Evaluation of Corneal Confocal Microscopy for the Identification and Prediction of Neuropathy in Type 1 Diabetes

Sponsor
Samuel Lunenfeld Research Institute, Mount Sinai Hospital (Other)
Overall Status
Completed
CT.gov ID
NCT02423434
Collaborator
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (NIH), University of Calgary (Other), Queensland University of Technology (Other), University of Michigan (Other), University of Manchester (Other)
624
5
47
124.8
2.7

Study Details

Study Description

Brief Summary

Through the multinational pooled dataset approach, this trial will aim to derive and validate specific in vivo Corneal Confocal Microscopy (CCM) parameter thresholds for the identification of diabetic polyneuropathy, and - more importantly - the identification of individuals at future risk. Results of the study will permit application in clinical practice and intervention trials for diabetic polyneuropathy (DPN) risk stratification.

The primary goal of the study is to re-examine individuals with type 1 and type 2 diabetes with and without neuropathy, who had CCM performed in the past as a part of their neurological examination, to assess concurrent and predictive validity of different CCM parameters in individuals . These subjects will be invited to the study to be re-examined by CCM along with other neurological tests (physical exam, nerve conduction studies, quantitative sensory testing, blood test and in some centres also skin biopsy) during the single study visit. Additionally CCM data will be analyzed both manually and by recently developed automated analytical software to evaluate accuracy of the automated method. Evaluation of automated image analysis will influence likelihood of successful knowledge translation of this surrogate biomarker for DPN into clinical practice - in which the procedure could be harmonized with annual retinal examinations - and into intervention trials.

Secondary aim of the study is to determine the factors associated with CCM parameters and their longitudinal change and collect bio-samples for future research in this field.

Condition or Disease Intervention/Treatment Phase
  • Other: Exposure: Corneal nerve fibre morphology by the CCM Procedure

Detailed Description

The diffuse injury to peripheral nerves (diabetic neuropathy) is exceptionally common in type 1 diabetes, but there is a lack of an objective surrogate marker to identify early subclinical stages when treatments might be most effective, prior to late-stage progression to troublesome and costly foot infection, ulceration, and limb amputation. In contrast to the ability to objectively measure disease-specific surrogate markers for retinopathy and nephropathy, this lack of a diabetic neuropathy surrogate marker has seriously impeded the development of specific interventions in clinical research trials. Representing 5 independent research groups that have together created a consortium of investigators dedicated to the development of a surrogate marker for early diabetic neuropathy, we have focused on using the eye as a window to non-invasively image by a method of in-vivo corneal confocal microscopy (CCM) the small nerve fibres that innervate the cornea. We have demonstrated that changes in these nerve fibre endings occur early in the development of neuropathy, reflect well the changes seen in other peripheral nerves by invasive skin biopsy evaluation, and that their measurement is feasible and reproducible. As a multinational consortium, we have the benefit in this proposal of pooling multiple cohorts to apply the most valid study methods in biomarker development. First, we aim to determine in the analysis of an existing pooled dataset of 516 type 1 and 524 type 2 diabetes subjects the exact levels of CCM measurement that can identify the presence of diabetic neuropathy. Secondly, we propose over three years to re-examine at least 70% of this cohort, which will provide 5- to 7-year follow-up data to determine which type and level of CCM measurement can predict the future onset of neuropathy, as well as its progression in those who had neuropathy at baseline. Finally, we will evaluate the role of time- and cost-saving automated image analysis software. By virtue of large sample size from data pooling, we are uniquely afforded the methodological power to confirm our objectives by way of separate derivation and validation analysis sets. Through a unique and unprecedented multinational pooled dataset approach for diabetic neuropathy, this work will derive and validate specific CCM parameter thresholds for the identification of neuropathy, and - more importantly - the identification of individuals at future risk. These results will permit application in clinical practice and intervention trials for neuropathy risk stratification. Evaluation of automated image analysis will influence likelihood of successful knowledge translation of this surrogate biomarker into clinical practice - in which the procedure could be harmonized with annual retinal examinations - and into intervention trials.

Study Design

Study Type:
Observational
Actual Enrollment :
624 participants
Observational Model:
Cohort
Time Perspective:
Prospective
Official Title:
Multinational Collaborative Evaluation of Corneal Confocal Microscopy as a Surrogate Endpoint for the Identification and Prediction of Diabetic Neuropathy in Type 1 Diabetes
Actual Study Start Date :
Sep 1, 2014
Actual Primary Completion Date :
Aug 1, 2018
Actual Study Completion Date :
Aug 1, 2018

Arms and Interventions

Arm Intervention/Treatment
Corneal Confocal Microscopy subjects

Other: Exposure: Corneal nerve fibre morphology by the CCM Procedure
CCM is a non-invasive method for direct visualization of corneal nerve fibers. Previous research work has confirmed that corneal nerves status correlates with both small and large fibre damage as assessed by quantitative sensory testing and nerve conduction. In the current trial subjects will undergo a bilateral examination of the Bowman's layer of the cornea using the Rostock Cornea Module of the Heidelberg Tomograph III (Heidelberg Engineering, Smithfield RI, USA) to determine their corneal nerve fiber length, corneal nerve fiber density, corneal nerve branch density, and the tortuosity coefficient. Topical anaesthetic and a viscous gel medium will be applied to the eye, which will create a visual gel bridge between the cornea and the sterile single-use cap on the microscope objective lens. After the interface between the corneal epithelium and Bowman's layer is identified, batches of images will be taken and the most technically sound images will be identified and analyzed.

Outcome Measures

Primary Outcome Measures

  1. Evaluate the Concurrent Validity of CCM Parameters from Cross-Sectional Analysis of Well-Characterized T1D and T2D Subjects. [Any data obtained from pre-study measurements]

  2. Evaluate the Predictive Validity of CCM Parameters based on the 5-7 year Incidence of Neuropathy in Well-Characterized T1D and T2D Subjects Without Neuropathy at Baseline [Study visit]

  3. Evaluate the Predictive Validity of CCM Parameters for 5-7 year Progression of Neuropathy [Study visit]

  4. Comparison of Manual versus Automated Image analysis [Pre-study and study visit data]

Secondary Outcome Measures

  1. Determination of the Factors associated with CCM Parameters and their Longitudinal Change [Study visit]

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Individuals of any gender or race aged 18 or above

  • Type 1 diabetes mellitus or type 2 diabetes mellitus as defined by the American Diabetes Association guidelines (2014) of any duration

  • Availability of the initial CCM examination performed two to eight years ago

  • Ability to understand and cooperate with study procedures

Exclusion Criteria:
  • Confirmed to have neuropathy owing to non-diabetic causes (such as familial, alcoholic, nutritional, uremic)

  • Current eye infection, corneal damage, or severe movement disorders which could preclude a safe CCM exam

  • Allergy to proparacaine (the ocular topical anaesthetic used for the CCM exam)

Contacts and Locations

Locations

Site City State Country Postal Code
1 University of Michigan Ann Arbor Michigan United States 48105
2 Queensland University of Technology Brisbane Australia 4059
3 University of Calgary Calgary Alberta Canada T3B6A8
4 Mount Sinai Hospital and University Health Network Toronto Ontario Canada M5G 2C4
5 University of Manchester Manchester United Kingdom M139PT

Sponsors and Collaborators

  • Samuel Lunenfeld Research Institute, Mount Sinai Hospital
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
  • University of Calgary
  • Queensland University of Technology
  • University of Michigan
  • University of Manchester

Investigators

  • Principal Investigator: Bruce A Perkins, MD, MOUNT SINAI HOSPITAL

Study Documents (Full-Text)

None provided.

More Information

Publications

Responsible Party:
Samuel Lunenfeld Research Institute, Mount Sinai Hospital
ClinicalTrials.gov Identifier:
NCT02423434
Other Study ID Numbers:
  • DP3DK104386
  • 1DP3DK104386-01
First Posted:
Apr 22, 2015
Last Update Posted:
Nov 6, 2019
Last Verified:
Nov 1, 2019

Study Results

No Results Posted as of Nov 6, 2019