Response to Comment on Malik. Which Test for Diagnosing Early Human Diabetic Neuropathy? Diabetes 2014;63:2206–2208

We thank van der Heyden et al. (1) for their thoughtful comment in response to the commentary by author Malik (2). We totally agree there is a need to develop better surrogate markers if we are to translate clinically meaningful new therapies for diabetic peripheral neuropathy (DPN).Therefore, we read with interest their recent study (3) showing reduced motor nerve axonal excitability, measured using threshold-tracking techniques, in young type 1 diabetes patients with normal compound muscle action potential scan measures of axonal loss and reinnervation as well as conventional electrophysiology. This is not surprising given that minor perturbations in glucose can lead to anaerobic glycolysis, tissue acidosis, and reduced Na+/K …