Corneal nerve loss is related to the severity of painful diabetic neuropathy
Painful diabetic neuropathy is an occurrence associated with depression, anxiety and sleep disturbance. Current modes of treatment show limited efficiency and hence recognizing the primary site and the mechanism of the symptoms can help treat and enhance patient outcomes. Previous studies have reflected that patients with Painful Diabetic Neuropathy have greater corneal loss compared to Painless Diabetic Neuropathy. Shazli Azmi and colleagues hence conducted a research titled “Corneal nerve loss is related to the severity of painful diabetic neuropathy” and the article has been summarized below.
Objective:
To investigate whether the severity of corneal nerve loss and the severity of PDN were related.
Method:
The participants included patients with Type 1 (n = 45) and Type 2 Diabetes (n = 73). The patient underwent comprehensive testing where the body mass index, blood pressure and HbA1c were evaluated. Pin-prick sensation, temperature perception and the presence or absence of ankle reflexes were used to determine the Neuropathy Disability Score (NDS). A neurothesiometer was used to evaluate Vibration perception threshold (VPT). The Cold Perception threshold and the Warm Perception Threshold as well as Corneal Sensitivity Threshold were also measured. Analysis was carried out via SPSS tool.
Findings:
PDN follows a complex aetiology with an amalgamation of influences of genetics, gender, glycemic control, peripheral nerve, spinal cord and brain pathology. The study confirms that patients with Painful Diabetic Neuropathy have greater corneal loss compared to Painless Diabetic Neuropathy. Lower corneal sensitivity has been portrayed previously in patients with PDN compared to patients with Painless Diabetic Neuropathy. Deep breathing heart rate variability which is a marker of cardiac autonomic dysfunction was lower in patients with PDN. The findings of the study are consistent with other studies which report that the small nerve fibre damage is greater but no considerable difference in measures of large fibre neuropathy between patients with PDN compared to painless diabetic peripheral neuropathy. On a conclusive note, corneal confocal microscopy detects smaller fibre nerve loss accurately in patients with PDN and hence serves as an excellent diagnostic tool for ruling out patients with PDN.
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