In This Issue of Diabetes

摘要

Although early detection of diabetic sensorimotor polyneuropathy (DSPN) may facilitate improved treatment outcomes, patients can only benefit from intervention if they receive an early and accurate DSPN diagnosis. Historically, assessment of DSPN-even among highly skilled clinicians-has been inconsistent, and development of objective and reproducible measures has been advocated for some time. In this issue of Diabetes, Ziegler et al. (p. 2454) compared 86 patients recently diagnosed with type 2 diabetes (T2D) with 48 control subjects to determine whether early nerve damage could be detected by corneal confocal microscopy (CCM). This new strategy for quantitative assessment of small nerve fiber damage was related to existing assessments including skin biopsy and neurophysiological tests. Although CCM detected early nerve fiber loss with a slightly greater overall frequency than skin biopsies, there was incomplete overlap across the methods, perhaps due to small fiber pathology developing at different times in different organs. To understand sensitivity among various measures, the researchers identified the proportion of participants whose values fell below the 2.5 percentile limit of normal. Those analyses showed that among six CCM measures such as nerve fiber length, connecting points, and branch density, nerve fiber density was the most sensitive. This measure was below normal limits in 21% of patients with T2D. In contrast, skin biopsies revealed that intraepidermal nerve fiber density was reduced below the 2.5 percentile in only 14% of T2D patients. Taken together, the results indicate that CCM may be a promising tool for early detection of diabetic neuropathy. If further studies confirm the utility of this assessment strategy, new opportunities may be available for early diagnosis and treatment of patients with DSPN.