We must not forget that foot problems are very common in people with diabetes, and so is diabetic neuropathy. In one of our studies, we showed that up to half of older patients with type 2 diabetes have significant neuropathy. Half of these patients may not realize that, because they have no symptoms. Therefore, screening for neuropathy is absolutely crucial to identify those people who are at risk of developing foot problems, and neuropathy itself is one of the most important contributory factors in the causation of foot ulcers. So screening and early treatment of neuropathy may help to reduce the incidence of foot ulcers, which themselves, sadly, may ultimately require amputation, and of course, this has significant morbidity and mortality.
Interview with Professor Andrew Boulton
University of Manchester and Manchester University Foundation Trust, Manchester, UK
- Foot problems are very common in people with diabetes, and so is diabetic neuropathy.
- Screening for neuropathy is absolutely crucial to identify those people who are at risk of developing foot problems.
- For the proper diagnosis of diabetic neuropathy, one really needs a good clinical examination of the foot and also measurement of simple tests for sensation.
How important is the management of diabetic neuropathy for the prevention of diabetic foot problems?
What implications does the COVID-19 pandemic have for patients with diabetic neuropathy or diabetic foot problems?
Well, during the COVID-19 pandemic, people with diabetes have been understandably rather frightened about coming to hospitals or clinics. They realized that people with diabetes who get COVID don’t do as well as those without, and indeed, in my country, one in three people dying in hospital with COVID has diabetes, type 2 mainly. This fear is quite understandable and we need to reassure our patients that very strict hygiene, social distancing and maskwearing is enforced in our clinics. To improve attendance, I moved some of my clinics to an off-site facility in Primary Care which certainly increased attendance. Throughout the pandemic and always, it is important for people with diabetes to continue to attend their appointments, to look after their feet with regular inspection and take any medications they are prescribed for their neuropathy. And even though we’ve done a lot of telemedicine, for the proper diagnosis of diabetic neuropathy, one really needs a good clinical examination of the foot and also measurement of simple tests for sensation and motor function that are outlined in the guidelines, so these are crucial, and hopefully people will be less frightened to attend clinics now that in most countries things are gradually improving, and of course, we encourage all our patients to be vaccinated.