Abstract Details

Title Does the Prevailing Concept That Small-Fibre Dysfunction Precedes Large-Fibre Dysfunction in Diabetic Neuropathy Apply to Type 1 Diabetes?

Topic Peripheral Nerve

Presentation(s) P01 - (-)

Poster/Presentation
Number 122

Objective

Background BACKGROUND: The prevailing hypothesis that small nerve fibres are injured earlier than large myelinated fibres in DSP is primarily supported by the existence of decreased intraepithelial nerve fibre density (IEFND) despite normal nerve conduction studies (NCS) in patients at risk of type 2 diabetes. This prevailing hypothesis has not been shown to be generalizable to type 1 diabetes.

Design/Methods DESIGN/METHODS: Cross-sectional (contingency table) analysis of a cohort of type 1 diabetes patients (n=134) who were first dichotomized according to the presence or absence of DSP and then dichotomized according to normal and abnormal results of 4 small-fibre tests: cooling detection thresholds (CDT), laser doppler imaging of heat-evoked flare (LDI-FLARE), heart rate variability (HRV), and corneal confocal microscopy (CCM).

Results RESULTS: In diabetes subjects, the proportions of normal small-fibre tests among those with DSP were 5.5, 18.0, 21.1, and 16.9% for CDT, LDI-FLARE, HRV and CCM, respectively. However, the combination of CDT and/or CCM as evidence of small-fibre dysfunction led to a proportion of only 1.5% (2/134 patients) with normal results and abnormal NCS. The severity of small-fibre test abnormalities increased with increasing number of NCS abnormalities (ANOVA, p-value<0.01).

Conclusions CONCLUSIONS: Our findings in type 1 diabetes support the prevailing hypothesis that small-fibre dysfunction occurs early in DSP. However, because the presence of abnormality in more than one non-invasive small-fibre test was necessary to demonstrate this finding, determination of which combination of small-fibre tests could serve as a surrogate marker in clinical trials requires further research.

Authors/Disclosures
Ari Breiner, MD (Ottawa Hospital, Civic Campus) PRESENTER	Dr. Breiner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MT Pharma. Dr. Breiner has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. The institution of Dr. Breiner has received research support from Deparment of Medicine, University of Ottawa.
	No disclosure on file
Bruce A. Perkins, MPH (Toronto General Hospital)	No disclosure on file
Vera Bril, MD (Toronto General Hospital)	Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CSL. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alnylam. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grifols. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octapharma. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Powell Mansfield. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akcea. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ionis. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immunovant. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Momenta (now J&J). Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovoNordisk. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Takeda. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunovant. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Bril has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Akcea. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CSL. Dr. Bril has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. The institution of Dr. Bril has received research support from UCB. The institution of Dr. Bril has received research support from Argenx. The institution of Dr. Bril has received research support from Momenta (now J&J). The institution of Dr. Bril has received research support from Immunovant. The institution of Dr. Bril has received research support from Alexion. The institution of Dr. Bril has received research support from Takeda. The institution of Dr. Bril has received research support from Grifols. The institution of Dr. Bril has received research support from CSL. The institution of Dr. Bril has received research support from Octapharma. The institution of Dr. Bril has received research support from Akcea. The institution of Dr. Bril has received research support from Ionis. The institution of Dr. Bril has received research support from Viela Bio (now Horizon). Dr. Bril has received intellectual property interests from a discovery or technology relating to health care.
Thomas A. Berger, MD (Dept. of Neurology, Medical University of Vienna)	Prof. Berger has received personal compensation in the range of $10,000-$49,999 for serving as a speaker at scientific meetings and participant of local and international advisory boards with various companies producing and markerting treatments for multiple sclerosis (Almirall, Biogen, Biologix, Bionorica, Celgene-BMS, Merck, Novartis, Roche, Sanofi-Genzyme, TG Therapeutics, UCB).

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