Book Review
Type 2 Diabetes Mellitus: An Evidence-Based Approach to Practical Management
N Engl J Med 2009; 360:549January 29, 2009
- Article
Type 2 Diabetes Mellitus: An Evidence-Based Approach to Practical Management
(Contemporary Endocrinology.) Edited by Mark N. Feinglos and M. Angelyn Bethel. 474 pp., illustrated. Totowa, NJ, Humana Press, 2008. $139. ISBN: 978-1-58829-794-5Changes in lifestyle that promote obesity and physical inactivity have led to a global increase in the prevalence of type 2 diabetes and its coexisting diseases among people of all ages. Given the numerous articles that have been published about diabetes, a synthesis of the evidence supporting current practices is the cornerstone of a successful approach to this public health problem. Written by an expert team of collaborators and edited by Mark Feinglos and M. Angelyn Bethel, this book contains information on most topics related to type 2 diabetes, and the best evidence is integrated into a practical understanding of the disease and its treatment.
There is discussion of epidemiologic information about the increase in type 2 diabetes, not only in adults but also in children, adolescents, and the elderly. The pathogenesis of type 2 diabetes and its complications, as well as the metabolic mechanisms that are involved in insulin resistance, are masterfully presented. Emphasis is placed on the role that an increase of plasma-free fatty acid plays in the impairment of insulin sensitivity and insulin secretion.
There are also practical recommendations for nutrition therapy and exercise training. Although the health benefits of exercise and the effectiveness of nutrition in the treatment of diabetes are well documented, physicians are often poorly trained in these topics. The authors of this book introduce readers to the basic elements of realistic strategies for helping patients to initiate good nutrition and physical activity.
Despite the existence of numerous effective pharmacologic treatments for diabetes and its coexisting diseases, the frequent failure to achieve recommended treatment goals is a major challenge. The suboptimal systems for the delivery of diabetes care, the failure of some clinicians to adopt a treat-to-target approach, patients' lack of adherence to pharmacologic and nonpharmacologic therapies, and the issue of the cost of care are among the many barriers to optimal outcomes in diabetes care. The authors of this book assert that the system of traditional health care is not appropriate, emphasizing the scarcity of multidisciplinary teams that can provide comprehensive services and the frequently passive attitudes of physicians who ignore the point that the outcome is in the hands of the patient.
In summary, this book, written in an easily read format, must be placed among the required readings for those who seek a comprehensive understanding of the nature and treatment of type 2 diabetes.
Fernando Guerrero-Romero, M.D., Ph.D.
Mexican Social Security Institute, 34067 Durango, Mexico
guerrero_romero@hotmail.com
