Mitra Tavakoli1, Piyara Begum2, John McLaughlin2, Rayaz A Malik1,3. 1. Centre for Endocrinology & Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester. 2. Gastrointestinal Centre, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester. 3. Weill Cornell Medical College in Qatar.
Abstract
BACKGROUND: Diabetic autonomic neuropathy (DAN) results in increased morbidity and mortality. The early diagnosis of DAN can be difficult and is commonly evaluated using cardiac autonomic function tests as a surrogate. However, they are not widely available, have limited sensitivity and specificity, and can be confounded by concomitant cardiovascular disease and medications. METHODS: The diagnostic utility of corneal confocal microscopy for diagnosis of DAN was assessed. Thirty-four diabetic patients without [Composite Autonomic Scoring Scale (CASS)≤2] vs with (CASS>2) DAN and 18 healthy control subjects (HC) underwent detailed assessment of somatic and autonomic neuropathy, Composite Autonomic Symptom Scale (COMPASS), (CASS), and Corneal Confocal Microscopy (CCM). RESULTS: Corneal nerve fiber density, branch density, and length showed a progressive and significant reduction in patients with DAN vs HC and those without DAN. CCM correlated highly significantly with COMPASS and CASS, and corneal nerve fiber parameters demonstrated a high sensitivity and specificity for diagnosis of DAN. CONCLUSIONS: This study demonstrates that corneal nerve damage detected using CCM can be deployed to diagnose subclinical and overt DAN. It therefore represents a rapid, non-invasive, highly sensitive and specific diagnostic test for DAN.
BACKGROUND:Diabetic autonomic neuropathy (DAN) results in increased morbidity and mortality. The early diagnosis of DAN can be difficult and is commonly evaluated using cardiac autonomic function tests as a surrogate. However, they are not widely available, have limited sensitivity and specificity, and can be confounded by concomitant cardiovascular disease and medications. METHODS: The diagnostic utility of corneal confocal microscopy for diagnosis of DAN was assessed. Thirty-four diabeticpatients without [Composite Autonomic Scoring Scale (CASS)≤2] vs with (CASS>2) DAN and 18 healthy control subjects (HC) underwent detailed assessment of somatic and autonomic neuropathy, Composite Autonomic Symptom Scale (COMPASS), (CASS), and Corneal Confocal Microscopy (CCM). RESULTS: Corneal nerve fiber density, branch density, and length showed a progressive and significant reduction in patients with DAN vs HC and those without DAN. CCM correlated highly significantly with COMPASS and CASS, and corneal nerve fiber parameters demonstrated a high sensitivity and specificity for diagnosis of DAN. CONCLUSIONS: This study demonstrates that corneal nerve damage detected using CCM can be deployed to diagnose subclinical and overt DAN. It therefore represents a rapid, non-invasive, highly sensitive and specific diagnostic test for DAN.
Authors: Shrestha Priyadarsini; Tina B McKay; Akhee Sarker-Nag; Jeremy Allegood; Charles Chalfant; Jian-Xing Ma; Dimitrios Karamichos Journal: Exp Eye Res Date: 2016-10-11 Impact factor: 3.467
Authors: Lewis Kass-Iliyya; Saad Javed; David Gosal; Christopher Kobylecki; Andrew Marshall; Ioannis N Petropoulos; Georgios Ponirakis; Mitra Tavakoli; Maryam Ferdousi; Kallol Ray Chaudhuri; Maria Jeziorska; Rayaz A Malik; Monty A Silverdale Journal: Parkinsonism Relat Disord Date: 2015-11-03 Impact factor: 4.891