title: Using in vivo corneal confocal microscopy to identify diabetic sensorimotor polyneuropathy risk profiles in patients with type 1 diabetes.
abstract: OBJECTIVE
  Diabetic sensorimotor peripheral neuropathy (DSP) is the most prevalent complication in diabetes mellitus. Identifying DSP risk is essential for intervening early in the natural history of the disease. Small nerve fibers are affected earliest in the disease progression and evidence of this damage can be identified using in vivo corneal confocal microscopy (IVCCM).
  
  
  METHODS
  We applied IVCCM to a cohort of 40 patients with type 1 diabetes to identify their DSP risk profile. We measured standard IVCCM parameters including corneal nerve fiber length (CNFL), and performed nerve conduction studies and quantitative sensory testing.
  
  
  RESULTS
  40 patients (53% female), with a mean age of 48±14, BMI 28.1±5.8, and diabetes duration of 27±18 years were enrolled between March 2014 and June 2015. Mean IVCCM CNFL was 12.0±5.2 mm/mm2(normal ≥15 mm/mm2). Ten patients (26%) without DSP were identified as being at risk of future DSP with mean CNFL 11.0±2.1 mm/mm2. Six patients (15%) were at low risk of future DSP with mean CNFL 19.0±4.6 mm/mm2, while 23 (59%) had established DSP with mean CNFL 10.5±4.5 mm/mm2.
  
  
  CONCLUSIONS
  IVCCM can be used successfully to identify the risk profile for DSP in patients with type 1 diabetes. This methodology may prove useful to classify patients for DSP intervention clinical trials.
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
authors.forename: Evan J H
authors.initials: EJ
authors.lastname: Lewis
authors.affiliation: Leadership Sinai Centre for Diabetes, Mount Sinai Hospital , Toronto, Ontario , Canada.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perkins
authors.affiliation: Leadership Sinai Centre for Diabetes, Mount Sinai Hospital , Toronto, Ontario , Canada.
authors.forename: Lief E
authors.initials: LE
authors.lastname: Lovblom
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bazinet
authors.affiliation: Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
authors.forename: Thomas M S
authors.initials: TM
authors.lastname: Wolever
authors.affiliation: Division of Neurology , Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital , Toronto, Ontario , Canada.
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
keywords: CCM; Neuropathy; Neuropathy Clinical Trials; Risk Assessment