Meera F Iyengar1, Luis F Soto2, David Requena3, Andrea O Ruiz-Alejos4, Yvonne Huaylinos5, Ricardo Velasquez6, Antonio Bernabe-Ortiz7, Robert H Gilman8. 1. CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: iyengar.m27@gmail.com. 2. Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima 15102, Peru. 3. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Laboratory of Cellular Biophysics, The Rockefeller University, New York, New York, USA. 4. CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Vanderbilt University, Nashville, TN, USA. 5. Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru. 6. Division of Ophthalmology, Department of Surgery, Hospital Nacional Cayetano Heredia, Lima, Peru. 7. CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. 8. CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Área de Investigación y Desarrollo, A.B. PRISMA, Lima, Peru.
Abstract
AIMS: Explore potential of 31 tear biomarkers involved in screening for diabetic peripheral neuropathy (DPN). Assess the utility of aesthesiometry for measuring corneal damage in DPN and determine optimal cutoff point for detecting DPN. METHODS: Screening test pilot study recruited 90 participants from a tertiary hospital in Lima, Peru. Participants were grouped by diabetes and neuropathy status. Tears collected on Schirmer strips, and proteins measured by both ELISA and multiplex-bead assay. Corneal sensitivity was measured by aesthesiometry, and DPN by vibration perception threshold testing. RESULTS: There were 89 participants included in the analysis. The mean age was 55.7 ± 1.46, and 58.4% were female. MMP-9 and TGF-alpha concentrations were higher in participants with DPN versus diabetes alone, though not significant. Aesthesiometry was decreased in individuals with DPN when compared to participants with diabetes alone (p < 0.01) and normal controls (p < 0.01). Optimal cutoff point for aesthesiometry was found to be 5.8 cm, with 79% sensitivity and 75% specificity. CONCLUSIONS: Tears are an insufficient standalone tool for detecting DPN based on the biomarkers analyzed. Aesthesiometry is a simple, inexpensive, and accurate method to assess corneal damage associated with moderate-severe DPN, and its integration into screening practices has potential to improve detection of DPN in poor-resource settings.
AIMS: Explore potential of 31 tear biomarkers involved in screening for diabetic peripheral neuropathy (DPN). Assess the utility of aesthesiometry for measuring corneal damage in DPN and determine optimal cutoff point for detecting DPN. METHODS: Screening test pilot study recruited 90 participants from a tertiary hospital in Lima, Peru. Participants were grouped by diabetes and neuropathy status. Tears collected on Schirmer strips, and proteins measured by both ELISA and multiplex-bead assay. Corneal sensitivity was measured by aesthesiometry, and DPN by vibration perception threshold testing. RESULTS: There were 89 participants included in the analysis. The mean age was 55.7 ± 1.46, and 58.4% were female. MMP-9 and TGF-alpha concentrations were higher in participants with DPN versus diabetes alone, though not significant. Aesthesiometry was decreased in individuals with DPN when compared to participants with diabetes alone (p < 0.01) and normal controls (p < 0.01). Optimal cutoff point for aesthesiometry was found to be 5.8 cm, with 79% sensitivity and 75% specificity. CONCLUSIONS: Tears are an insufficient standalone tool for detecting DPN based on the biomarkers analyzed. Aesthesiometry is a simple, inexpensive, and accurate method to assess corneal damage associated with moderate-severe DPN, and its integration into screening practices has potential to improve detection of DPN in poor-resource settings.
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