Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study

Eline E B De Clerck; Jan S A G Schouten; Tos T J M Berendschot; Renée S Koolschijn; Rudy M M A Nuijts; Miranda T Schram; Nicolaas C Schaper; Ronald M A Henry; Pieter C Dagnelie; Alfredo Ruggeri; Pedro Guimarães; Coen D A Stehouwer; Carroll A B Webers

doi:10.1111/aos.14359

Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study

Eline E B De Clerck^*, Jan S A G Schouten, Tos T J M Berendschot, Renée S Koolschijn, Rudy M M A Nuijts, Miranda T Schram, Nicolaas C Schaper, Ronald M A Henry, Pieter C Dagnelie, Alfredo Ruggeri, Pedro Guimarães, Coen D A Stehouwer, Carroll A B Webers

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

7 Citations (Web of Science)

Abstract

PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).

METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.

RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).

CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

Original language	English
Pages (from-to)	485-491
Number of pages	7
Journal	Acta Ophthalmologica
Volume	98
Issue number	5
Early online date	3 Feb 2020
DOIs	https://doi.org/10.1111/aos.14359
Publication status	Published - Aug 2020

Keywords

COMPLICATIONS
CONFOCAL MICROSCOPY
DENSITY
GLUCOSE-TOLERANCE
INNERVATION
NEUROPATHY
OPHTHALMIC MARKERS
PLEXUS
RETINOPATHY
SENSITIVITY
corneal confocal microscopy
corneal nerves
prediabetes
type 2 diabetes

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10.1111/aos.14359Licence: CC BY

Cite this

De Clerck, E. E. B., Schouten, J. S. A. G., Berendschot, T. T. J. M., Koolschijn, R. S., Nuijts, R. M. M. A., Schram, M. T., Schaper, N. C., Henry, R. M. A., Dagnelie, P. C., Ruggeri, A., Guimarães, P., Stehouwer, C. D. A., & Webers, C. A. B. (2020). Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study. Acta Ophthalmologica, 98(5), 485-491. https://doi.org/10.1111/aos.14359

@article{816e814bde04499d98e676cd85ab4f62,

title = "Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study",

abstract = "PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.",

keywords = "COMPLICATIONS, CONFOCAL MICROSCOPY, DENSITY, GLUCOSE-TOLERANCE, INNERVATION, NEUROPATHY, OPHTHALMIC MARKERS, PLEXUS, RETINOPATHY, SENSITIVITY, corneal confocal microscopy, corneal nerves, prediabetes, type 2 diabetes",

author = "{De Clerck}, {Eline E B} and Schouten, {Jan S A G} and Berendschot, {Tos T J M} and Koolschijn, {Ren{\'e}e S} and Nuijts, {Rudy M M A} and Schram, {Miranda T} and Schaper, {Nicolaas C} and Henry, {Ronald M A} and Dagnelie, {Pieter C} and Alfredo Ruggeri and Pedro Guimar{\~a}es and Stehouwer, {Coen D A} and Webers, {Carroll A B}",

note = "{\textcopyright} 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.",

year = "2020",

month = aug,

doi = "10.1111/aos.14359",

language = "English",

volume = "98",

pages = "485--491",

journal = "Acta Ophthalmologica",

issn = "1755-375X",

publisher = "Wiley",

number = "5",

}

De Clerck, EEB, Schouten, JSAG, Berendschot, TTJM, Koolschijn, RS, Nuijts, RMMA , Schram, MT , Schaper, NC , Henry, RMA , Dagnelie, PC, Ruggeri, A, Guimarães, P, Stehouwer, CDA & Webers, CAB 2020, 'Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study', Acta Ophthalmologica, vol. 98, no. 5, pp. 485-491. https://doi.org/10.1111/aos.14359

TY - JOUR

T1 - Reduced corneal nerve fibre length in prediabetes and type 2 diabetes

T2 - The Maastricht Study

AU - De Clerck, Eline E B

AU - Schouten, Jan S A G

AU - Berendschot, Tos T J M

AU - Koolschijn, Renée S

AU - Nuijts, Rudy M M A

AU - Schram, Miranda T

AU - Schaper, Nicolaas C

AU - Henry, Ronald M A

AU - Dagnelie, Pieter C

AU - Ruggeri, Alfredo

AU - Guimarães, Pedro

AU - Stehouwer, Coen D A

AU - Webers, Carroll A B

PY - 2020/8

Y1 - 2020/8

N2 - PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

AB - PURPOSE: In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM).METHODS: Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex.RESULTS: In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04).CONCLUSIONS: A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.

KW - COMPLICATIONS

KW - CONFOCAL MICROSCOPY

KW - DENSITY

KW - GLUCOSE-TOLERANCE

KW - INNERVATION

KW - NEUROPATHY

KW - OPHTHALMIC MARKERS

KW - PLEXUS

KW - RETINOPATHY

KW - SENSITIVITY

KW - corneal confocal microscopy

KW - corneal nerves

KW - prediabetes

KW - type 2 diabetes

U2 - 10.1111/aos.14359

DO - 10.1111/aos.14359

M3 - Article

C2 - 32017403

VL - 98

SP - 485

EP - 491

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

SN - 1755-375X

IS - 5

ER -