title: Diabetic foot syndrome and corneal subbasal nerve plexus changes in congolese patients with type 2 diabetes.
abstract: BACKGROUND
  To study the severity of diabetic neuropathy, diabetic retinopathy and grades of diabetic foot syndrome for correlations with corneal subbasal nerve plexus (SBP) changes in Congolese patients with type 2 diabetes.
  
  
  RESULTS
  Twenty-eight type 2 diabetes patients with diabetes-related foot ulceration were recruited in a diabetic care unit in Kinshasa, Democratic Republic of Congo. Corneal SBP was investigated by confocal laser-scanning microscopy to analyse nerve fibre density (NFD) [µm/ µm²], number of branches [n] and number of connectivity points [n]. Foot ulceration was graded using the Wagner ulcer classification. Corneal sensitivity (Cochet-Bonnet), Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), ankle-brachial index (ABI) and ophthalmological status were evaluated. Foot ulceration was ranked as mild (Wagner 0-1: 13 patients/46.4%), moderate (Wagner 2-3: 10 patients/35.7%) and severe (Wagner 4-5: 5 patients/17.9%). The correlation between Wagner Score and NFD (p=0.017, r = - 0,454), NDS and NFD (p=0,039, r = - 0.400) as well as Wagner Score and HbA1c (p=0,007, r = - 0.477) was stated. Significant differences in confocal SBP parameters were observed between Wagner 0-1 and Wagner 4 5 (number of branches (p=0.012), number of connectivity points (p=0.001), nerve fibre density (p=0.033)) and ABI (p=0.030), and between Wagner 2-3 and Wagner 4-5 (number of branches (p=0.003), number of connectivity points (p=0.005) and nerve fibre density (p=0.014)). Differences in NDS (p=0.001) and corneal sensation (p=0.032) were significant between Wagner 0-1 and Wagner 2-3. Patients with diabetic retinopathy had significantly longer diabetes duration (p=0.03) and higher NDS (p=0.01), but showed no differences in SBP morphology or corneal sensation.
  
  
  CONCLUSIONS
  While confirming the diabetic aetiology of foot ulceration due to medial arterial calcification, this study indicates that the grade of diabetic foot syndrome correlates with corneal SBP changes and corneal sensation in patients in sub-Saharan Africa.
authors: Department of Ophthalmology, University of Rostock, Rostock, Germany.
authors: Andrey
authors: A
authors: Zhivov
authors: Department of Ophthalmology, University of Rostock, Rostock, Germany.
authors: Sabine
authors: S
authors: Peschel
authors: Clinic of Internal Medicine I, Klinikum Südstadt, Rostock, Germany.
authors: Hans-Christof
authors: HC
authors: Schober
authors: Department of Ophthalmology, University of Rostock, Rostock, Germany.
authors: Oliver
authors: O
authors: Stachs
authors: Institute of Medical Biochemistry and Molecular Biology, University of Rostock, Rostock, Germany.
authors: Simone
authors: S
authors: Baltrusch
authors: Department of Ophthalmology, St. Joseph Hospital, Kinshasa, Democratic Republic of Congo.
authors: Marie Therese
authors: MT
authors: Bambi
authors: Department of Ophthalmology, St. Joseph Hospital, Kinshasa, Democratic Republic of Congo.
authors: Janvier
authors: J
authors: Kilangalanga
authors: Translational Centre for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.
authors: Karsten
authors: K
authors: Winter
authors: Institute for Biostatistics and Informatics in Medicine and Ageing Research, University of Rostock, Rostock, Germany.
authors: Guenther
authors: G
authors: Kundt
authors: Department of Ophthalmology, University of Rostock, Rostock, Germany.
authors: Rudolf F
authors: RF
authors: Guthoff
mesh_terms: D000368:Aged; D003223:Congo; D003315:Cornea / Q000294:innervation* / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D017719:Diabetic Foot / Q000175:diagnosis / Q000209:etiology*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged