Chris Hani Baragwanath Academic Hospital has become the first healthcare facility in Gauteng to use a confocal corneal microscope to diagnose nerve damage in diabetes patients.

The confocal corneal microscope was officially donated to Bara Hospital in November 2017 as part of a commitment of Novo Nordisk South Africa to facilitate improved clinical care of diabetes in the public sector.

“The impact such machines have on the lives of the millions of people who do not have medical aid and rely on government facilities is tremendous, because it allows a government facility like Bara an opportunity to provide world-class services using advance innovative equipment to South Africans who would otherwise not have access to such machinery,” said General Manager at Novo Nordisk South Africa, Dr Timmy Kedijang.

“It truly is an honour for us as Novo Nordisk South Africa to be able to play a pivotal role in providing the biggest hospital in the Southern Hemisphere with technologically advanced machinery that will positively change  the lives of mostly those affected by diabetes  for many years to come,” continued Dr Kedijang.

“At Bara we have experienced a dramatic increase in diabetic patients. In general, we see about double the number of diabetes patients who are referred for specialised diabetic care due to complications and poor control,” said Specialist at Chris Hani Baragwanath Academic Hospital Diabetes and Endocrinology Centre, Dr Bruno Pauly.

Confocal corneal microscopy (CCM) is used to detect small nerve fibre damage. This is done by using a strong microscope that is attached to the cornea and can visualise certain aspects of nerve morphology at a micrometre level. Doctors are able to analyse the length, number of branches and the straightness of the nerves.

“Although the nerve damage in the cornea is not in itself painful, visualising their morphology reflects what nerves in the rest of the body look like. If the nerves in the cornea are damaged, the nerves in the entire body are damaged,” said Dr Pauly.

“Diabetes can cause nerve damage which is very painful in patients and difficult to treat. This is called peripheral diabetic neuropathy and manifests in painful sensations of the feet such as burning, extreme cold and pins and needles. Painful diabetic neuropathy is difficult to treat and results in foot gangrene, which often leads to amputation,” continued Dr Pauly.

Traditionally doctors were only able to detect nerve damage at the point where patients were experiencing pain, which meant it was already too late for effective treatment. The use of CCM now allows doctors to detect nerve damage before the patient experiences pain.

This earlier diagnosis not only enables the intensification of treatment to prevent further damage, but also encourages the patient to improve adherence to their medication.

To date the new technology has been used on 35 patients at Bara Hospital. “We have picked up a high rate of early nerve fibre damage, which  has helped to counsel patients, intensify treatment and hopefully help prevent or delay clinical pain,” said Dr Pauly.

The technology donated by Novo Nordisk South Africa is also helping Dr Pauly’s team conduct new research into nerve regeneration.

“Up until to now we didn’t know that nerves can regenerate; it was understood that nerve damage gets progressively worse and cannot improve. However, recent research findings have changed this view,” said Dr Pauly.

“CCM has shown that the health of nerves can improve. Improvement of nerve health has already been shown with some newer medications such as GLP1 analogues and DPPIV inhibitors. We are now conducting research to find out which known treatments are most effective in improving nerve health and which new treatment modalities might improve nerve health and prevent worsening damage,” concluded Dr Pauly.

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