Burgess, J, Frank, B, Marshall, A, Khalil, RS, Ponirakis, G, Petropoulos, IN, Cuthbertson, DJ, Malik, RA and Alam, U (2021) Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics, 11 (2). ISSN 2075-4418

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Abstract

Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.

Item Type:	Article
Uncontrolled Keywords:	Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; diabetes; neuropathy; peripheral neuropathy; distal sensory polyneuropathy; diabetic neuropathy; diabetic peripheral neuropathy; early detection; screening; diagnostics; point-of-care; CORNEAL CONFOCAL MICROSCOPY; HEAT-EVOKED-POTENTIALS; CURRENT PERCEPTION THRESHOLD; DISTAL SYMMETRIC POLYNEUROPATHY; REFLEX-RELATED VASODILATION; IMPAIRED GLUCOSE-TOLERANCE; LOWER-EXTREMITY AMPUTATION; GERMAN RESEARCH NETWORK; INDICATOR TEST; RISK-FACTORS; diabetes; diabetic neuropathy; diabetic peripheral neuropathy; diagnostics; distal sensory polyneuropathy; early detection; neuropathy; peripheral neuropathy; point-of-care; screening
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Divisions:	Psychology (from Sep 2019)
Publisher:	MDPI
SWORD Depositor:	A Symplectic
Date Deposited:	12 May 2022 09:40
Last Modified:	12 May 2022 09:45
DOI or ID number:	10.3390/diagnostics11020165
URI:	https://researchonline.ljmu.ac.uk/id/eprint/16808

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