Suranjita Ganguly

Proposal summary

India is the diabetic capital of the world with more than 68 million individuals affected by it. Diabetic peripheral neuropathy (DPN) is a microvascular complication associated with diabetes which manifests itself several years after its onset and by the time it is diagnosed, the disease progression is irreversible. The onset of DPN is marked by axonal retractions or demyelination of the smaller diameter nerve fibers (unmyelinated C and Aδ fibres) followed by larger diameter fibers (Aα and Aβ fibres). Nerve conduction studies (NCS) and quantitative sensory testing (QST) are the most widely used diagnostic methods. NCS is painful and inefficient in detecting anomalies in smaller diameter fibers while QST is qualitative and ridden with subjective aspects in testing protocols, making them ineffective in early diagnosis. Hence there arises a need for the development of a painless, non-invasive, mass screening tool that can effectively diagnose DPN before it becomes irreversible.

The current study aims to employ vibrotactile and thermal modalities with a focus on smaller diameter fibers for the early assessment of subclinical DPN so that interventions are possible. The novelty of the study lies in the electrophysiological approach wherein electroencephalography (EEG) shall be used to investigate the cortical correlates associated with thermal stimuli on the lower limb for the first time on a healthy cohort, and the corresponding cortical correlates of the two modalities in diabetic and pre-diabetic cohorts. These cortical correlates are expected to objectively quantify the extent of the disorder and we hypothesize can form biomarkers for early detection of DPN.