In Focus

www.thelancet.com/diabetes-endocrinology Vol 2 November 2014 865

Despite being born and raised in Ethiopia, Solomon Tesfaye was given a taste of the English school system while attending General Wingate School in Addis Ababa. However, when Ethiopia’s military government closed the school in the 1970s, Tesfaye was ejected along with others his age into a period of national service. He worked supporting and educating rural communities, aged just 16 years.

Tesfaye’s break came from applying for an international scholarship at Sevenoaks School in Kent, England, where he completed his schooling, developing his interest in science and enjoying the weekly lectures given by some of the biggest names in various fi elds, including the late Sir AJ Ayer, philosopher and Professor of Logic at Oxford University. He briefl y tutored science at Columbia University in New York, before returning to the UK to study medicine at Bristol University. “I had always wanted to study medicine after watching my mother pass away due to gall stones in Addis Ababa”, Tesfaye told The Lancet Diabetes & Endocrinology. “It took 10 days to diagnose her, when an early diagnosis would have saved her. I didn’t ever want to watch such needless suff ering again.” His medical training in various areas in the UK led to a role in Sheffi eld, a city he fell in love with after visiting for a Bruce Springsteen concert in 1987. There he worked with eminent researcher Professor John Ward who was to become the most important person in shaping Tesfaye’s development. “I was advised not to try and publish too many studies, but instead focus on a few that answer fundamental questions”, recalls Tesfaye.

Now Research Lead in Diabetes and Endocrinology at Sheffi eld Teaching Hospital and the University of Sheffi eld in the UK, Tesfaye’s long career in diabetes—especially diabetic neuropathy—has not gone unnoticed, and he was thrilled to be told that he was 2014’s recipient of the prestigious Camillo Golgi Prize awarded by the European Association for the Study of Diabetes (EASD). “Ever since I was a junior research fellow it has been my dream to win this prestigious prize, which to me is the highest honor in my fi eld”, he says.

Andrew Boulton, President of the EASD, says of Tesfaye: “From my fi rst meeting with Solomon it was clear that he was an extremely bright clinician with an inquisitive mind. He set high standards in that he wanted to understand more about the pathogenesis of painful diabetic neuropathy. In recent years he has made key observations in a number of pivotal papers that ‘peripheral’ neuropathy may not be as its name suggests.”

Early research highlights included showing nerve vascular architecture in diabetic neuropathy, demonstrating that impaired blood fl ow to nerves was causing nerve damage. He then moved to Liverpool where he worked at the Pain Relief Foundation at Walton Hospital studying treatments

for peripheral neuropathy. “We found that many patients with this condition also had depression, anxiety, fear, and stress, and were also not sleeping well. Around half were not responding to drugs”, says Tesfaye. In Liverpool, he helped lead a pilot study into electrical spinal cord stimulation, with a wire inserted in the patients’ epidural space. “Most patients experienced pain relief, and a huge improvement in quality of life”, says Tesfaye. This groundbreaking work, published in The Lancet in 1996, led to spinal cord stimulation becoming a well established treatment for painful diabetic neuropathy.

“As so often in research, one kind of research leads to another”, recalls Tesfaye. As 20% of patients did not respond to stimulation, Tesfaye set about fi nding out why. He returned to Sheffi eld and began challenging existing assumptions about peripheral neuropathy, including that it only aff ected peripheral nerves, and not the spinal cord and the brain. This led to another study in The Lancet in 2001, revealing shrinkage of the spinal cord in diabetic patients with neuropathy.

Other important work by Tesfaye in this area has focused on proving that blood fl ow in the thalamus is diff erent for patients with painful diabetic neuropathy, making this a potential target for new drug therapies. “These studies clearly show that peripheral is not the right term, as the condition also aff ects the CNS”, he says. He then went on to lead the neuropathy component of a major European study (the EURODIAB type 1 diabetes study, published in the New England Journal of Medicine in 2005) showing that nerve damage in these patients is caused not only by high blood sugar levels, but also by traditional risk factors for coronary heart disease such as smoking, high blood pressure, high cholesterol, and obesity.

One of Tesfaye’s current research interests is the use of new devices to diagnose neuropathy early to bring down amputation and mortality rates. He is currently part of a study in China attempting to recruit 1000 patients to see if their neuropathy can be detected early using new point-of-care devices. The patients will be followed up for 5 years from diagnosis of type 2 diabetes. “If neuropathy is detected early, we will then see if using antioxidant treatment can help prevent progression.”

This study is not his only international interest. Having come from Ethiopia, Tesfaye is aware that millions of patients with diabetes have inadequate access to treatment. He helps run the International Insulin Foundation that aims to get insulin to all who need it in poorer countries, and is also a founding member of Sheffi eld Health Action Resource in Ethiopia (SHARE), which supports hospitals in Ethiopia.

Tony Kirby

Profi leSolomon Tesfaye: preventing complications of diabetic neuropathy

Published OnlineOctober 14, 2014http://dx.doi.org/10.1016/S2213-8587(14)70179-2