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This study assessed the association of corneal nerve parameters with abnormalities identified by electromyography (EMG) and neuropathic pain in a large population with and without (pre)diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this study we included cross-sectional data for 3425 participants from the Maastricht Study. Wide-field corneal confocal microscopy (WF-CCM) was performed using fully automated analysis of three corneal nerve parameters: corneal nerve branch density (CNBD), corneal nerve fibre density (CNFD) and corneal nerve fibre length (CNFL). An axonal degeneration composite score comprising compound muscle action potential amplitudes (peroneal and tibial) and the sensory nerve action potential amplitude of the sural nerve was created by categorising EMG amplitudes as normal or indicating minor (\u226410th percentile), moderate (\u22645th percentile) or severe (\u22642.5th percentile) abnormalities. Neuropathic pain was determined as a modified Douleur Neuropathique en 4 Questions (DN4) interview score \u22653.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age of the participants was 59.2 years; 51.6% were female, 15% had prediabetes (defined as impaired fasting glucose, impaired glucose tolerance or both) and 19% had type 2 diabetes. The median diabetes duration was 3.0 years. Regression analyses revealed statistically significant associations between the axonal degeneration EMG score and WF-CCM parameters (CNFL: \u03b2=\u22120.51 [95% CI \u22120.78, \u22120.24]; CNFD: \u03b2=\u22121.56 [95% CI \u22123.04, \u22120.08]; CNBD: \u03b2=\u22123.08 [95% CI \u22125.51, \u22120.64]; all\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.05) but no statistically significant associations between neuropathic pain and WF-CCM parameters (CNFL: \u03b2=\u22120.06; CNFD: \u03b2=\u22121.15; CNBD: \u03b2=\u22120.22; all\n                      <jats:italic>p<\/jats:italic>\n                      &gt;0.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>The study found associations between the axonal degeneration EMG score and WF-CCM, but no associations were observed between neuropathic pain and WF-CCM parameters, suggesting that WF-CCM has limited value in assessing neuropathic pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06676-8","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:29:19Z","timestamp":1770701359000},"page":"1519-1531","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of corneal nerve parameters with nerve abnormalities and neuropathic pain in prediabetes and type 2 diabetes: the Maastricht Study"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0178-3409","authenticated-orcid":false,"given":"Mette K.","family":"Borbjerg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4209-0502","authenticated-orcid":false,"given":"Sara","family":"Mokhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4697-3644","authenticated-orcid":false,"given":"Nadia","family":"Sutedja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1583-7391","authenticated-orcid":false,"given":"Annemarie","family":"Koster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6693-2028","authenticated-orcid":false,"given":"Carsten D.","family":"M\u00f8rch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8101-939X","authenticated-orcid":false,"given":"Tos T. 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However, data are available from the authors on reasonable request and with permission from the Maastricht Study management team. Data analysis is available from the authors on reasonable request.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"Open access funding provided by Aalborg University Hospital. This study was supported by the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (grant 31O.041), the Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), the Cardiovascular Center (CVC, Maastricht, the Netherlands), the CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands), the CAPHRI Care and Public Health Research Institute (Maastricht, the Netherlands), the NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), the Stichting Annadal (Maastricht, the Netherlands) and the Health Foundation Limburg (Maastricht, the Netherlands), and by unrestricted grants from Janssen-Cilag BV (Tilburg, the Netherlands), Novo Nordisk Farma BV (Alphen aan den Rijn, the Netherlands) and Sanofi-Aventis Netherlands BV (Gouda, the Netherlands).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"MKB, SM, NSu, AK, CDM, TTJMB, NSc, NE and JR were involved in the conception, design and conduct of the study. MKB, SM, CDM, NSc and JR were involved in the analysis and interpretation of the results. MKB wrote the first draft of the manuscript and all authors edited, reviewed and approved the final version of the manuscript. MKB is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}