Diabetes in Women: Pathophysiology and Therapy

Abstract

This book is written for clinicians and scientists with an interest in diabetes, endocrinologists, obstetricians, gynaecologists, generalists, as well as students and trainees in these areas of health. Each chapter has been written by authors who are well known in their respective fields. In the preface the editors explain that they have structured the book into five sections: (1) sex differences in cardiometabolic risk; (2) impact of diabetes on women's health; (3) diabetes and pregnancy; (4) offspring of the diabetic mother; and (5) the disease management of women with diabetes. Unfortunately, the book is then organized into 23 chapters without any sections. With the book's overwhelming bulk at almost 500 pages, the reader would have appreciated logical divisions of the broad subjects. Different chapters without structured divisions in the book give a chaotic first impression. After the first interesting chapter on sex differences in energy balance comes a chapter on menopause and diabetes and thereafter a chapter on cardiovascular disease (CVD) in women with diabetes. Temporal sequence of chapters would have been more logical. The first chapter summarizes the sex differences in energy balance, body composition and body fat distribution. The third chapter on CVD in women with diabetes discusses the effects of diabetes on platelets, coagulation and endothelium. Only a short chapter is devoted to treatment of CVD in women with diabetes. The chapter on developmental programming of polycystic ovarian syndrome (PCOS) reveals new insights into the development of PCOS. Could this syndrome be due to androgen excess in utero? The multiple speculations in this chapter are exhausting. The chapter on anthropological views of the impact of poverty and globalization on the emerging epidemic of obesity is stimulating, but at the end the text is too general and the diabetic woman is missing. Chapter 7 deals with eating disorders and depression. Both are more common in women than in men and could lead to an increased risk of diabetes. But I expected some biological explanations for how depression could be related to diabetes, not only via obesity and eating disorders. One entire chapter is dedicated to pre-eclampsia. Only half a page contains information on diabetes and pre-eclampsia, namely on diabetic nephropathy. The authors also fail to mention the known association between previous pre-eclampsia and subsequent diabetes later in life. The chapters are mainly well written, perhaps too long and containing a large number of references (100–200 per chapter). This reduces readability significantly. Many chapters overlap, e.g. chapters 3 and 4 on cardiovascular risk factors and chapters 4 and 5 on hyperandrogenism. There are three chapters on PCOS. In many chapters concepts are revisited, e.g. endothelial dysfunction. The book would have benefited from more harmonization of the chapters, more good quality figures and less text and references. Despite these criticisms, this is a thorough and informative text on diabetes in women.