Book Review: Type 2 Diabetes in Practice

Abstract

In the UK, the prevalence of all types of diabetes is 3-7%. It is even higher in certain ethnic groups, whilst the indirect costs of diabetes are currently estimated at 9% of total healthcare budgets. The aims of treatment for type 2 diabetes, which accounts for more than 90% of all patients with diabetes, are focused on optimizing quality of life, tight control of blood glucose and attention to a syndrome of associated risk factors. This requires input from a broad spectrum of disciplines and much of the work in improving diabetes care involves primary-care-led services—a strategy requiring much education and substantial resources. Many of these issues will be addressed by the Department of Health's soon-to-be-published National Service Framework (NSF) in Diabetes, so Krentz and Bailey's book is very timely. Type 2 Diabetes in Practice is the first in a series to be published by the RSM Press with the aim of presenting opinion-leader advice relevant to everyday clinical practice. It serves as a concise but comprehensive review of all aspects of the management of type 2 diabetes and is likely to be of greatest interest to those looking after diabetic patients in primary care. I approached this book as a consultant diabetologist who has been asked to coordinate diabetes care in the community. Although not detailed enough for a specialist's textbook, Type 2 Diabetes in Practice provides sufficient basic information to allow an understanding of all aspects of the management of type 2 diabetes, with evidence-based guidelines where available. It is clear that, although the most complex patients are managed within secondary care, the NSF will recognize that the greatest opportunities for improvement in quality and efficiency lie in refocusing the hospital services to the areas of greatest need. As a result, increasing numbers of patients with type 2 diabetes will be managed in primary care. The chapters deal with aetiology, pathophysiology and natural history while providing numerous evidence-based guidelines for management of all aspects of type 2 diabetes. Main points are highlighted, and brief but comprehensive references are provided. The tables and diagrams, particularly those dealing with molecular mechanisms, are clear. I was impressed by the references to recent trials suggesting benefits from ACE inhibitors such as HOPE and MICROHOPE and the inclusion of American Diabetes Association guidelines on glycaemic control. The NICE guidelines for the glitazones were obviously published after the book was written but a discussion of their potential role is included. In areas where evidence was less clear-cut I found myself agreeing with the practical advice being offered. Inevitably there are a few areas where omissions have occurred—for example the use of the anticonvulsant gabapentin in painful peripheral neuropathy. In conclusion, I will find this book very useful in the preparation of teaching programmes for primary care colleagues within my district.