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Greater small nerve fibre damage in the skin and cornea of type 1 diabetic patients with painful compared to painless diabetic neuropathy
Author(s) -
Ferdousi Maryam,
Azmi Shazli,
Kalteniece Alise,
Petropoulos Ioannis Nikolaos,
Ponirakis Georgios,
Asghar Omar,
Alam Uazman,
Marshall Andrew,
Boulton Andrew J. M.,
Efron Nathan,
Soran Handrean,
Jeziorska Maria,
Malik Rayaz A.
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14757
Subject(s) - medicine , diabetic neuropathy , diabetes mellitus , sural nerve , skin biopsy , peripheral neuropathy , nerve conduction velocity , ophthalmology , surgery , biopsy , endocrinology
Background and aim Damage to small nociceptive fibres may contribute to painful diabetic neuropathy. We aimed to compare large and small nerve fibre measurements together with skin biopsy and corneal confocal microscopy in patients with type 1 diabetes and painful or painless diabetic neuropathy. Methods We have assessed the McGill pain questionnaire, neuropathy disability score, vibration perception threshold, warm and cold sensation thresholds, electrophysiology, corneal confocal microscopy and skin biopsy in participants with type 1 diabetes and painful ( n = 41) or painless ( n = 50) diabetic neuropathy and control subjects ( n = 50). Results The duration of diabetes, body mass index, glycated haemoglobin (HbA1c), blood pressure and lipid profile did not differ between subjects with painful and painless neuropathy. Neuropathy disability score and vibration perception threshold were higher and sural nerve conduction velocity was lower, but sural nerve amplitude, peroneal nerve amplitude and conduction velocity and cold and warm sensation thresholds did not differ between patients with painful compared to painless diabetic neuropathy. However, intraepidermal nerve fibre density, corneal nerve fibre density, corneal nerve branch density and corneal nerve fibre length were significantly lower in subjects with painful compared to painless diabetic neuropathy. Conclusions There is evidence of more severe neuropathy, particularly small fibre damage in the skin and cornea, of patients with painful compared to painless diabetic neuropathy.