Corneal Confocal Microscopy Shows an Improvement in Small-Fiber Neuropathy in Subjects With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Compared With Multiple Daily Injection

Improved glycemic control is the only treatment that has been shown to be effective for diabetic peripheral neuropathy in patients with type 1 diabetes (1). Continuous subcutaneous insulin infusion (CSII) is superior to multiple daily insulin injection (MDI) for reducing HbA1c and hypoglycemic events (2). Here, we have compared the benefits of CSII compared with MDI for neuropathy over 24 months. A total of 49 subjects with T1DM (18 on CSII vs. 31 on MDI) and 40 age-matched control subjects underwent assessment of vibration perception threshold (VPT), cold threshold (CT), warm threshold (WT), neurophysiology, deep breathing heart rate variability (DB-HRV), intraepidermal nerve fiber density (IENFD), and corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL) at baseline and after 24 months. At baseline, subjects on CSII and MDI were …