Abstract
Purpose :
Screening for presence and severity of Diabetic Peripheral Neuropathy with using Corneal Confocal Microscopy in a cohort of newly diagnosed type 2 diabetic mellitus patients.
Methods :
After screening 460 diabetic patients, 91 newly diagnosed type 2 diabetic patients (62% male, Age: 63±12; Ethnicity: 80% Caucasian,14.4% Afro-Caribbean; 5% South Asians) have been screened for Diabetic Peripheral Neuropathy (DPN) with using corneal confocal microscopy (HRT III- RCM), alongside of 60 age and sex matched healthy control subjects (65% male, Age: 62±14). All patients were part of South Manchester Screening Programme and have been screened for diabetic retinopathy at the same visit by four independent, experienced optometrists that have been trained for CCM. Selection of CCM images was done by optometrists and after sending the images to leading centre, images have been graded and analysed at the leading centre. Retinopathy grading has been done by optometrists based on national retinopathy screening programme (ETDRS).
As part of this screening programme, all patients filled some questionnaires including Diabetic Neuropathy Symptoms profile (DNS) and self-reported questionnaires regards to the history of retinopathy, retinopathy laser treatment, diabetic foot problem, foot ulcer and neuropathy.
Results :
Average duration of diabetes was 1 year (1.04± 0.07). 80% of patients had no retinopathy and 19.7% of patients had background retinopathy. 15.3% of patients had symptoms of diabetic neuropathy (DNS>1).
There was significant alterations in corneal nerves morphological parameters in patients compare to control subjects including CNFD (P<0.001); CNBD (P=0.007); CNFL (P<0.001), and size of beading along c-nerve fibres (P<0.001).
CNFD and CNFL were reduced below the 2.5th percentile in 15.5%, and 14.4% of the diabetes patients, respectively.
There was no correlation between neuropathy symptoms and severity of alterations of corneal nerves. No correlation has been also found for retinopathy and neuropathy.
Conclusions :
As part of a bigger screening programme, feasibility and acceptability of using CCM alongside retinopathy screening have been established. This study showed the significant level of nerve damage and presence of DPN in newly diagnosed type 2 diabetic patients without evidence of other microvascular complications.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.