Diabetic peripheral neuropathy can be detected using non-invasive confocal microscopy of the cornea (IVCM) and such abnormalities may precede the development of clinical neuropathy. The current study aimed to assess any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery. People with known type 2 diabetes for at least five years and listed for bariatric surgery were recruited. Participants were assessed before, and 12, 26, and 52 weeks following bariatric surgery. IVCM and corneal sensitivity measurements were performed. A modified total neuropathy score (mTNS) was obtained from neuropathy questionnaire, clinical assessment and biothesiometry. Twenty-nine participants (M:F, 11:18) with mean BMI of 44.7 ± 6.4 kg/m, and 11 ± 7.6 years duration of diabetes, were assessed. Corneal sub-basal nerve fibre length (CNFL), displayed an increase from a baseline mean of 12.20 ± 1.00 to 17.48 ± 0.92 mm/mm at 52 weeks (p < 0.0001). Corneal sensitivity threshold displayed a decrease over time, thus corneal sensitivity improved, falling from a mean of 1.11 ±0 .15 to 0.62 ± 0.11 (mBAR) (p < 0.0001). Clinical neuropathy scores demonstrated significant improvements from baseline, displaying a decrease in average mTNS score from 3.29 ± 0.68 to 0.76 ± 0.30 (p < 0.0001). A significant inverse relationship was shown between CNFL and sensitivity (β coefficient = −0.047, p < 0.001), and CNFL and mTNS (β coefficient = −0.178, p < 0.001). Bariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with improvement in corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fibre neuropathy.

中文翻译：

---

糖尿病患者减肥手术后角膜和周围神经病变的缓解


可以使用非侵入性角膜共聚焦显微镜 (IVCM) 检测糖尿病周围神经病变，并且此类异常可能先于临床神经病变的发展。目前的研究旨在评估接受减肥手术的 2 型糖尿病患者的角膜和周围神经病变的进展或缓解情况。招募患有 2 型糖尿病至少五年并列入减肥手术名单的人。参与者在减肥手术前以及减肥手术后 12、26 和 52 周进行评估。进行 IVCM 和角膜敏感性测量。改良的总神经病变评分（mTNS）是通过神经病变问卷、临床评估和生物电测法获得的。对 29 名平均 BMI 为 44.7 ± 6.4 kg/m、糖尿病病程为 11 ± 7.6 年的参与者（男：女，11:18）进行了评估。 52 周时，角膜基底神经纤维长度 (CNFL) 从基线平均值 12.20 ± 1.00 增加到 17.48 ± 0.92 mm/mm (p < 0.0001)。角膜敏感性阈值随着时间的推移而降低，因此角膜敏感性提高，从平均值 1.11 ±0 .15 降至 0.62 ± 0.11 (mBAR) (p < 0.0001)。临床神经病变评分较基线有显着改善，平均 mTNS 评分从 3.29 ± 0.68 下降至 0.76 ± 0.30 (p < 0.0001)。 CNFL 和敏感性（β 系数 = -0.047，p < 0.001）以及 CNFL 和 mTNS（β 系数 = -0.178，p < 0.001）之间显示出显着的负相关关系。减肥手术改善了糖尿病的代谢控制和体重减轻，同时改善了角膜神经微结构、角膜敏感性和神经性症状，表明小纤维和大纤维神经病变的逆转。