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New strategy to study the impact of ethnicity on diabetic neuropathy

Diabetic neuropathy (DN) is a common and debilitating but often undiagnosed complication affecting up to 66% of subjects with diabetes. As main cause of limb amputation, one of the most debilitating events patients may experience, DN has a huge impact on patients and healthcare systems. An early diagnosis and correct staging of DN are essential for risk stratification and therapeutic decisions. Unfortunately, pathologic pathways to be tackled for a cure of DN have not yet been completely elucidated. As a result, DN may be barely managed but still not cured with disease‐modifying agents. In vivo corneal confocal microscopy (IVCCM) has been largely investigated in the last decade as a non‐invasive technique allowing an easy assessment of DN and it may now be considered as a standardized and validated technique for diagnosing DN. By evaluating the small nerve fibres innervating cornea, IVCCM may also provide new biomarkers of disease to be used in clinical research. A reliable marker of DN is essential for elucidating the pathophysiology of DN. Moreover, we have recently highlighted in this journal the urgent need for clinical trials specifically designed to tackle microvascular complications of diabetes. In this regard, easy tools to measure these complications are crucial for designing such trials, and IVCCM is probably one of the most important advancement in the field as a surrogate marker that predicts those who will develop DN and as an endpoint in therapeutic trials. The paper by Fadavi et al “Explanations for less small fibre neuropathy in South Asian versus European people with type 2 diabetes mellitus in the UK” serves as an example of the benefits achievable by using IVCCM to investigate DN. In this study, the authors evaluated ethnic differences in corneal nerve innervation and related risk factors between South Asian and European people. South Asian immigrants in the United Kingdom represent a special cohort of patients showing protection from DN, which is highlighted by a