Andrew J.M. Boulton, MD, DSc


November 01, 2016

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Hi. I'm Andrew Boulton, immediate past president of the European Association for the Study of Diabetes (EASD). This year I have been able to attend one or two sessions, although I have to admit that I'm still pretty busy with meetings and I have just taken over as president of the Worldwide Initiative for Diabetes Education. But I remain active clinically and I guess I am best known for my work in the area of peripheral neuropathy and diabetic foot disease.

All of our diabetic patients, of course, should be screened annually for risk of complications. An interesting presentation[1] from Sheffield, England, caught my attention this year where they are emphasizing annual screening. They had the idea that if everyone in England is called for an annual photograph that screens for diabetic retinopathy, could screening for kidney disease and peripheral nerve disease be added?

They showed that it was entirely feasible. In their study, while the patient attended the optician for screening for diabetic eye disease and drops were dilating the fundi, a quick foot exam was done by a trained individual, and they looked for evidence of microalbuminuria.

We are facing an epidemic of type 2 diabetes, and screening is going to be essential because we must not forget that type 2 diabetes can present with a leg complication. When you are screening for one complication, why not screen for the others as well?

In another study,[2] my colleagues and I in Manchester have been working with opticians to use corneal confocal microscopy to look at the corneal nerves. We can do screening with a photograph for diabetic retinopathy, and at the same time, examine corneal nerve fibers, which can be predictive of diabetic neuropathy.

I hope these novel ideas are of interest to you, and I thank you for listening.


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