 8.

Corneal confocal microscopy predicts 4-year incident peripheral neuropathy in type 1 diabetes

Nicola Pritchard  1 , Katie Edwards  1 , Anthony W Russell  2 , Bruce A Perkins  3 , Rayaz A Malik  4 , Nathan Efron  5
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Free article

Corneal confocal microscopy predicts 4-year incident peripheral neuropathy in type 1 diabetes

Nicola Pritchard et al. Diabetes Care. 2015 Apr.
Free article

Abstract

Objective: This study determined if deficits in corneal nerve fiber length (CNFL) assessed using corneal confocal microscopy (CCM) can predict future onset of diabetic peripheral neuropathy (DPN).

Research design and methods: CNFL and a range of other baseline measures were compared between 90 nonneuropathic patients with type 1 diabetes who did or did not develop DPN after 4 years. The receiver operator characteristic (ROC) curve was used to determine the capability of single and combined measures of neuropathy to predict DPN.

Results: DPN developed in 16 participants (18%) after 4 years. Factors predictive of 4-year incident DPN were lower CNFL (P = 0.041); longer duration of diabetes (P = 0.002); higher triglycerides (P = 0.023); retinopathy (higher on the Early Treatment of Diabetic Retinopathy Study scale) (P = 0.008); nephropathy (higher albumin-to-creatinine ratio) (P = 0.001); higher neuropathy disability score (P = 0.037); lower cold sensation (P = 0.001) and cold pain (P = 0.027) thresholds; higher warm sensation (P = 0.008), warm pain (P = 0.024), and vibration (P = 0.003) thresholds; impaired monofilament response (P = 0.003); and slower peroneal (P = 0.013) and sural (P = 0.002) nerve conduction velocity. CCM could predict the 4-year incident DPN with 63% sensitivity and 74% specificity for a CNFL threshold cutoff of 14.1 mm/mm(2) (area under ROC curve = 0.66, P = 0.041). Combining neuropathy measures did not improve predictive capability.

Conclusions: DPN can be predicted by various demographic, metabolic, and conventional neuropathy measures. The ability of CCM to predict DPN broadens the already impressive diagnostic capabilities of this novel ophthalmic marker.

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