title: Clinical and diagnostic features of small fiber damage in diabetic polyneuropathy.
abstract: Small fiber neuropathy represents a significant component of diabetic sensorimotor polyneuropathy (DSPN) which has to date been ignored in most recommendations for the diagnosis of DSPN. Small fibers predominate in the peripheral nerve, serve crucial and highly clinically relevant functions such as pain, and regulate microvascular blood flow, mediating the mechanisms underlying foot ulceration. An increasing number of diagnostic tests have been developed to quantify small fiber damage. Because small fiber damage precedes large fiber damage, diagnostic tests for DSPN show good sensitivity but moderate specificity, because the gold standard which is used to define DSPN is large fiber-weighted. Hence new diagnostic algorithms for DSPN should acknowledge this emerging data and incorporate small fiber evaluation as a key measure in the diagnosis of DSPN, especially early neuropathy.
authors.affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Javed
authors.affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Weill Cornell Medical College in Qatar, Doha, Qatar.
authors.forename: I N
authors.initials: IN
authors.lastname: Petropoulos
authors.affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Tavakoli
authors.affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Weill Cornell Medical College in Qatar, Doha, Qatar. Electronic address: rayaz.a.malik@manchester.ac.uk.
authors.forename: R A
authors.initials: RA
authors.lastname: Malik
mesh_terms: D000818:Animals; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D004916:Erythromelalgia / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D009412:Nerve Fibers / Q000473:pathology*; D012867:Skin / Q000294:innervation
keywords: IENFD; Small fibers; corneal confocal microscopy; quantitative sensory testing; sudomotor dysfunction