Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Aims/hypothesis

The aim of this study was to identify the contribution of small- and large-fibre neuropathy to erectile dysfunction in men with type 1 diabetes mellitus.

Methods

A total of 70 participants (29 without and 41 with erectile dysfunction) with type 1 diabetes and 34 age-matched control participants underwent a comprehensive assessment of large- and small-fibre neuropathy.

Results

The prevalence of erectile dysfunction in participants with type 1 diabetes was 58.6%. After adjusting for age, participants with type 1 diabetes and erectile dysfunction had a significantly higher score on the Neuropathy Symptom Profile (mean ± SEM 5.3 ± 0.9 vs 1.8 ± 1.2, p = 0.03), a higher vibration perception threshold (18.3 ± 1.9 vs 10.7 ± 2.4 V, p = 0.02), and a lower sural nerve amplitude (5.0 ± 1.1 vs 11.7 ± 1.5 mV, p = 0.002), peroneal nerve amplitude (2.1 ± 0.4 vs 4.7 ± 0.5 mV, p < 0.001) and peroneal nerve conduction velocity (34.8 ± 1.5 vs 41.9 ± 2.0 m/s, p = 0.01) compared with those without erectile dysfunction. There was also evidence of a marked small-fibre neuropathy with an impaired cold threshold (19.7 ± 1.4°C vs 27.3 ± 1.8°C, p = 0.003), warm threshold (42.9 ± 0.8°C vs 39.0 ± 0.9°C, p = 0.005) and heart rate variability (21.5 ± 3.1 vs 30.0 ± 3.7 beats/min, p = 0.001) and reduced intraepidermal nerve fibre density (2.8 ± 0.7 vs 5.9 ± 0.7/mm, p = 0.008), corneal nerve fibre density (12.6 ± 1.5 vs 23.9 ± 2.0/mm ², p < 0.001), corneal nerve branch density (12.7 ± 2.5 vs 31.6 ± 3.3/mm ², p < 0.001) and corneal nerve fibre length (8.3 ± 0.7 vs 14.5 ± 1.0 mm/mm ², p < 0.001) in participants with type 1 diabetes and erectile dysfunction. Erectile dysfunction correlated significantly with measures of both large- and small-fibre neuropathy.

Conclusions/interpretation

Small-fibre neuropathy is prominent in patients with type 1 diabetes, and is associated with erectile dysfunction and can be objectively quantified using corneal confocal microscopy. This may allow the identification of patients who are less likely to respond to conventional therapies such as phosphodiesterase type 5 inhibitors.

Related collections

Most cited references 30

Record: found
Abstract: found
Article: not found

Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study.

Thirugnanam Umapathi, Dan Ziegler, Lois E. H. Smith … (2010)

The diagnostic reliability of skin biopsy in small fiber neuropathy depends on the availability of normative reference values. We performed a multicenter study to assess the normative values of intraepidermal nerve fiber (IENF) density at distal leg stratified by age deciles. Eight skin biopsy laboratories from Europe, USA, and Asia submitted eligible data. Inclusion criteria of raw data were healthy subjects 18 years or older; known age and gender; 3-mm skin biopsy performed 10-cm above the lateral malleolus; bright-field immunohistochemistry protocol, and quantification of linear IENF density in three 50-µm sections according to published guidelines. Data on height and weight were recorded, and body mass index (BMI) was calculated in subjects with both available data. Normative IENF density reference values were calculated through quantile regression analysis; influence of height, weight, or BMI was determined by regression analyses. IENF densities from 550 participants (285 women, 265 men) were pooled. We found a significant age-dependent decrease of IENF density in both genders (women p < 0.001; men p = 0.002). Height, weight, or BMI did not influence the calculated 5th percentile IENF normative densities in both genders. Our study provides IENF density normative reference values at the distal leg to be used in clinical practice. © 2010 Peripheral Nerve Society.

0 comments Cited 141 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Corneal confocal microscopy: a non-invasive surrogate of nerve fibre damage and repair in diabetic patients.

N Efron, Wiley Abbott, P Kallinikos … (2003)

The accurate detection, characterization and quantification of human diabetic neuropathy are important to define at risk patients, anticipate deterioration, and assess new therapies. Corneal confocal microscopy is a reiterative, rapid, non-invasive in vivo clinical examination technique capable of imaging corneal nerve fibres. The aim of this study was to define the ability of this technique to quantify the extent of degeneration and regeneration of corneal nerve fibres in diabetic patients with increasing neuropathic severity. We scanned the cornea and collected images of Bowman's layer (containing a rich nerve plexus) from 18 diabetic patients and 18 age-matched control subjects. Corneal nerve fibre density (F(3)=9.6, p<0.0001), length (F(3)=23.8, p<0.0001), and branch density (F(3)=13.9, p<0.0001) were reduced in diabetic patients compared with control subjects, with a tendency for greater reduction in these measures with increasing severity of neuropathy. Corneal confocal microscopy is a rapid, non-invasive in vivo clinical examination technique which accurately defines the extent of corneal nerve damage and repair and acts as a surrogate measure of somatic neuropathy in diabetic patients. It could represent an advance to define the severity of neuropathy and expedite assessment of therapeutic efficacy in clinical trials of human diabetic neuropathy.

0 comments Cited 132 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Small Nerve Fiber Quantification in the Diagnosis of Diabetic Sensorimotor Polyneuropathy: Comparing Corneal Confocal Microscopy With Intraepidermal Nerve Fiber Density

XIN-JUN CHEN, Jim Graham, Mohammad Dabbah … (2015)

OBJECTIVE Quantitative assessment of small fiber damage is key to the early diagnosis and assessment of progression or regression of diabetic sensorimotor polyneuropathy (DSPN). Intraepidermal nerve fiber density (IENFD) is the current gold standard, but corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, has the potential to be a noninvasive and objective image biomarker for identifying small fiber damage. The purpose of this study was to determine the diagnostic performance of CCM and IENFD by using the current guidelines as the reference standard. RESEARCH DESIGN AND METHODS Eighty-nine subjects (26 control subjects and 63 patients with type 1 diabetes), with and without DSPN, underwent a detailed assessment of neuropathy, including CCM and skin biopsy. RESULTS Manual and automated corneal nerve fiber density (CNFD) (P < 0.0001), branch density (CNBD) (P < 0.0001) and length (CNFL) (P < 0.0001), and IENFD (P < 0.001) were significantly reduced in patients with diabetes with DSPN compared with control subjects. The area under the receiver operating characteristic curve for identifying DSPN was 0.82 for manual CNFD, 0.80 for automated CNFD, and 0.66 for IENFD, which did not differ significantly (P = 0.14). CONCLUSIONS This study shows comparable diagnostic efficiency between CCM and IENFD, providing further support for the clinical utility of CCM as a surrogate end point for DSPN.

0 comments Cited 101 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Rayaz A. Malik: rayaz.a.malik@manchester.ac.uk

Journal

Journal ID (nlm-ta): Diabetologia

Journal ID (iso-abbrev): Diabetologia

Title: Diabetologia

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0012-186X

ISSN (Electronic): 1432-0428

Publication date (Electronic): 29 March 2017

Publication date PMC-release: 29 March 2017

Publication date (Print): 2017

Volume: 60

Issue: 6

Pages: 1094-1101

Affiliations

[1 ]ISNI 0000 0004 0417 0074, GRID grid.462482.e, , Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, ; 46 Grafton Street, Core Technology Facility, Manchester, M13 9NT UK

[2 ]ISNI 0000 0004 1936 8470, GRID grid.10025.36, Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, , University of Liverpool, ; Liverpool, UK

[3 ]Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

[4 ]ISNI 0000 0004 0430 9101, GRID grid.411037.0, Department of Clinical Neurophysiology, , Central Manchester NHS Foundation Trust, ; Manchester, UK

[5 ]ISNI 0000 0004 1936 8024, GRID grid.8391.3, Department of Medicine, , The University of Exeter Medical School, ; Exeter, UK

[6 ]ISNI 0000000089150953, GRID grid.1024.7, Institute of Health and Biomedical Innovation, , Queensland University of Technology, ; Brisbane, QLD Australia

Article

Publisher ID: 4245

DOI: 10.1007/s00125-017-4245-z

PMC ID: 5423985

PubMed ID: 28357503

SO-VID: 2bc271cb-32a8-46f3-a8f8-b66742ec3324

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 29 October 2016

Date accepted : 7 February 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000901, Juvenile Diabetes Research Foundation International;

Award ID: 27-2008-362

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: corneal confocal microscopy,erectile dysfunction,neuropathy,small-fibre neuropathy,type 1 diabetes

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: corneal confocal microscopy, erectile dysfunction, neuropathy, small-fibre neuropathy, type 1 diabetes

Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study

Read this article at

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 30

Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study.

Corneal confocal microscopy: a non-invasive surrogate of nerve fibre damage and repair in diabetic patients.

Small Nerve Fiber Quantification in the Diagnosis of Diabetic Sensorimotor Polyneuropathy: Comparing Corneal Confocal Microscopy With Intraepidermal Nerve Fiber Density

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 351

Cited by 15

Most referenced authors 350