ArticleBMJ open diabetes research & care2020
Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy.
Article in BMJ open diabetes research & care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta-analysis.Journal of diabetes investigation · 2022Pooled it
- Innovative strategies for diabetic peripheral neuropathy: From clinical management to emerging bioengineering solutions.Bioactive materials · 2026Review
- Methods for the evaluation of corneal nerve fibres in diabetes mellitus by in vivo confocal microscopy: a scoping review.BMJ open · 2025Article
- Ocular changes as potential biomarkers for early diagnosis of Alzheimer's disease.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Review
- Deep-learning based analysis of in-vivo confocal microscopy images of the subbasal corneal nerve plexus' inferior whorl in patients with neuropathic corneal pain and dry eye disease.The ocular surface · 2024Article
- Article
- Assessing Corneal Confocal Microscopy and Other Small Fiber Measures in Diabetic Polyneuropathy.Neurology · 2023Article
- Continuous glucose monitoring reveals a novel association between duration and severity of hypoglycemia, and small nerve fiber injury in patients with diabetes.Endocrine connections · 2022Article
- Diabetic corneal neuropathy as a surrogate marker for diabetic peripheral neuropathy.Neural regeneration research · 2022Review
- Diabetes Distal Peripheral Neuropathy: Subtypes and Diagnostic and Screening Technologies.Journal of diabetes science and technology · 2022Review
- Recent updates in the treatment of diabetic polyneuropathy.Faculty reviews · 2022Review
- Corneal Confocal Microscopy Predicts the Development of Diabetic Neuropathy: A Longitudinal Diagnostic Multinational Consortium Study.Diabetes care · 2021Article
- Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres.Diagnostics (Basel, Switzerland) · 2021Review
- Therapeutic effect of opioid analgesics combined with non-steroidal anti-inflammatory drugs on peripheral neuropathy and its influence on inflammatory factors.American journal of translational research · 2021Article
Corrections and comments
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Authors and funding
14 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionDiabetic neuropathy can be diagnosed and assessed using a number of techniques including corneal confocal microscopy (CCM). RESEARCH DESIGN AND
methodsWe have undertaken quantitative sensory testing, nerve conduction studies and CCM in 143 patients with type 1 and type 2 diabetes without neuropathy (n=51), mild neuropathy (n=47) and moderate to severe neuropathy (n=45) and age-matched controls (n=30).
resultsVibration perception threshold (p<0.0001), warm perception threshold (WPT) (p<0.001), sural nerve conduction velocity (SNCV) (p<0.001), corneal nerve fiber density (CNFD) (p<0.0001), corneal nerve branch density (CNBD) (p<0.0001), corneal nerve fiber length (CNFL) (p=0.002), inferior whorl length (IWL) (p=0.0001) and average nerve fiber length (ANFL) (p=0.0001) showed a progressive abnormality with increasing severity of diabetic neuropathy. Receiver operating characteristic curve analysis for the diagnosis of diabetic neuropathy showed comparable performance in relation to the area under the curve (AUC) but differing sensitivities and specificities for vibration perception threshold (AUC 0.79, sensitivity 55%, specificity 90%), WPT (AUC 0.67, sensitivity 50%, specificity 76%), cold perception threshold (AUC 0.64, sensitivity 80%, specificity 47%), SNCV (AUC 0.70, sensitivity 76%, specificity 54%), CNFD (AUC 0.71, sensitivity 58%, specificity 83%), CNBD (AUC 0.70, sensitivity 69%, specificity 65%), CNFL (AUC 0.68, sensitivity 64%, specificity 67%), IWL (AUC 0.72, sensitivity 70%, specificity 65%) and ANFL (AUC 0.72, sensitivity 71%, specificity 66%).
conclusionThis study shows that CCM identifies early and progressive corneal nerve loss at the inferior whorl and central cornea and has comparable utility with quantitative sensory testing and nerve conduction in the diagnosis of diabetic neuropathy.
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