COMPLICATIONS that different patterns of nerve damage can be attributed to different risk factors (e.g., hyperglycemia and dyslipidemia), and that diffusion tensor imaging (DTI) allows for a very accurate assessment of the structural integrity of affected nerves (13-15). This study combined hsTNT and proBNP assays with results derived from automated nerve fiber segmentation after 3T DTI MRN, as well as clinical, electrophysiological, and serological testing, to investigate whether hsTNT and proBNP may serve as potential markers for nerve damage in DN. RESEARCH DESIGN AND METHODS Study Design and Participants The local ethics committee approved this study (Heidelberg Study on Diabetes and Complications [HEIST-DiC], local ethics number S-383/2016, ClinicalTrials.gov identifier NCT03022721), and all study participants gave informed, written consent. There were 51 patients (17 women, 34 men; mean age 66.7 6 9.7 years; age range 41-86 years) with T2D (23 without DN, 28 with DN) and 10 control subjects (7 women, 3 men; mean age 55.9 6 12.6 years; age range 31-69 years) who took part in this study between June 2015 and February 2019. Overall exclusion criteria were age ,18, pregnancy, any history of lumbar surgery or disc protrusion, any contraindications for MRI, any other risk factors for neuropathy, such as alcoholism, hypovitaminosis, malignant or infectious diseases, any previous or ongoing exposure to neurotoxic agents, monoclonal gammopathy, and any chronic neurological diseases such as Parkinson disease, multiple sclerosis, or restless leg syndrome. Additional exclusion criteria for control subjects were any signs of neuropathy in their medical history or in the clinical and electrophysiological examinations listed below.
