Aims-In the light of goals for reducing blindness due to diabetes, published in the St Vincent Declaration, 1989, the aim of this study was to find the incidence and prevalence of blindness in the diabetic population of Fife. Methods-All blind registrations for the period 1990-9 were studied. Those with diabetes as the first or main diagnosis were included as new diabetic blind. The prevalence of diabetes was studied in a large sample population and extrapolated to the estimated population of Fife. Results-The incidence of blindness due to diabetes was 64 (SD 24, 95% CI 49-79) per 100 000 diabetic population/year. The point prevalence of blindness due to diabetes on 31 December 1999 was 210 per 100 000 diabetic population. Conclusion-The incidence of blindness due to diabetes, in a diabetic population, is now known. Without this benchmark it is impossible to assess the implementation of the St Vincent Declaration. (Br J Ophthalmol 2001;85:354-356)

Obesity is a modifiable risk factor in the development of type 2 diabetes mellitus (T2DM), with the prevalence of both increasing worldwide. This trend is associated with increasing mortality, cardiovascular risk and healthcare costs. An individual's weight will be determined by complex physiological, psychological and societal factors. Assessment by a skilled multidisciplinary team will help identify these factors and will also support screening for secondary causes, assessing cardiovascular risk and identifying sequelae of obesity. A range of treatment options are available for people with obesity and T2DM, including low-calorie diets, medications and bariatric surgery. People should be carefully counselled and personalised care plans developed. Bariatric surgery is an under-utilised resource in this context.Obesity should also be considered when choosing medical therapy for T2DM. Common diabetes medications may lead to weight gain whereas others (such as glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors) support weight loss.Bariatric surgery improves obesity-related complications and all-cause mortality. Diabetes remission is possible after surgery and is recommended by National Institute for Health and Care Excellence in individuals with a body mass index of >35 kg/m 2 and recent onset T2DM. Pathophysiology of obesity and T2DMThe mechanisms linking obesity and T2DM are complex and still being understood, but likely involve a combination of: > adipose tissue release of excess circulating fatty acids, glycerol, hormones and pro-inflammatory cytokines, impairing cellular insulin signalling and increasing insulin resistance 5 > chronically raised lipid levels leading to impaired islet beta-cell function and lower levels of insulin production. 6An approach to the patient with obesity and diabetesAn individual with T2DM and obesity may present to a range of specialties. Typically, recurrent patterns of dieting and weight

People with diabetes are more likely to require surgical intervention than those without and have an increased risk of developing postoperative complications. The Highs and lows review from the National Confidential Enquiry into Patient Outcome and Death reported on inadequate diabetes care in the perioperative period. As a result, the Centre for Perioperative Care has published guidance on perioperative management of diabetes recently.Early identification and glucose optimisation preoperatively is key, and assists in formulating an individualised plan for diabetes care during admission, surgery and postoperatively. The plan will include dose adjustments of diabetes medication, and use of variable rate insulin infusion or continuous subcutaneous insulin infusion where applicable. The guideline also highlights the importance of improved communication between healthcare teams involved in the perioperative pathway in order to improve outcomes and care.

WS-MRI in patients without a guideline indication did not detect any lesions that threatened the spinal cord. WS-MRI is essential in those with guideline indications. WS-MRI is of benefit to patients with smouldering myeloma where documentation of lesions not seen on plain film will result in treatment rather than observation.

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