Corneal confocal microscopy predicts 4-Year incident peripheral neuropathy in type 1 diabetes

Nicola Pritchard, Katie Edwards, Anthony W. Russell, Bruce A. Perkins, Rayaz Malik, Nathan Efron

Research output: Contribution to journalArticle

70 Citations (Scopus)


OBJECTIVE This study determined if deficits in corneal nerve fiber length (CNFL) assessed using corneal confocal microscopy (CCM) can predict future onset of diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS CNFL and a range of other baseline measures were compared between 90 nonneuropathic patients with type 1 diabetes who did or did not develop DPN after 4 years. The receiver operator characteristic (ROC) curve was used to determine the capability of single and combined measures of neuropathy to predict DPN. RESULTS DPN developed in 16 participants (18%) after 4 years. Factors predictive of 4-year incident DPN were lower CNFL (P = 0.041); longer duration of diabetes (P = 0.002); higher triglycerides (P = 0.023); retinopathy (higher on the Early Treatment of Diabetic Retinopathy Study scale) (P = 0.008); nephropathy (higher albumin-tocreatinine ratio) (P = 0.001); higher neuropathy disability score (P = 0.037); lower cold sensation (P = 0.001) and cold pain (P = 0.027) thresholds; higher warm sensation (P = 0.008), warm pain (P = 0.024), and vibration (P = 0.003) thresholds; impaired monofilament response (P = 0.003); and slower peroneal (P = 0.013) and sural (P = 0.002) nerve conduction velocity. CCM could predict the 4-year incident DPN with 63% sensitivity and 74% specificity for a CNFL threshold cutoff of 14.1 mm/mm2 (area under ROC curve = 0.66, P = 0.041). Combining neuropathymeasures did not improve predictive capability. CONCLUSIONS DPN can be predicted by various demographic, metabolic, and conventional neuropathy measures. The ability of CCM to predict DPN broadens the already impressive diagnostic capabilities of this novel ophthalmic marker.

Original languageEnglish
Pages (from-to)671-675
Number of pages5
JournalDiabetes Care
Issue number4
Publication statusPublished - 1 Apr 2015
Externally publishedYes

ASJC Scopus subject areas

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

Fingerprint Dive into the research topics of 'Corneal confocal microscopy predicts 4-Year incident peripheral neuropathy in type 1 diabetes'. Together they form a unique fingerprint.

  • Cite this

    Pritchard, N., Edwards, K., Russell, A. W., Perkins, B. A., Malik, R., & Efron, N. (2015). Corneal confocal microscopy predicts 4-Year incident peripheral neuropathy in type 1 diabetes. Diabetes Care, 38(4), 671-675.