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. 2022 Oct 21:13:938659.
doi: 10.3389/fendo.2022.938659. eCollection 2022.

Optical coherence tomography of the retina combined with color Doppler ultrasound of the tibial nerve in the diagnosis of diabetic peripheral neuropathy

Weimiao Chen  1 , Xiaohong Wu  2 , Shilin Li  3 , Yan Zhang  4 , Yinqiong Huang  2 , Yong Zhuang  2 , Xuefeng Bai  2 , Xiaoyu Chen  2 , Xiahong Lin  5   6
Affiliations

Optical coherence tomography of the retina combined with color Doppler ultrasound of the tibial nerve in the diagnosis of diabetic peripheral neuropathy

Weimiao Chen et al. Front Endocrinol (Lausanne). .

Abstract

Objective: To investigate the value of the retinal nerve fiber layer (RNFL) thickness in the optic disc and the cross-sectional area (CSA) of lower limb nerves in the diagnosis of diabetic peripheral neuropathy (DPN) separately and in combination.

Methods: A total of 140 patients with type 2 diabetes were enrolled, including 51 patients with DPN (DPN group) and 89 patients without DPN (NDPN group). Clinical data and biochemical parameters were collected. Electromyography/evoked potential instrument was performed for nerve conduction study. Optical coherence tomography was performed to measure the RNFL thickness of the optic disc. Color Doppler ultrasound was performed to measure CSA of lower limb nerves.

Results: The RNFL thickness was lower and the CSA of the tibial nerve (TN) in the DPN group was larger than that in the NDPN group. The album/urine creatinine ratio, diabetic retinopathy, and CSA of TN at 3 cm were positively correlated with DPN. The RNFL thickness in the superior quadrant of the optic disc was negatively correlated with DPN. For RNFL thickness to diagnose DPN, the area under the curve (AUC) of the superior quadrant was the largest, which was 0.723 (95% confidence interval [CI]: 0.645-0.805), and the best cutoff value was 127.5 μm (70.5% sensitivity, 72.1% specificity). For CSA of TN to diagnose DPN, the AUC of the distance of 5 cm was the largest, which was 0.660 (95% CI: 0.575-0.739), and the best cutoff value was 13.50 mm2 (82.0% sensitivity, 41.6% specificity). For the combined index, the AUC was greater than that of the above two indicators, which was 0.755 (95% CI: 0.664-0.846), and the best cutoff value was 0.376 (64.3% sensitivity, 83.0% specificity).

Conclusions: Patients with DPN have a reduction of the RNFL thickness and an increase in the CSA of TN, and these two changes are related to DPN. The RNFL thickness of the optic disc and the CSA of TN can be used as diagnostic indicators of DPN, and the combination of the two indicators has a higher diagnostic value.

Keywords: color doppler ultrasound; diabetes mellitus; diagnosis; optical correlation tomography; peripheral neuropathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Measurement of the RNFL thickness of the optic disc. (A) Scanning image of the optic disc area. The green circle represents the scanning range. (B) Longitudinal section of the optic disc nerve fibers. The red line represents the internal limiting membrane; the blue line represents RNFL. (C) The thickness of RNFL in each quadrant of the optic disc. S, superior quadrant; N, nasal quadrant; I, inferior quadrant; T, temporal quadrant; G, overall average. (D) Pattern diagram of RNFL thickness. The abscissa indicates the quadrant, the ordinate indicates the thickness, the green line represents the normal value, and the black line represents the measured value. RNFL, retinal nerve fiber layer.
Figure 2
Figure 2
Color Doppler ultrasound image of the tibial nerve. The area circled by the dashed line is the CSA of the tibial nerve. CSA, cross-sectional area.
Figure 3
Figure 3
ROC curve of DPN diagnosed by RNFL thickness of the optic disc, the CSA of TN, and the combined index. (A) The ROC curve of DPN diagnosed by RNFL thickness of the optic disc. The AUC of the overall average was 0.675(95% CI: 0.587–0.755). The AUC of the superior quadrant was 0.723 (95% CI: 0.645–0.805). The AUC of the inferior quadrant was 0.686 (95% CI: 0.599–0.765). (B) The ROC curve of DPN diagnosed by CSA of TN. The AUC of the CSA of TN was 0.584 (95% CI: 0.497–0.667) at 1 cm, 0.617 (95% CI: 0.530–0.698) at 3 cm, and 0.660 (95% CI: 0.575–0.739) at 5 cm. (C) The ROC curve of DPN diagnosed by the combined index. The AUC of the combined index was 0.755 (95% CI: 0.664-0.846). AUC, area under the curve; ROC, receiver operator characteristic; DPN, diabetic peripheral neuropathy; CI, confidence interval; CSA, the cross-sectional area; TN, tibial nerve; RNFL, retinal nerve fiber layer. Combined index: the combined index of the CSA of TN at 3 cm and RNFL thickness in the superior quadrant. The calculation process is shown in Supplementary Materials and Formula S3 ( Supplemental Data ).
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References

    1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. . Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract (2019) 157:107843. doi: 10.1016/j.diabres.2019.107843 - DOI - PubMed
    1. Lu Y, Xing P, Cai X, Luo D, Li R, Lloyd C, et al. . Prevalence and risk factors for diabetic peripheral neuropathy in type 2 diabetic patients from 14 countries: Estimates of the interpret-dd study. Front Public Health (2020) 8:534372. doi: 10.3389/fpubh.2020.534372 - DOI - PMC - PubMed
    1. Mizokami-Stout KR, Li Z, Foster NC, Shah V, Aleppo G, McGill JB, et al. . The contemporary prevalence of diabetic neuropathy in type 1 diabetes: Findings from the T1d exchange. Diabetes Care (2020) 43(4):806–12. doi: 10.2337/dc19-1583 - DOI - PMC - PubMed
    1. Zhang Y, Zhang M, Lu D-b. Analysis of the causes and characteristic of amputation in diabetic patients with peripheral neuropathy. Med J West China (2011) 7:1241–3. doi: 10.3969/.issn.1672-3511.2011.07.014 - DOI
    1. Gylfadottir SS, Christensen DH, Nicolaisen SK, Andersen H, Callaghan BC, Itani M, et al. . Diabetic polyneuropathy and pain, prevalence, and patient characteristics: A cross-sectional questionnaire study of 5,514 patients with recently diagnosed type 2 diabetes. Pain (2020) 161(3):574. doi: 10.1097/j.pain.0000000000001744 - DOI - PMC - PubMed

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