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Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry
A G Lerner1,2, A Bernabé-Ortiz1, R Ticse3,4
1CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Summary
Pupillometry shows potential for screening diabetes and cardiac autonomic neuropathy. However, its accuracy is insufficient for current clinical use as a diagnostic tool.
Area of Science:
- Ophthalmology
- Diabetology
- Neurology
Background:
- Diabetes mellitus is a global health concern associated with microvascular complications.
- Cardiac autonomic neuropathy (CAN) is a common and serious complication of diabetes.
- Early detection of diabetes and its complications is crucial for effective management.
Purpose of the Study:
- To evaluate pupillometry as a non-invasive screening tool for diabetes.
- To assess the association between pupillary response and cardiac autonomic neuropathy in individuals with and without diabetes.
Main Methods:
- A cross-sectional study involving 384 participants (213 with diabetes) from hospital and community settings.
- Pupillometry measurements using an LED light stimulus test.
- Diabetes diagnosed via oral glucose tolerance test; cardiac autonomic dysfunction assessed using established diagnostic tests.
Main Results:
- The amplitude of pupil reaction demonstrated the highest area under the curve (0.69) for diabetes screening (sensitivity: 78%; specificity: 55%).
- For diagnosing cardiac autonomic neuropathy, baseline pupil radius (AUC: 0.71) and amplitude of pupil reaction (AUC: 0.70) showed the highest accuracy.
- Cardiac autonomic neuropathy was present in 37% of evaluated participants.
Conclusions:
- Pupillometry is an accessible and inexpensive method for screening diabetes and cardiac autonomic neuropathy.
- Despite promising results, pupillometry currently lacks the required accuracy for widespread clinical adoption as a screening tool.
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