Book Review

Childhood and Adolescent Diabetes

N Engl J Med 1995; 333:1160October 26, 1995

Article

Childhood and Adolescent Diabetes
Edited by Christopher J.H. Kelnar. 633 pp., illustrated. New York, Chapman and Hall Medical, 1995. $129. ISBN: 0-412-48610-5

Childhood and Adolescent Diabetes will be a welcome addition to the home and office libraries of pediatric specialists and generalists. It comprehensively covers practical aspects of diabetes in childhood and adolescence, provides scholarly accounts of recent investigative work, and suggests future directions of research in the field.

The editor has brought together a knowledgeable and diverse group of contributors in this well-written book. From part 1, which covers basic fuel homeostasis from fetal life through adolescence, to part 6, which reviews future directions in the treatment of insulin-dependent diabetes mellitus (IDDM), experts from many fields carefully review clinical features and treatment, psychosocial aspects, and research in childhood diabetes. Normal growth and development and the endocrine changes of puberty with its associated insulin resistance receive eloquent coverage. There are superb discussions of the psychosocial aspects of living with and caring for a child with diabetes.

There is some welcome redundancy with 46 chapters, which provide a framework for presenting differing treatment strategies. The veteran pediatric diabetologist will welcome the diversity of approaches, but the inexperienced practitioner may find them confusing. For example, chapter 17 discusses the ease with which insulin can be administered by a young child. However, the same chapter and a multitude of other chapters caution that diabetes management is not the responsibility of the child but belongs in the hands of the parents. Actually, I applaud the authors for highlighting the stresses and strains placed on families and the frequent physical and emotional discomfort suffered by diabetic children and teenagers. In general, the book is consistent with respect to the need for parental and familial involvement in the diabetes-treatment program.

Because of the inevitable delays in publishing a large textbook such as Childhood and Adolescent Diabetes, the most recent references are for 1993. The results of the Diabetes Control and Complications Trial appear as addendums in certain sections (chapters 16 and 39). This remarkable study included findings of a 30 to 60 percent reduction in the occurrence of retinopathy, nephropathy, and neuropathy but a threefold increased risk of hypoglycemia. However, the reader is informed that the results are not applicable to all children with IDDM, particularly because the prevention of severe hypoglycemia is paramount in children under seven years of age. The book does include new information on the molecular epidemiology and genetics of IDDM (chapters 10 and 11), yet the publication date precluded a discussion of new dietary guidelines that allow the inclusion of sucrose in meal plans through carbohydrate counting.

The majority of the authors come from the United Kingdom, with scattered chapters written by experts from the United States, Israel, Australia, and Scandinavia. Approaches to care of diabetic children are similar throughout the industrial world, but chapters on access to health care and health insurance in the United States would have been welcome. It would have been helpful to include both conventional units and Système International (SI) units; this was done only in chapter 15.

Remarkable readability and clarity earn this book a place as a resource for any professional interested in childhood diabetes. It can be read for its educational and training value, or it can serve as a reference for special topics. Endocrinologists who care for young adults, teenagers, or children with IDDM will find this textbook a practical reference.

Lori M.B. Laffel, M.D., M.P.H.
Joslin Diabetes Center, Boston, MA 02215