Validating Novel Tools for Measuring Diabetic Nerve Damage

Diabetes-related nerve damage, called diabetic neuropathy, can be a painful and potentially disabling complication of diabetes, contributing to non-healing ulcers and amputations. It can be difficult to diagnose and the advancement of therapies for treatment has been stymied by a lack of sensitive ways to measure improvements in neuropathy during clinical trials. Recently, counting small fibers has emerged as a potential new method of predicting diabetic neuropathy progression and its response to new therapies. These fibers can be measured in nerves in skin following a biopsy or in small nerves in the cornea of the eye, using non-invasive microscopy. Another study by another group used Corneal Confocal Microscopy nerve measures as a potential assessment technique of diabetic neuropathy. Clinical trials are required to test and validate the usefulness of these techniques. This study represents an independent verification of the potential for corneal nerves to be used in measuring diabetic neuropathy. The group identified one particular measure, corneal nerve fiber length, as being the most promising to help assess patients with different severity of diabetic neuropathy. The group also proposed that early changes in this measure could identify patients with early signs of neuropathy; too early to be diagnosed by other means.

Reference:

Detection of Diabetic Sensorimotor Polyneuropathy by Corneal Confocal Microscopy in Type 1 Diabetes: A concurrent validity study. Ahmed A, Bril V, Orszag A, Paulson J, Yeung E, Ngo M, Orlov S, Perkins BA. Diabetes Care. 2012 Feb 8. [Epub ahead of print]

Ramifications for Individuals with Type 1 Diabetes:

If sensitive techniques or tools can be validated, it may be possible to detect diabetic neuropathy earlier and more objectively, allowing treatment to be targeted to those most at risk. Ideally, if these new techniques and tools show potential in measuring a response to therapy, they could help guide early clinical trials, and give companies a fast and efficient way to determine whether their therapies can preserve or improve small nerve fibers damaged by diabetes.

JDRF Involvement:

JDRF funded this study.