Corneal confocal microscopy detects neuropathy in subjects with impaired glucose tolerance

Omar Asghar, Ioannis N. Petropoulos, Uazman Alam, Wendy Jones, Maria Jeziorska, Andrew Marshall, Georgios Ponirakis, Hassan Fadavi, Andrew J M Boulton, Mitra Tavakoli, Rayaz Malik

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OBJECTIVE: Impaired glucose tolerance (IGT) represents one of the earliest stages of glucose dysregulation and is associated with macrovascular disease, retinopathy, and microalbuminuria, but whether IGT causes neuropathy is unclear. RESEARCH DESIGN AND METHODS Thirty-seven subjects with IGT and 20 age-Matched control subjects underwent a comprehensive evaluation of neuropathy by assessing symptoms, neurological deficits, nerve conduction studies, quantitative sensory testing, heart rate variability deep breathing (HRVdb), skin biopsy, and corneal confocal microscopy (CCM). RESULTS: Subjects with IGT had a significantly increased neuropathy symptom profile (P < 0.001), McGill pain index (P < 0.001), neuropathy disability score (P = 0.001), vibration perception threshold (P = 0.002), warm threshold (P = 0.006), and coolthreshold (P = 0.03), with a reduction in intraepidermal nerve fiber density (P = 0.03), corneal nerve fiber density (P < 0.001), corneal nerve branch density (P = 0.002), and corneal nerve fiber length (P = 0.05). No significant difference was found in sensory and motor nerve amplitude and conduction velocity or HRVdb. CONCLUSIONS: Subjects with IGT have evidence of neuropathy, particularly small-Fiber damage, which can be detected using skin biopsy and CCM.

Original languageEnglish
Pages (from-to)2643-2646
Number of pages4
JournalDiabetes Care
Issue number9
Publication statusPublished - 2014


ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Asghar, O., Petropoulos, I. N., Alam, U., Jones, W., Jeziorska, M., Marshall, A., Ponirakis, G., Fadavi, H., Boulton, A. J. M., Tavakoli, M., & Malik, R. (2014). Corneal confocal microscopy detects neuropathy in subjects with impaired glucose tolerance. Diabetes Care, 37(9), 2643-2646.