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1. Diabetic foot

Author

Miyan, Zahid, primary, Boulton, Andrew J.M., additional, and Pedrosa, Hermelinda Cordeiro, additional

Published
2024
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2. Contributors

Author

Abbasi, Muhammad Zafar Iqbal, primary, Abdul Rehman, Rabia, additional, Ahmedani, Muhammad Yakoob, additional, Albache, Nizar, additional, Ali-Eltom, Mohamed, additional, Askari, Saima, additional, Azad Khan, Abul Kalam, additional, Basit, Abdul, additional, Basit, Khalid Abdul, additional, Bhowmik, Bishwajit, additional, Boulton, Andrew J.M., additional, Buyukbese, Mehmet Akif, additional, Eichorst, Barbara, additional, Eigenmann, Cecile Alice, additional, El-Sayed, Adel Abdel Aziz, additional, Faheem, Osman, additional, Farooqi, Meena Iqbal, additional, Fawwad, Asher, additional, Ghafoor, Erum, additional, Hakeem, Rubina, additional, Hinchliffe, Robert J., additional, Hussain, Akhtar, additional, Hydrie, Muhammad Zafar Iqbal, additional, Jabbar, Abdul, additional, Jamil, Bushra, additional, Jenkins, Alicia Josephine, additional, Khan, Muhammad Farhatullah, additional, Khan, Shair Zaman, additional, Khan, Uzma Zubair, additional, Khan, Yasmin, additional, Little, Erin Elizabeth, additional, Majumdar, Kalpita, additional, Malik, Rayaz Ahmed, additional, Mehar, Salma, additional, Memon, Riaz Ahmed, additional, Miyan, Zahid, additional, Mohan, Viswanathan, additional, Moyeen, Fauzia, additional, Niazi, Asima Khan, additional, Ogle, Graham David, additional, Pedrosa, Hermelinda Cordeiro, additional, Rashid, Thamina, additional, Riaz, Musarrat, additional, Saif-Ul Haque, M., additional, Salman, Ahmed, additional, Schwartz, Peter Egbert Hermann, additional, Senneville, Eric, additional, Shafique, Kashif, additional, Sheikh, Aisha, additional, Sheikh, Muhammad Adil, additional, Shiraz, Mahwish, additional, Simmons, David, additional, Soomro, Marium Habib, additional, Sultan, Sharjeel, additional, Syed, Furrukh Omair, additional, Tayeb, Khaled Abdullah, additional, Unnikrishnan, Ambika Gopalakrishnan, additional, Venkatesan, Radha, additional, Wild, Sarah, additional, Yousuf, Sanobia, additional, and Zafar, Awn Bin, additional

Published
2024
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10. Diabetic foot

Author

Bowling, Frank Lee, primary, Foley, Keeley Jane, additional, and Boulton, Andrew J.M., additional

Published
2022
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11. List of contributors

Author

Akinci, Gulcin, primary, Andersen, Henning, additional, Boulton, Andrew J.M., additional, Bowling, Frank Lee, additional, Bril, Vera, additional, Calcutt, Nigel A., additional, Callaghan, Brian C., additional, Carmichael, Josie, additional, Chandrasekaran, Krish, additional, Colombo, Joseph, additional, Ejskjaer, Niels, additional, Fadavi, Hassan, additional, Feldman, Eva L., additional, Foley, Keeley Jane, additional, Gallagher, Gary, additional, Harno, Hanna, additional, Ishibashi, Fukashi, additional, Karlsson, Páll, additional, Kavarthapu, Venu, additional, Lim, Joyce, additional, Marshall, Andrew G., additional, Marshall, Anne, additional, Menon, Deepak, additional, Pafili, Kalliopi, additional, Papanas, Nikolaos, additional, Peltier, Amanda C., additional, Putko, Brendan N., additional, Rodríguez-Sánchez, Beatriz, additional, Røikjer, Johan, additional, Rosengård-Bärlund, Milla, additional, Russell, James W., additional, Savelieff, Masha G., additional, Selvarajah, Dinesh, additional, Shore, Angela C., additional, Sinclair, Alan, additional, Stouge, Anders, additional, Tavakoli, Mitra, additional, Tesfaye, Solomon, additional, Vas, Prashanth R.J., additional, Yagihashi, Soroku, additional, Yavuz, Dilek Gogas, additional, Yorek, Mark, additional, Zilliox, Lindsay A., additional, and Zochodne, Douglas W., additional

Published
2022
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13. Race/ethnicity and challenges for optimal insulin therapy

Author

do Vale Moreira, Nayla Cristina, Ceriello, Antonio, Basit, Abdul, Balde, Naby, Mohan, V., Gupta, Ritesh, Misra, Anoop, Bhowmik, Bishwajit, Lee, Moon K., Zuo, Hui, Shi, Zumin, Wang, Youfa, Montenegro, Renan M., Fernandes, Virgínia Oliveira, Colagiuri, Stephen, Boulton, Andrew J.M., and Hussain, Akhtar

Published
2021
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16. Psychosocial Care for People With Diabetic Neuropathy: Time for Action.

Author

Pouwer, Frans, Mizokami-Stout, Kara, Reeves, Neil D., Pop-Busui, Rodica, Tesfaye, Solomon, Boulton, Andrew J.M., and Vileikyte, Loretta

Abstract

Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Response to Comment on Orlando et al. Acute Effects of Vibrating Insoles on Dynamic Balance and Gait Quality in Individuals With Diabetic Peripheral Neuropathy: A Randomized Crossover Study. Diabetes Care 2024;47:1004–1011.

Author

Orlando, Giorgio, Brown, Steven, Jude, Edward, Bowling, Frank L., Boulton, Andrew J.M., and Reeves, Neil D.

Subjects
WALKING speed, DYNAMIC balance (Mechanics), DIABETIC neuropathies, POSTURAL balance, PHYSICAL mobility
Abstract

This document is a response to a comment on a study that explored the effects of vibrating insoles on gait and balance in individuals with diabetic peripheral neuropathy (DPN). The authors address concerns raised by Wang et al. regarding the statistical analysis and conclusions drawn in the study. They reanalyzed the data and confirmed the original results were correct. The authors explain that the variability in paired differences, rather than group means and standard deviations, is what determines the likelihood of significant differences. They also clarify that their findings do not establish a relationship between acute gait speed improvement with vibration and the risk of falling. The authors acknowledge the need for further studies to investigate the long-term effects of vibrating insoles on peripheral sensation and physical function in individuals with DPN. The research was funded by an EU grant, and no conflicts of interest were reported. [Extracted from the article]

Published
2024
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27. Contributors

Author

Achermann, John C., primary, Aiello, Lloyd P., additional, Alexander, Erik K., additional, Allen, Rebecca H., additional, Altshuler, David, additional, Anderson, Mark S., additional, Atkinson, Mark A., additional, Bahn, Rebecca S., additional, Barker, Jennifer M., additional, Basson, Rosemary, additional, Berga, Sarah L., additional, Bhasin, Shalender, additional, Birnbaum, Morris J., additional, Black, Dennis M., additional, Bose, Anirban, additional, Boulton, Andrew J.M., additional, Braunstein, Glenn D., additional, Bremner, William J., additional, Brent, Gregory A., additional, Bringhurst, F. Richard, additional, Brownlee, Michael, additional, Bulun, Serdar E., additional, Burant, Charles F., additional, Bushinsky, David A., additional, Cone, Roger D., additional, Cooke, David W., additional, Cooper, Mark E., additional, Cryer, Philip E., additional, Dattani, Mehul T., additional, Davies, Terry F., additional, de Paula, Francisco J.A., additional, Demay, Marie B., additional, DiVall, Sara A., additional, Elmquist, Joel K., additional, Filetti, Sebastiano, additional, Gevers, Evelien F., additional, Ghigo, Ezio, additional, Goldberg, Anne C., additional, Goldberg, Ira J., additional, Gottlieb, Peter A., additional, Grinspoon, Steven K., additional, Grumbach, Melvin M., additional, Hay, Ian D., additional, Hayes, Frances J., additional, Hickey, Martha, additional, Hirschhorn, Joel N., additional, Ho, Ken K.Y., additional, Hughes, Ieuan A., additional, Kaiser, Ursula, additional, Kaunitz, Andrew M., additional, Klein, Samuel, additional, Kleinberg, David, additional, Kronenberg, Henry M., additional, Lamberts, Steven W.J., additional, Lanfranco, Fabio, additional, Larsen, P. Reed, additional, Laurberg, Peter, additional, Lazar, Mitchell A., additional, Loriaux, Lynn, additional, Low, Malcolm J., additional, Majithia, Amit R., additional, Marx, Stephen J., additional, Matsumoto, Alvin M., additional, Melmed, Shlomo, additional, Monk, Rebeca D., additional, Murray, Robert D., additional, Newell-Price, John D.C., additional, Nitsche, Joshua F., additional, Öberg, Kjell, additional, Plutzky, Jorge, additional, Polonsky, Kenneth S., additional, Radovick, Sally, additional, Robinson, Alan G., additional, Romijn, Johannes A., additional, Rosen, Clifford J., additional, Salvatore, Domenico, additional, Schlumberger, Martin-Jean, additional, Semenkovich, Clay F., additional, Sluss, Patrick M., additional, Stewart, Paul M., additional, Strasburger, Christian J., additional, Styne, Dennis M., additional, van den Beld, Annewieke W., additional, Vella, Adrian, additional, Verbalis, Joseph G., additional, Vinik, Aaron I., additional, Weetman, Anthony P., additional, Wells, Samuel A., additional, and Young, William F., additional

Published
2016
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28. Contributors

Author

Aiello, Lloyd Paul, primary, Alatzoglou, Kyriaki S., additional, Alexander, Erik K., additional, Allan, Carolyn A., additional, Allolio, Bruno, additional, Amino, Nobuyuki, additional, Anawalt, Bradley D., additional, Angelos, Peter, additional, Arboleda, Valerie A., additional, Auchus, Richard J., additional, Axelrod, Lloyd, additional, Bahn, Rebecca S., additional, Baker, MD, PhD, FRACP, H.W. Gordon, additional, Barak, Shlomi, additional, Barnes, Randall B., additional, Barthel, Andreas, additional, Bastepe, Murat, additional, Beardsley, Emma K., additional, Beck-Peccoz, Paolo, additional, Bell, Graeme I., additional, Bi, Wenya Linda, additional, Bilezikian, John P., additional, Blum, Manfred, additional, Bonnema, Steen J., additional, Bornstein, Stefan R., additional, Bouillon, Roger, additional, Boulton, Andrew J.M., additional, Braunstein, Glenn D., additional, Bringhurst, F. Richard, additional, Broekmans, Frank J., additional, Bronstein, Marcello D., additional, Brown, Edward M., additional, Brown, Wendy A., additional, Bulun, Serdar E., additional, Burch, Henry B., additional, Burger, Henry G., additional, Burney, Richard O., additional, Burt, Morton G., additional, Cagliero, Enrico, additional, Callender, Glenda G., additional, Avancini Caramori, Maria Luiza, additional, Carey, Robert M., additional, Carling, Tobias, additional, Cavagnini, Francesco, additional, Cavallerano, Jerry D., additional, Challet, Etienne, additional, Chan, Shu Jin, additional, Chang, R. Jeffrey, additional, Chapurlat, Roland D., additional, Chatterjee, V. Krishna, additional, Chiofalo, Francesco, additional, Chiovato, Luca, additional, Cho, Kyung J., additional, Christison-Lagay, Emily, additional, Christophe, Daniel, additional, Chrousos, George P., additional, Cidlowski, John A., additional, Clemmons, David R., additional, Considine, Robert V., additional, Conti, Marco, additional, Copinschi, Georges, additional, Copps, Kyle D., additional, Cowley, Michael A., additional, Cuttler, Leona, additional, Dattani, Mehul T., additional, Davis, Stephen N., additional, De Felice, Mario, additional, De Groot, Leslie J., additional, de Kretser, David M., additional, DeFronzo, Ralph A., additional, Delli, Ahmed J., additional, Demay, Marie B., additional, Dennedy, Michael C., additional, Di Lauro, Roberto, additional, Dineen, Rosemary, additional, Ding, Su Ann, additional, Dinneen, Sean F., additional, Drucker, Daniel J., additional, Dumont, Jacques E., additional, Dungan, Kathleen M., additional, Dunn, Ian F., additional, Econs, Michael J., additional, Ehrmann, David A., additional, Eisenhofer, Graeme, additional, Ergun-Longmire, Berrin, additional, Eugster, Erica A., additional, Farooqi, Sadaf I., additional, Fassnacht, Martin, additional, Fauser, Bart C.J.M., additional, Fenzi, Gianfranco, additional, Ferrannini, Ele, additional, Findlay, David M., additional, Finlayson, Courtney Anne, additional, Fisher, Delbert A., additional, Francis, Isaac R., additional, Freeman, Mason W., additional, Frohman, Lawrence A., additional, Frydenberg, Mark, additional, Fuller, Peter J., additional, Gaglia, Jason L., additional, Galizia, Gianluigi, additional, Gardella, Thomas J., additional, Garvey, Katharine C., additional, Genant, Harry K., additional, German, Michael S., additional, Gevers, Evelien F., additional, Giraldi, Francesca Pecori, additional, Giudice, Linda C., additional, Giustina, Andrea, additional, Glasier, Anna, additional, Glorieux, Francis H., additional, Goldfine, Allison B., additional, Gooren, Louis J., additional, Gordon, David F., additional, Gregerson, Karen A., additional, Grogan, Raymon H., additional, Gross, Milton D., additional, Grossman, Ashley B., additional, Gruber, Matthias, additional, Guimarães, Valeria C., additional, Gurnell, Mark, additional, Haddad, Nadine G., additional, Haisenleder, Daniel J., additional, Handelsman, David J., additional, Hanks, John B., additional, Hannon, Mark J., additional, Harno, Erika, additional, Hebrok, Matthias, additional, Hedger, Mark P., additional, Hegedüs, Laszlo, additional, Heindel, Jerrold J., additional, Hernandez, Arturo, additional, Herndon, Maria K., additional, Ho, Ken K.Y., additional, Horseman, Nelson D., additional, Hughes, Ieuan A., additional, Hupfeld, Christopher J., additional, Hussain, Hero K., additional, Iodice, Valeria, additional, James, Benjamin C., additional, Jameson, J. Larry, additional, Jones, Glenville, additional, Josso, Nathalie, additional, Jüppner, Harald, additional, Juszczak, Agata, additional, Kalish, Jeffrey, additional, Kaplan, Edwin L., additional, Karavitaki, Niki, additional, Karczewska-Kupczewska, Monika, additional, Khattab, Ahmed, additional, Klein, David C., additional, Klein, Ronald, additional, Kleinau, Gunnar, additional, Koontz, Michaela, additional, Kopchick, John J., additional, Kopp, Peter, additional, Kowalska, Irina, additional, Krane, Stephen M., additional, Krohn, Knut, additional, Kronenberg, Henry M., additional, Lamos, Elizabeth M., additional, Lania, Andrea, additional, Lau, Sue Lynn, additional, Laws, Edward R., additional, Lazarus, John H., additional, Learoyd, Diana L., additional, Lebovitz, Harold E., additional, Lenmark, Åke, additional, List, Edward O., additional, Loveland, Kate, additional, Low, David A., additional, Macchia, Paolo E., additional, Maclaren, Noel K., additional, Madeiros-Neto, Geraldo, additional, Maenhaut, Carine, additional, Maes, Christa, additional, Main, Katharina M., additional, Malchoff, Carl D., additional, Malchoff, Diana M., additional, Malik, Rayaz A., additional, Mandel, Susan J., additional, Mantzoros, Christos S., additional, Maratos-Flier, Eleftheria, additional, Marino, Michele, additional, Marshall, John C., additional, Martin, T. John, additional, Martin, Thomas F.J., additional, Mathias, Christopher J., additional, McGee, Elizabeth A., additional, McKenzie, Travis, additional, McLachlan, Robert I., additional, Meier, Juris J., additional, Melmed, Shlomo, additional, Metzger, Boyd E., additional, Meyer-Bahlburg, Heino F.L., additional, Millar, Robert P., additional, Miller, Walter L., additional, Misra, Madhusmita, additional, Molitch, Mark E., additional, Moravek, Molly B., additional, Morris, Damian G., additional, Nagar, Sapna, additional, Nakamoto, Jon, additional, New, Maria I., additional, Nieman, Lynnette K., additional, Nilson, John H., additional, Ntali, Georgia, additional, O’Bryan, Moira, additional, O’Rahilly, Stephen, additional, Öberg, Kjell, additional, Olefsky, Jerrold M., additional, Olson, Matthew T., additional, Pacak, Karel, additional, Pacini, Furio, additional, Padia, Shetal H., additional, Paschke, Ralf, additional, Pasquel, Francisco J., additional, Perry, Katherine Wesseling, additional, Persani, Luca, additional, Philipson, Louis H., additional, Pina, Christian, additional, Pomposelli, Frank B., additional, Potts, John T., additional, Quigley, Charmian A., additional, Quinkler, Marcus O., additional, Quirk, Christine Campion, additional, Rajpert-De Meyts, Ewa, additional, Ravussin, Eric, additional, Ray, David W., additional, Refetoff, Samuel, additional, Retnakaran, Ravi, additional, Rey, Rodolfo A., additional, Rhodes, Christopher J., additional, Ridgway, E. Chester, additional, Risbridger, Gail P., additional, Rizza, Robert A., additional, Robinson, Bruce G., additional, Roger, Pierre P., additional, Rosenfeld, Michael G., additional, Rosenfield, Robert L., additional, Rossing, Peter, additional, Rubin, Robert T., additional, Rubio, Ileana G.S., additional, Ruderman, Neil B., additional, Russo, Jose, additional, Russo, Irma H., additional, Salusky, Isidro B., additional, Santoro, Nanette, additional, Scully, Kathleen M., additional, Sexton, Patrick M., additional, Shulman, Gerald I., additional, Silva, Paolo S., additional, Silverberg, Shonni J., additional, Singer, Frederick R., additional, Skakkebaek, Niels E., additional, Skaznik-Wikiel, Malgorzata E., additional, Skowronska-Krawczyk, Dorota, additional, Smith, Carolyn L., additional, Smith, Philip W., additional, Smith, Roger, additional, Smith, Steven R., additional, Snyder, Peter J., additional, St. Germain, Donald L., additional, St-Arnaud, René, additional, Steiner, Donald F., additional, Stewart, Paul M., additional, Strączkowski, Marek, additional, Strauss, Jerome F., additional, Styne, Dennis M., additional, Swan, Karena L., additional, Swerdloff, Ronald S., additional, Tacon, Lyndal J., additional, Tello, Javier A., additional, Thakker, Rajesh V., additional, Thompson, Christopher J., additional, Timmers, Henri J.L.M., additional, Toppari, Jorma, additional, Traub, Michael L., additional, Tsoukas, Michael A., additional, Udelsman, Robert, additional, Umpierrez, Guillermo E., additional, Van den Berghe, Greet, additional, Vassart, Gilbert, additional, Vernon, Ashley H., additional, Vilain, Eric, additional, Visser, Theo J., additional, Vitti, Paolo, additional, Walford, Geoffrey A., additional, Wang, Christina, additional, Weetman, Anthony P., additional, Weigel, Nancy L., additional, Weir, Gordon C., additional, Weiss, Roy E., additional, White, Anne, additional, White, Kenneth E., additional, White, Morris F., additional, Whyte, Michael P., additional, Wiersinga, Wilmar M., additional, Willenberg, Holger S., additional, Wolfsdorf, Joseph I., additional, Wondisford, Fredric E., additional, Wong, Ka Kit, additional, Wysolmerski, John J., additional, Yau, Mabel, additional, Young, Morag J., additional, Younk, Lisa M., additional, Yu, Run, additional, Yuen, Tony, additional, Zeiger, Martha A., additional, Zinman, Bernard, additional, and Zoeller, R. Thomas, additional

Published
2016
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30. Complications of Diabetes Mellitus

Author

Brownlee, Michael, primary, Aiello, Lloyd P., additional, Cooper, Mark E., additional, Vinik, Aaron I., additional, Plutzky, Jorge, additional, and Boulton, Andrew J.M., additional

Published
2016
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32. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers.

Author

McDermott, Katherine, Fang, Michael, Boulton, Andrew J.M., Selvin, Elizabeth, and Hicks, Caitlin W.

Subjects
FOOT diseases, DIABETIC foot, PEOPLE with diabetes, DIABETES complications, FOOT ulcers, ETIOLOGY of diseases
Abstract

Diabetic foot ulcers (DFU) are a major source of preventable morbidity in adults with diabetes. Consequences of foot ulcers include decline in functional status, infection, hospitalization, lower-extremity amputation, and death. The lifetime risk of foot ulcer is 19% to 34%, and this number is rising with increased longevity and medical complexity of people with diabetes. Morbidity following incident ulceration is high, with recurrence rates of 65% at 3–5 years, lifetime lower-extremity amputation incidence of 20%, and 5-year mortality of 50–70%. New data suggest overall amputation incidence has increased by as much as 50% in some regions over the past several years after a long period of decline, especially in young and racial and ethnic minority populations. DFU are a common and highly morbid complication of diabetes. The pathway to ulceration, involving loss of sensation, ischemia, and minor trauma, is well established. Amputation and mortality after DFU represent late-stage complications and are strongly linked to poor diabetes management. Current efforts to improve care of patients with DFU have not resulted in consistently lower amputation rates, with evidence of widening disparities and implications for equity in diabetes care. Prevention and early detection of DFU through guideline-directed multidisciplinary care is critical to decrease the morbidity and disparities associated with DFU. This review describes the epidemiology, presentation, and sequelae of DFU, summarizes current evidence-based recommendations for screening and prevention, and highlights disparities in care and outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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33. Contributors

Author

Abbasi, Muhammad Zafar Iqbal, Abdul Rehman, Rabia, Ahmedani, Muhammad Yakoob, Albache, Nizar, Ali-Eltom, Mohamed, Askari, Saima, Azad Khan, Abul Kalam, Basit, Abdul, Basit, Khalid Abdul, Bhowmik, Bishwajit, Boulton, Andrew J.M., Buyukbese, Mehmet Akif, Eichorst, Barbara, Eigenmann, Cecile Alice, El-Sayed, Adel Abdel Aziz, Faheem, Osman, Farooqi, Meena Iqbal, Fawwad, Asher, Ghafoor, Erum, Hakeem, Rubina, Hinchliffe, Robert J., Hussain, Akhtar, Hydrie, Muhammad Zafar Iqbal, Jabbar, Abdul, Jamil, Bushra, Jenkins, Alicia Josephine, Khan, Muhammad Farhatullah, Khan, Shair Zaman, Khan, Uzma Zubair, Khan, Yasmin, Little, Erin Elizabeth, Majumdar, Kalpita, Malik, Rayaz Ahmed, Mehar, Salma, Memon, Riaz Ahmed, Miyan, Zahid, Mohan, Viswanathan, Moyeen, Fauzia, Niazi, Asima Khan, Ogle, Graham David, Pedrosa, Hermelinda Cordeiro, Rashid, Thamina, Riaz, Musarrat, Saif-Ul Haque, M., Salman, Ahmed, Schwartz, Peter Egbert Hermann, Senneville, Eric, Shafique, Kashif, Sheikh, Aisha, Sheikh, Muhammad Adil, Shiraz, Mahwish, Simmons, David, Soomro, Marium Habib, Sultan, Sharjeel, Syed, Furrukh Omair, Tayeb, Khaled Abdullah, Unnikrishnan, Ambika Gopalakrishnan, Venkatesan, Radha, Wild, Sarah, Yousuf, Sanobia, and Zafar, Awn Bin

Published
2024
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42. Statement of Principle

Author

Seaquist, Elizabeth R., Boulton, Andrew J.M., Harrell, R. Mack, Grunberger, George, and Santen, Richard J.

Published
2014

44. Corneal Confocal Microscopy Predicts the Development of Diabetic Neuropathy: A Longitudinal Diagnostic Multinational Consortium Study

Author

Perkins, Bruce A., primary, Lovblom, Leif Erik, primary, Lewis, Evan J.H., primary, Bril, Vera, primary, Ferdousi, Maryam, primary, Orszag, Andrej, primary, Edwards, Katie, primary, Pritchard, Nicola, primary, Russell, Anthony, primary, Dehghani, Cirous, primary, Pacaud, Danièle, primary, Romanchuk, Kenneth, primary, Mah, Jean K., primary, Jeziorska, Maria, primary, Marshall, Andrew, primary, Shtein, Roni M., primary, Pop-Busui, Rodica, primary, Lentz, Stephen I., primary, Tavakoli, Mitra, primary, Boulton, Andrew J.M., primary, Efron, Nathan, primary, and Malik, Rayaz A., primary

Published
2021
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45. Corneal Confocal Microscopy Predicts the Development of Diabetic Neuropathy : A Longitudinal Diagnostic Multinational Consortium Study

Author

Perkins, Bruce A., Lovblom, Leif Erik, Lewis, Evan J.H., Bril, Vera, Ferdousi, Maryam, Orszag, Andrej, Edwards, Katie, Pritchard, Nicola, Russell, Anthony, Dehghani, Cirous, Pacaud, Danièle, Romanchuk, Kenneth, Mah, Jean K., Jeziorska, Maria, Marshall, Andrew, Shtein, Roni M., Pop-Busui, Rodica, Lentz, Stephen I., Tavakoli, Mitra, Boulton, Andrew J.M., Efron, Nathan, Malik, Rayaz A., Perkins, Bruce A., Lovblom, Leif Erik, Lewis, Evan J.H., Bril, Vera, Ferdousi, Maryam, Orszag, Andrej, Edwards, Katie, Pritchard, Nicola, Russell, Anthony, Dehghani, Cirous, Pacaud, Danièle, Romanchuk, Kenneth, Mah, Jean K., Jeziorska, Maria, Marshall, Andrew, Shtein, Roni M., Pop-Busui, Rodica, Lentz, Stephen I., Tavakoli, Mitra, Boulton, Andrew J.M., Efron, Nathan, and Malik, Rayaz A.

Abstract

OBJECTIVE: Corneal nerve fiber length (CNFL) has been shown in research studies to identify diabetic peripheral neuropathy (DPN). In this longitudinal diagnostic study, we assessed the ability of CNFL to predict the development of DPN. RESEARCH DESIGN AND METHODS: From a multinational cohort of 998 participants with type 1 and type 2 diabetes, we studied the subset of 261 participants who were free of DPN at baseline and completed at least 4 years of follow-up for incident DPN. The predictive validity of CNFL for the development of DPN was determined using time-dependent receiver operating characteristic (ROC) curves. RESULTS: A total of 203 participants had type 1 and 58 had type 2 diabetes. Mean follow-up time was 5.8 years (interquartile range 4.2-7.0). New-onset DPN occurred in 60 participants (23%; 4.29 events per 100 person-years). Participants who developed DPN were older and had a higher prevalence of type 2 diabetes, higher BMI, and longer duration of diabetes. The baseline electrophysiology and corneal confocal microscopy parameters were in the normal range but were all significantly lower in participants who developed DPN. The time-dependent area under the ROC curve for CNFL ranged between 0.61 and 0.69 for years 1-5 and was 0.80 at year 6. The optimal diagnostic threshold for a baseline CNFL of 14.1 mm/mm2 was associated with 67% sensitivity, 71% specificity, and a hazard ratio of 2.95 (95% CI 1.70-5.11; P < 0.001) for new-onset DPN. CONCLUSIONS: CNFL showed good predictive validity for identifying patients at higher risk of developing DPN ∼6 years in the future.

Published
2021

46. Protection from neuropathy in extreme duration type 1 diabetes

Author

Azmi, Shazli, Ferdousi, Maryam, Kalteniece, Alise, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Sankar, Adhithya, Boulton, Andrew J.M., Soran, Handrean, Efron, Nathan, Malik, Rayaz A., Azmi, Shazli, Ferdousi, Maryam, Kalteniece, Alise, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Sankar, Adhithya, Boulton, Andrew J.M., Soran, Handrean, Efron, Nathan, and Malik, Rayaz A.

Abstract

A proportion of individuals with type 1 diabetes mellitus for more than 50 years (medallists) may be protected from developing nephropathy, retinopathy and neuropathy. Detailed neuropathy phenotyping was undertaken in a cohort of 33 medallists aged 63.7 ± 1.4 years with diabetes for 58.5 ± 0.8 years and HbA1c of 65.9 ± 2.1 mmol/mmol. Medallists had a significantly higher HbA1c (P <.001), lower estimated glomerular filtration rate (eGFR) (P =.005) and higher albumin creatinine excretion ratio (ACR) (P =.01), but a lower total cholesterol (P <.001), triacylglycerols (P =.001), low density lipoprotein-cholesterol (P <.001) and higher high density lipoprotein-cholesterol (P =.03), compared to controls. Twenty-four percent of participants were identified as “escapers” without confirmed diabetic neuropathy. They had a lower neuropathy symptom profile (P =.002), vibration perception threshold (P =.02), warm threshold (P =.05), higher peroneal amplitude (P =.005), nerve conduction velocity (P =.03), heart rate variability (P =.001), corneal nerve fibre density (P = 0.001), branch density (P <.001) and length (P =.001), compared to medallists with diabetic neuropathy. Escapers had a shorter duration of diabetes (P =.006), lower alcohol consumption (P =.04), lower total cholesterol (P =.04) and LDL (P =.02), higher eGFR (P =.001) and lower ACR (P <.001). Patients with extreme duration diabetes without diabetic neuropathy have a comparable HbA1c, blood pressure and body mass index, but a more favourable lipid profile and consume less alcohol compared to those with diabetic neuropathy.

Published
2021

47. Greater small nerve fibre damage in the skin and cornea of type 1 diabetic patients with painful compared to painless diabetic neuropathy

Author

Ferdousi, Maryam, Azmi, Shazli, Kalteniece, Alise, Petropoulos, Ioannis Nikolaos, Ponirakis, Georgios, Asghar, Omar, Alam, Uazman, Marshall, Andrew, Boulton, Andrew J.M., Efron, Nathan, Soran, Handrean, Jeziorska, Maria, Malik, Rayaz A., Ferdousi, Maryam, Azmi, Shazli, Kalteniece, Alise, Petropoulos, Ioannis Nikolaos, Ponirakis, Georgios, Asghar, Omar, Alam, Uazman, Marshall, Andrew, Boulton, Andrew J.M., Efron, Nathan, Soran, Handrean, Jeziorska, Maria, and Malik, Rayaz A.

Abstract

Background and aim: Damage to small nociceptive fibres may contribute to painful diabetic neuropathy. We aimed to compare large and small nerve fibre measurements together with skin biopsy and corneal confocal microscopy in patients with type 1 diabetes and painful or painless diabetic neuropathy. Methods: We have assessed the McGill pain questionnaire, neuropathy disability score, vibration perception threshold, warm and cold sensation thresholds, electrophysiology, corneal confocal microscopy and skin biopsy in participants with type 1 diabetes and painful (n = 41) or painless (n = 50) diabetic neuropathy and control subjects (n = 50). Results: The duration of diabetes, body mass index, glycated haemoglobin (HbA1c), blood pressure and lipid profile did not differ between subjects with painful and painless neuropathy. Neuropathy disability score and vibration perception threshold were higher and sural nerve conduction velocity was lower, but sural nerve amplitude, peroneal nerve amplitude and conduction velocity and cold and warm sensation thresholds did not differ between patients with painful compared to painless diabetic neuropathy. However, intraepidermal nerve fibre density, corneal nerve fibre density, corneal nerve branch density and corneal nerve fibre length were significantly lower in subjects with painful compared to painless diabetic neuropathy. Conclusions: There is evidence of more severe neuropathy, particularly small fibre damage in the skin and cornea, of patients with painful compared to painless diabetic neuropathy.

Published
2021

48. Diagnosis of Neuropathy and Risk Factors for Corneal Nerve Loss in Type 1 and Type 2 Diabetes: A Corneal Confocal Microscopy Study

Author

Ferdousi, Maryam, Kalteniece, Alise, Azmi, Shazli, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Fullwood, Catherine, Jeziorska, Maria, Abbott, Caroline, Lauria, Giuseppe, Faber, Catharina G., Soran, Handrean, Efron, Nathan, Boulton, Andrew J.M., Malik, Rayaz A., Ferdousi, Maryam, Kalteniece, Alise, Azmi, Shazli, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Fullwood, Catherine, Jeziorska, Maria, Abbott, Caroline, Lauria, Giuseppe, Faber, Catharina G., Soran, Handrean, Efron, Nathan, Boulton, Andrew J.M., and Malik, Rayaz A.

Abstract

OBJECTIVE To assess the diagnostic utility of corneal confocal microscopy (CCM) for diabetic peripheral neuropathy (DPN) and the risk factors for corneal nerve loss. RESEARCH DESIGN AND METHODS A total of 490 participants, including 72 healthy control subjects, 149 with type 1 diabetes, and 269 with type 2 diabetes, underwent detailed assessment of peripheral neuropathy and CCM in relation to risk factors. RESULTS Corneal nerve fiber density (CNFD) (P < 0.0001 and P < 0.0001), corneal nerve fiber branch density (CNBD) (P < 0.0001 and P < 0.0001), and corneal nerve fiber length (CNFL) (P < 0.0001 and P = 0.02) were significantly lower in patients with type 1 and type 2 diabetes compared with control subjects. CNFD (P < 0.0001), CNBD (P < 0.0001), and CNFL (P < 0.0001) were lower in type 1 diabetes compared with type 2 diabetes. Receiver operating characteristic curve analysis for the diagnosis of DPN demonstrated a good area under the curve for CNFD of 0.81, CNBD of 0.74, and CNFL of 0.73. Multivariable regression analysis showed a significant association among reduced CNFL with age (b =-0.27, P = 0.007), HbA1c (b=-1.1; P = 0.01), and weight (b=-0.14; P = 0.03) in patients with type 2 diabetes and with duration of diabetes (b=-0.13; P = 0.02), LDL cholesterol (b=1.8, P = 0.04), and triglycerides (b =-2.87; P = 0.009) in patients with type 1 diabetes. CONCLUSIONS CCM identifies more severe corneal nerve loss in patients with type 1 diabetes compared with type 2 diabetes and shows good diagnostic accuracy for DPN. Furthermore, the risk factors for a reduction in corneal nerve fiber length differ between type 1 and type 2 diabetes.

Published
2021

49. Small nerve fiber damage and langerhans cells in type 1 and type 2 diabetes and LADA measured by corneal confocal microscopy

Author

D'Onofrio, Luca, Kalteniece, Alise, Ferdousi, Maryam, Azmi, Shazli, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Boulton, Andrew J.M., Efron, Nathan, Buzzetti, Raffaella, Soran, Handrean, Malik, Rayaz A., D'Onofrio, Luca, Kalteniece, Alise, Ferdousi, Maryam, Azmi, Shazli, Petropoulos, Ioannis N., Ponirakis, Georgios, Alam, Uazman, Asghar, Omar, Marshall, Andrew, Boulton, Andrew J.M., Efron, Nathan, Buzzetti, Raffaella, Soran, Handrean, and Malik, Rayaz A.

Abstract

PURPOSE. Increased corneal and epidermal Langerhans cells (LCs) have been reported in patients with diabetic neuropathy. The aim of this study was to quantify the density of LCs in relation to corneal nerve morphology and the presence of diabetic neuropathy and to determine if this differed in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and latent autoimmune diabetes of adults (LADA). METHODS. Patients with T1DM (n = 25), T2DM (n = 36), or LADA (n = 23) and control subjects (n = 23) underwent detailed assessment of peripheral neuropathy and corneal confocal microscopy. Corneal nerve fiber density (CNFD), branch density (CNBD), length (CNFL) and total, immature and mature LC densities were quantified. RESULTS. Lower CNFD (P < 0.001), CNBD (P < 0.0001), and CNFL (P < 0.0001) and higher LC density (P = 0.03) were detected in patients with T1DM, T2DM, and LADA compared to controls. CNBD was inversely correlated with mature (r = -0.5; P = 0.008), immature (r = -0.4; P = 0.02) and total (r = -0.5; P = 0.01) LC density, and CNFL was inversely correlated with immature LC density (r = -0.4; P = 0.03) in patients with T1DM but not in patients with T2DM and LADA. CONCLUSIONS. This study shows significant corneal nerve loss and an increase in LC density in patients with T1DM, T2DM, and LADA. Furthermore, increased LC density correlated with corneal nerve loss in patients with T1DM.

Published
2021

50. Vitamin D deficiency is associated with painful diabetic neuropathy

Author

Alam, Uazman, Petropoulos, Ioannis N., Ponirakis, Georgios, Ferdousi, Maryam, Asghar, Omar, Jeziorska, Maria, Marshall, Andrew, Boulton, Andrew J.M., Efron, Nathan, Malik, Rayaz A., Alam, Uazman, Petropoulos, Ioannis N., Ponirakis, Georgios, Ferdousi, Maryam, Asghar, Omar, Jeziorska, Maria, Marshall, Andrew, Boulton, Andrew J.M., Efron, Nathan, and Malik, Rayaz A.

Abstract

Background: The aetiology of painful diabetic neuropathy is unclear. We have evaluated vitamin D levels in diabetic patients with and without painful neuropathy. Methods: Forty-three patients with type 1 diabetes and painless (DPN) (n = 20) or painful (PDN) (n = 23) neuropathy and 14 non-diabetic healthy control subjects (C) underwent assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal confocal microscopy (CCM) and measurement of serum 25(OH)D. Results: There were no significant differences for age, BMI, HbA1c, lipids, neurological deficits, QST, electrophysiology, intra-epidermal nerve fibre density (IENFD) and corneal nerve morphology between patients with DPN and PDN. Both positive (hyperalgesia and allodynia) and negative symptoms (paraesthesia and numbness) of diabetic neuropathy were greater in PDN compared with DPN (P =.009 and P =.02, respectively). Serum 25(OH)D levels were significantly lower in PDN (24.0 ± 14.1 ng/mL) compared with DPN (34.6 ± 15.0 ng/mL, P =.01) and controls (34.1 ± 8.6 ng/mL, P =.03). The odds ratio in favour of painful diabetic neuropathy was 9.8 [P =.003 (95% CI, 2.2–76.4)] for vitamin D deficiency (<20 ng/mL) and 4.4 [P =.03 (95% CI, 1.1-19.8)] for vitamin D insufficiency (<30 ng/mL). Conclusions: This study suggests that vitamin D deficiency and insufficiency are associated with painful diabetic neuropathy.

Published
2021

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