Corneal Confocal Microscopy to Detect Diabetic Neuropathy in Children

Corneal Confocal Microscopy to Detect Diabetic Neuropathy in Children

The overall aim of this study is to confirm the utility of corneal confocal microscopy (CCM) as a new technique to rapidly and non-invasively assess diabetic neuropathy (DN) in children. This study will be divided into two phases: Phase 1 will be a cross-sectional study of children with type 1 diabetes and normal controls, while phase 2 will be a longitudinal assessment of a subgroup of children with type 1 diabetes recruited during Phase 1.

In phase 1: To compare corneal nerve density (CND), length (CNL), and branching (CBD) by CCM between

1. children with type 1 diabetes for 5 years or more to children without diabetes;
2. children with type 1 diabetes with and without evidence of diabetic neuropathy;
3. to examine the relationship between CND, CNL & CBD and known risk factors of diabetic neuropathy

In phase 2:

1. to examine for changes in corneal nerve morphology two years after the initial CCM exam.
2. to describe the evolution of diabetic neuropathy based on clinical symptoms, neurological deficits, and other tests of nerve dysfunction.
3. to assess if changes in corneal nerve morphology correlate with changes in nerve conduction velocity and autonomic testing.
4. To examine the risk factors associated with progression of diabetic neuropathy in our pediatric population.

Inclusion Criteria:

• CASES: Children with Type 1 Diabetes 8 to 18 years old followed at the Alberta Children's Hospital Diabetes Clinic with a duration of diabetes of at least 5 years.
• CONTROLS: Healthy children aged 8 to 18 years.

Exclusion Criteria:

• Patients with known history of corneal abnormality, trauma, or surgery
• Any other cause of neuropathy
• Individuals with uncontrolled hypothyroidism
• Individuals with celiac disease
• Other serious chronic illnesses besides diabetes
• Inability to cooperate with testing
• Families unwilling to provide written informed consent