Introduction: Diabetic neuropathy (DN) affects up to 50% of patients with type 1 diabetes mellitus (T1DM).
Clinical manifestations include painful polyneuropathy with autonomic and orthostatic symptoms. Corneal
confocal microscopy (CCM) is one of the promising non-invasive methods for DN evaluation and tracking the
effectiveness of treatment.
Objectives: To perform the early diagnosis of DN in T1DM patients and describe the morphological changes in
nerve fibers during the treatment process.
Patients and Methods: This prospective study included 77 T1DM patients and 42 healthy controls. All patients
underwent CCM and electroneuromyography (ENMG). Twenty-five patients with T1DM and HbA1c 7-10%
underwent strict glycemic control with the correction of insulin therapy and the subsequent CCM and ENMG
investigations for the second time.
Results: In T1DM patients a decrease in the main nerve trunks with age was revealed, as well as an increase in
corneal nerve tortuosity (P < 0.05). The number of branches of nerve fibers did not change with the increasing age
(P = 0.07). After reaching T1DM compensation, patients underwent a course of alpha-lipoic acid therapy. Confocal
microscopy of the cornea parameters did not undergo significant changes during therapy since significant positive
dynamics were noted only in the tortuosity of nerve fibers (P < 0.05), which decreased by 11.8%.
Conclusion: In patients with T1DM, strict glycemic control, correction of insulin therapy, and courses of alpha-
lipoic acid prescription help to reduce the morphological changes of small fiber neuropathy, which can be
evaluated by the confocal microscopy of the cornea.