title: The usefulness of quantifying intraepidermal nerve fibers density in the diagnostic of diabetic peripheral neuropathy: a cross-sectional study.
abstract: BACKGROUND
  Distal symmetric polyneuropathy (DSPN) is the most common complication of type 2 diabetes mellitus (T2DM) and the most common form of peripheral neuropathy. DSPN increases the risk of foot ulceration up to seven-fold, and is a significant risk factor in more than 60 % of the amputations of the lower limbs in patients with T2DM. The aims of our study were to evaluate the difference in the density of intraepidermal nerve fibers (IENF) in patients with respectively without DSPN, to evaluate the strength of the relationship between the symptomatology of the DSPN and IENF density and to define a cutoff value of the IENF density for the diagnosis of DSPN.
  
  
  METHODS
  We enrolled, according to a consecutive, population-based method, 36 patients with T2DM admitted in our Clinic. For all patients, we measured HbA1c, lipid profile, body mass index and we assessed the presence and severity of DSPN using the evaluation of clinical symptoms, nerve conduction velocity and IENF density quantification.
  
  
  RESULTS
  The presence of neuropathy was significantly associated with a decreased density of IENF for both the proximal (11.6 vs. 14.9 fibers/mm; p = 0.014) and the distal biopsies (7.2 vs. 8.6 fibers/mm; p = 0.020). The optimal threshold value of IENF density (the point with the maximum sum of specificity and sensitivity), according to our model, was 10.1 fibers/mm.
  
  
  CONCLUSIONS
  Skin biopsy followed by IENF density quantification is a valid, reliable tool for the diagnosis of DSPN.
authors.affiliation: Department III - Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Timar
authors.affiliation: Department VII - Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Popescu
authors.affiliation: Department VII - Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania.
authors.forename: Romulus
authors.initials: R
authors.lastname: Timar
authors.affiliation: Department II - Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Flavia
authors.initials: F
authors.lastname: Baderca
authors.affiliation: Department X - Surgery, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Duica
authors.affiliation: Department VII - Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Vlad
authors.affiliation: Legal Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Codrina
authors.initials: C
authors.lastname: Levai
authors.affiliation: Department II - Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Balinisteanu
authors.affiliation: Department VIII - Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Simu
keywords: Diabetic peripheral neuropathy; Intraepidermal nerve fibers density; Skin biopsy