Leif E Lovblom1, Elise M Halpern1, Tong Wu1, Dylan Kelly1, Ausma Ahmed1, Genevieve Boulet1, Andrej Orszag1, Eduardo Ng2, Mylan Ngo2, Vera Bril2, Bruce A Perkins3. 1. Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: bperkins@mtsinai.on.ca.
Abstract
OBJECTIVE: In vivo corneal confocal microscopy (IVCCM) has been established in cross-sectional studies as a valid measure for the identification of diabetic sensorimotor polyneuropathy (DSP). We aimed to determine the predictive validity of a baseline IVCCM measure in identifying future DSP onset in patients with type 1 diabetes. METHODS: We followed 65 patients with type 1 diabetes without DSP at baseline. They were followed longitudinally for a mean of 3.5±0.9 years and underwent IVCCM, clinical and electrophysiologic examinations at baseline and follow up. At the end of follow up, participants were assigned as new-onset cases of DSP or as controls. Predictive validity was assessed using receiver operating characteristic curves. RESULTS: At baseline, participants were 34±15 years of age with mean diabetes duration of 18±12 years. The 11 (17%) new-onset cases of DSP were similar to the 54 (83%) controls in baseline age, diabetes duration, gender, glycated hemoglobin levels and electrophysiologic parameters (p≥0.20). However, cases of new onset had significantly lower baseline corneal nerve fibre length (CNFL) and branch density (p<0.05). For identification of new-onset cases, area under the receiver operating characteristic curve for CNFL was 0.78 with an optimal threshold of 14.9 mm/mm(2) (sensitivity=0.82, specificity=0.69). CONCLUSIONS: Despite similar clinical and electrophysiologic parameters, participants with type 1 diabetes at risk for future DSP had significantly lower baseline IVCCM measures. CNFL may have applicability in identifying high-risk patients for therapeutic intervention in clinical research and practice.
OBJECTIVE: In vivo corneal confocal microscopy (IVCCM) has been established in cross-sectional studies as a valid measure for the identification of diabetic sensorimotor polyneuropathy (DSP). We aimed to determine the predictive validity of a baseline IVCCM measure in identifying future DSP onset in patients with type 1 diabetes. METHODS: We followed 65 patients with type 1 diabetes without DSP at baseline. They were followed longitudinally for a mean of 3.5±0.9 years and underwent IVCCM, clinical and electrophysiologic examinations at baseline and follow up. At the end of follow up, participants were assigned as new-onset cases of DSP or as controls. Predictive validity was assessed using receiver operating characteristic curves. RESULTS: At baseline, participants were 34±15 years of age with mean diabetes duration of 18±12 years. The 11 (17%) new-onset cases of DSP were similar to the 54 (83%) controls in baseline age, diabetes duration, gender, glycated hemoglobin levels and electrophysiologic parameters (p≥0.20). However, cases of new onset had significantly lower baseline corneal nerve fibre length (CNFL) and branch density (p<0.05). For identification of new-onset cases, area under the receiver operating characteristic curve for CNFL was 0.78 with an optimal threshold of 14.9 mm/mm(2) (sensitivity=0.82, specificity=0.69). CONCLUSIONS: Despite similar clinical and electrophysiologic parameters, participants with type 1 diabetes at risk for future DSP had significantly lower baseline IVCCM measures. CNFL may have applicability in identifying high-risk patients for therapeutic intervention in clinical research and practice.
Authors: Evan J H Lewis; Bruce A Perkins; Lief E Lovblom; Richard P Bazinet; Thomas M S Wolever; Vera Bril Journal: BMJ Open Diabetes Res Care Date: 2017-02-16
Authors: Meera F Iyengar; Luis F Soto; David Requena; Andrea O Ruiz-Alejos; Yvonne Huaylinos; Ricardo Velasquez; Antonio Bernabe-Ortiz; Robert H Gilman Journal: Diabetes Res Clin Pract Date: 2020-04-10 Impact factor: 5.602
Authors: Bruce A Perkins; Leif Erik Lovblom; Evan J H Lewis; Vera Bril; Maryam Ferdousi; Andrej Orszag; Katie Edwards; Nicola Pritchard; Anthony Russell; Cirous Dehghani; Danièle Pacaud; Kenneth Romanchuk; Jean K Mah; Maria Jeziorska; Andrew Marshall; Roni M Shtein; Rodica Pop-Busui; Stephen I Lentz; Mitra Tavakoli; Andrew J M Boulton; Nathan Efron; Rayaz A Malik Journal: Diabetes Care Date: 2021-07-01 Impact factor: 17.152
Authors: Evan J H Lewis; Bruce A Perkins; Leif E Lovblom; Richard P Bazinet; Thomas M S Wolever; Vera Bril Journal: Neurology Date: 2017-05-17 Impact factor: 9.910