Book Review

Diabetes Mellitus: A fundamental and clinical text

N Engl J Med 1997; 336:1683-1684June 5, 1997

Article

Diabetes Mellitus: A fundamental and clinical text
Edited by Derek LeRoith, Simeon I. Taylor, and Jerrold M. Olefsky. 876 pp., illustrated. Philadelphia, Lippincott–Raven, 1996. $199. ISBN: 0-397-51456-5

The editors of Diabetes Mellitus: A Fundamental and Clinical Text have endeavored to bring together the latest information on the cellular, molecular, and therapeutic developments in the field. The result of their efforts is a comprehensive book in which they and their well-qualified team of contributing authors have identified the most exciting issues currently receiving attention from researchers and clinicians.

This book is organized ideally for both the reader who wants a broad review of diabetes mellitus and the one who needs timely and specific information. The chapters are intentionally concise, most with 10 pages or fewer. Each contains a solid selection of classic and current citations. One minor criticism is that the references in several chapters are heavily weighted toward works by their authors. However, the format of succinct chapters with extensive bibliographies generally works well.

Most chapters begin as general reviews and include updates of each topic. The first two sections, “Insulin Secretion” and “Insulin Action,” are well written and cover the latest developments in research on the regulation of insulin secretion and the metabolic actions of insulin. Even readers with mostly clinical backgrounds will appreciate these clearly written chapters. The fourth section covers the genetic and autoimmune aspects of type I diabetes (“Type I Diabetes: Therapeutics” is a subsequent section). The chapter entitled “Autoantibodies and the Disease Process of Insulin-Dependent Diabetes Mellitus” is especially good. It thoroughly describes the different types of autoantibodies associated with this disease and coherently discusses each assay used to measure them. As screening people at high risk for type I diabetes becomes a clinical reality, this information will be particularly useful.

The clinical sections take up the last two thirds of the book. The tone is set by two excellent chapters on the Diabetes Control and Complications Trial. The first is a succinct and unbiased review of the design of the study, with a discussion of its positive and negative results and the potential problem of population bias. The second sensibly discusses the application of the results to the different groups of patients with diabetes and the potential risks and benefits for each. What follows are many “hot topics,” including immune intervention, islet-cell transplantation, insulin resistance and coronary artery disease, fatty-acid–oxidation inhibitors, and advanced glycosylation end products. Although thorough, the chapter “Principles and Fundamentals of Glucose Monitoring” is perhaps too slanted toward bioengineering principles. The chapters on microvascular complications combine solid reviews of known pathophysiology with the leading etiologic theories.

Particularly timely are the excellent chapters on the newest therapeutic agents, the α-glucosidase inhibitors and the thiazolidinediones. The authors make no attempts to provide management guidelines, but it is nevertheless disappointing to have no specific information on the types of insulin and methods of insulin administration in type I diabetes. Also conspicuously absent are chapters on biguanides and the more traditional oral hypoglycemic agents, especially since there have been recent advances in research on topics such as the sulfonylurea receptor and in understanding the widespread metabolic effects of metformin.

The quality of the writing and the figures is quite high. However, the terms “type I” and “type II” diabetes are used interchangeably with the less-well-defined “insulin-dependent” and “noninsulin-dependent,” and results are presented in both Système International and conventional units without an appendix of conversion factors. A chapter might also have been included describing the different types of assays for glycosylated hemoglobin.

The sections on basic molecular and cellular biology are reason enough to obtain a copy of this book. The clinical sections are a bit less consistent, but they provide the most recent information in important therapeutic areas and give insight into the clinical future of diabetes and the prevention of its complications. Together, they make a unique textbook, worthy of being added to the libraries of clinicians and investigators.

Susan E. Kirk, M.D.
University of Virginia, Charlottesville, VA 22908