Book Review

Controversies in Treating Diabetes: Clinical and Research Aspects

N Engl J Med 2008; 359:323-324July 17, 2008

Article

Controversies in Treating Diabetes: Clinical and Research Aspects
(Contemporary Endocrinology.) Edited by Derek LeRoith and Aaron I. Vinik. 367 pp., illustrated. Totowa, NJ, Humana Press, 2008. $139. ISBN: 978-1-58829-708-2

Shortly before his election as president, John F. Kennedy wrote, “Let us welcome controversial books and controversial authors.” To this statement we might add “and books on controversial medical topics,” since the book Controversies in Treating Diabetes demonstrates that valuable knowledge can be gained from studying controversial topics in the field of diabetes.

The book is part of the Contemporary Endocrinology series from Humana Press, whose target audience is practicing endocrinologists and researchers. The editors, Derek LeRoith and Aaron Vinik, faced a challenging task: they set out to address both the clinical and the research aspects of diabetes in a book with fewer than 400 pages. The result is a collection of short reviews that are refreshing in their brevity without being overly simplistic, providing an excellent tool for lecturers facing inquisitive students, for practitioners quizzed by well-educated patients, and for diabetologists wishing to update their knowledge on the issues of the day. Among the topics covered, that of diabetic neuropathy gets the lion's share with regard to space assignment, reflecting Vinik's expertise and accomplishments in this area. The book will be especially valuable to those interested in this field.

Given the lag time inherent in publishing such a book, the reader should not expect discussions on the most recent controversies concerning the use of thiazolidinediones or on the latest results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which found an unexpected association between intensive blood glucose control and increased mortality (an observation that led to the termination of this part of the study in February 2008). Many other controversial subjects are covered, however, all of them timely and fit for a good discussion. Examples are the subjects of the first two chapters, which, unlike most of the other chapters in this volume, focus on type 1 diabetes. They address the questions of whether or not to transplant as well as what to transplant. The editors chose from the leaders in their fields to tackle the various topics. Whereas David Sutherland and Angelika Gruessner present their unambiguous view on the controversial issue of solitary pancreas transplantation (and the merit thereof), Eric Liu and David Harlan take a more balanced approach to the subject of islet transplantation.

Infiltration of Lymphocytes around the Pancreatic Islets of a Patient with Type 1 Diabetes. (From Dr. Shields Warren, 1930.)

LeRoith and Vinik provide a helpful introduction to the book in the preface, but their organization of the material overall is less intuitive. They should be applauded for providing space for an entire chapter on childhood diabetes as well as for discussions on the role of depression in diabetes and the provocative question of whether weight loss is worth the effort in patients with diabetes. Not all of the 17 chapters focus on controversies in diabetes treatment; the occasional interloper, such as the review of a unifying hypothesis of diabetic complications by Takeshi Matsumura and Michael Brownlee, is a useful appraisal of this complex issue. Most chapters do, however, contain succinct reviews of therapeutic topics that provide a general, balanced view, together with treatment tips that take into account the needs of individual patients, such as prescribing early insulin treatment in type 2 diabetes or intervening in a patient with the metabolic syndrome.

Although I recognize that the topic of controversies in treating diabetes might fill heftier books that would still not be considered all-inclusive, two major topics remain on my personal wish list for future contributions to the Contemporary Endocrinology series: stem-cell research and its implications for the future treatment of type 1 diabetes, and the role of bariatric surgery in the management of type 2 diabetes. In this book, however, the interested reader will find plenty of valuable information with the help of the detailed index, an item that is often less comprehensive in multiauthored, multisubject books. Thus, despite the absence of a report on the latest results of the ACCORD trial, a description of the trial and its implications can be easily found. In summary, LeRoith and Vinik have assembled a cast of excellent clinicians and investigators to share background information, data, experience, and opinions around a virtual roundtable.

Kristina I. Rother, M.D., M.H.Sc.
National Institutes of Health, Bethesda, MD 20892
kr58q@nih.gov