In vivo corneal confocal microscopy as a novel non‐invasive tool to investigate cardiac autonomic neuropathy in Type 1 diabetes2. Issue 2 (24th September 2014)

• Record Type: Journal Article
• Authors: Maddaloni, E.; Sabatino, F.; Del Toro, R.; Crugliano, S.; Grande, S.; Lauria Pantano, A.; Maurizi, A. R.; Palermo, A.; Bonini, S.; Pozzilli, P.; Manfrini, S.
• Is Part Of: Diabetic medicine. Volume 32:Issue 2(2015:Feb.)
• Page Start: 262
• Page End: 266
• Publication Date: 2014-09-24
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12583
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12583-abs-0001"> <title>Abstract</title> <sec id="dme12583-sec-0001" sec-type="section"> <title>Aims</title> <p>To investigate whether small nerve fibre degeneration detected using corneal confocal microscopy is associated with cardiac autonomic neuropathy in people with Type 1 diabetes.</p> </sec> <sec id="dme12583-sec-0002" sec-type="section"> <title>Methods</title> <p>Thirty‐six people with Type 1 diabetes and 20 age‐ and sex‐matched healthy control subjects were enrolled. Tests to determine heart rate response to deep‐breathing (expiratory‐to‐inspiratory ratio), heart rate response to lying‐to‐stand test (30:15 ratio) and blood pressure response to standing were performed to detect cardiac autonomic neuropathy. Corneal confocal microscopy was performed to assess: corneal nerve density and corneal nerve beadings; branching pattern; and nerve fibre tortuosity.</p> </sec> <sec id="dme12583-sec-0003" sec-type="section"> <title>Results</title> <p>Compared with control participants, participants with Type 1 diabetes had fewer (mean ± <sc>sd</sc> 45.4 ± 20.2 vs 92.0 ± 22.7 fibres/mm<sup>2</sup>; <italic>P </italic><<italic> </italic>0.001) and more tortuous corneal nerve fibres (20 participants with Type 1 diabetes vs four control participants had nerve tortuosity grade 2/3; <italic>P </italic>=<italic> </italic>0.022) and fewer beadings (mean ± <sc>sd</sc> 15.1 ± 3.5 vs 20.6 ± 5.0; <italic>P </italic><<italic> </italic>0.001). Of the participants with Type 1 diabetes, 11 met the criteria for the diagnosis of cardiac autonomic neuropathy. Corneal nerve density was significantly lower in participants with cardiac autonomic neuropathy than in those without (mean ± <sc>sd</sc> 32.8 ± 16.4 vs 51.7 ± 18.9 fibres/mm<sup>2</sup>; <italic>P </italic>=<italic> </italic>0.008). This difference remained significant after adjustment for age (<italic>P </italic>=<italic> </italic>0.02), gender (<italic>P </italic>=<italic> </italic>0.04), disease duration (<italic>P </italic>=<italic> </italic>0.005), insulin requirement (<italic>P </italic>=<italic> </italic>0.02) and neuropathy disability score (<italic>P </italic>=<italic> </italic>0.04).</p> </sec> <sec id="dme12583-sec-0004" sec-type="section"> <title>Conclusion</title> <p>This study suggests that corneal confocal microscopy could represent a new and non‐invasive tool to investigate cardiac autonomic neuropathy in people with Type 1 diabetes. Larger studies are required to define the role of corneal confocal microscopy in the assessment of cardiac autonomic neuropathy.</p> </sec> </abstract>