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Optimal Measures of Small Fiber Neuropathy in Diabetic Polyneuropathy

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Studies in Diabetes

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Abstract

Small fibers constitute the majority of peripheral nerve fibers and are responsible for the symptoms of painful diabetic neuropathy and are also key to the genesis of foot ulceration via reduced heat and pain perception, sudomotor dysfunction, and blunted pressure-induced vasodilation. Small fiber damage may also precede large fiber damage in subjects with impaired glucose tolerance (IGT) and early diabetic neuropathy. A number of functional tests such as thermal thresholds, quantitative sudomotor axon reflex testing (QSART), and the sympathetic skin response as well as the neuropad and the nerve axon reflex can be used to assess small fiber dysfunction. More recently skin biopsy has been advocated to provide a sensitive means to identify early small fiber damage, although the technique is invasive, requiring a skin biopsy. As an alternative corneal confocal microscopy, an ophthalmic technique represents a noninvasive means to quantify small fiber damage and is increasingly being deployed for the assessment of diabetic and other peripheral neuropathies.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Central Manchester Foundation Trust & University of Manchester, Manchester, M13 9WL, UK

    M. Tavakoli, H. Fadavi & R. A. Malik

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  1. M. Tavakoli
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  2. H. Fadavi
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  3. R. A. Malik
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Correspondence to R. A. Malik .

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  1. Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA

    Irina Obrosova

  2. Centre for Endocrinology and Metabolism, University of Brimingham, School of Clinical and Experimental Medicine, Birmingham, United Kingdom

    Martin J. Stevens

  3. Veterans Affairs Medical Center, University of Iowa, Iowa City, Iowa, USA

    Mark A. Yorek

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Tavakoli, M., Fadavi, H., Malik, R.A. (2014). Optimal Measures of Small Fiber Neuropathy in Diabetic Polyneuropathy. In: Obrosova, I., Stevens, M., Yorek, M. (eds) Studies in Diabetes. Oxidative Stress in Applied Basic Research and Clinical Practice. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4899-8035-9_6

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