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Book Review Malins clinical diabetes

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Malins? Clinical Diabetes 2nd edition
Malcom Nattrass, Chapman & Hall, London, UK. 1996. No. of pages 401 Price
�, Hardback ISBN 0 412 30860 6
The search for an ideal textbook by the
present day diabetologist can be likened
to the quest for the proverbial golden
fleece. A book that combines, in the right
proportion, basic science and clinical
diabetes would reflect the need of most
clinicians who encounter diabetic patients
in everyday practice. Malins? Clinical
Diabetes? second edition goes a long way
to satisfying this requirement.
This edition differs from the first in many
ways. It reflects the new developments and
progress in the field of diabetes, from
its biochemistry, molecular biology to
pancreatic and islet cell transplantation.
There is also a refreshing of our memory
on the historical aspects of diabetes. We
are led on a journey from ancient views
on the causation of diabetes to the discovery of insulin by Banting and Best in
the very first chapter, setting the frame
for an enlightening read.
The emphasis on the clinical aspects
of diabetes is maintained. From the pathogenesis of diabetes, through its clinical
features and management, to a very
comprehensive description of its complications, it holds your attention in its clear
analytical style. In areas of contention
and continued debate, the author gives a
balanced view of the topic, e.g. in the
section on the Definition and Diagnosis
of Diabetes. This gives the reader an
opportunity for broadminded thinking and
the feel for the need for continued
I found the chapters on diabetes in
pregnancy and children particularly interesting. The data and material presented
here are easily understood and can be
applied readily to the practical problems
usually faced in these situations. It will
help expand the scope of knowledge of
the clinicians who do not encounter
these groups of patients in their everyday
practice. I would, however, have liked to
see more on the best way to monitor
glycaemic control in pregnancy, the relative merits of pre- and postprandial blood
glucose control, and the shortcomings of
using either glycosylated haemoglobin
or fructosamine. An elaboration on the
importance of pre-conception care and
how to ensure this is carried out effectively
in the diabetic clinic would also have
been a bonus. I also do not share the
author?s scepticism on the term ?relative
hypoglycaemia?; symptomatic hypoglycaemia is known to occur at ?normal?
glucose levels in patients with poorly
controlled Type 2 diabetes and has been
demonstrated during formal studies. It will
appear to be a real phenomenon.
Issues on the influence of diabetes
on employment, driving, exercise, life
insurance, etc. are dealt with in the last
chapter. There is a good description of
the existing literature in this field. The
limitations of diabetes on lifestyle and
how they can be overcome or accommodated is addressed. The grey area of legal
implications of hypoglycaemia, and its
possible consequences, while driving are
also discussed, with examples.
There are a few typographical errors
(such as the footnote of figure 18.1) and
I found the book relatively sparse on
illustrations and photographs. Otherwise,
I found it well written in a clear, succinct
style. Its chapters have been extensively
researched and detailed. Its manner allows
for relaxed reading, at the same time
arming us with the knowledge we require
to deal with diabetes as we approach
the 21st century. This book is highly
recommended to the clinical diabetologist
who encounters diabetes in its infinite
variety of manifestations.
S.E. Joseph
King?s College School of Medicine and
The Origins and Consequences of Obesity.
CIBA Foundation Symposium 201. Edited
by W.P.T. James.
John Wiley & Sons, Chichester, 1996.
No. of pages 288. Price �.50, hardback
ISBN 0 471 96506 5
Readers of Diabetic Medicine would do
well to take obesity seriously. The best
estimates for the incidence rates for new
cases of NIDDM show that 85?95 %
of middle-age onset NIDDM occurs in
overweight people, and that the odds ratio
in very obese people rises to somewhere
between 50 and 120-fold increased risk.
A book on The Origins and Consequences
of Obesity is clearly therefore relevant
to diabetologists.
This book results from one of the CIBA
foundation?s regular symposia. In this case
their generous funding and farsighted
internationalism allowed Professor Gerry
Shaper to pull together a boldy eclectic
mix of scientists for an innovative meeting
in Kingston, Jamaica. Innovative because
it brought together affluence and poverty;
two extremes which influence obesity in
paradoxical ways. In affluent countries it
is the poor who are most likely to
be obese, while in developing countries
obesity is almost totally confined to the
CCC 0742?3071/97/100892?02$17.50
? 1997 by John Wiley & Sons, Ltd.
urban rich who succumb to the new
?McDonaldization? of the world.
In this context the chapters by Terrence
Forrester and Rainford Wilks from Jamaica
are the most novel. In collaboration with
colleagues from Barbados and Maywood,
USA, and with the addition of data from
Nigeria and Cameroon, they paint a
fascinating picture of the inexorable rise
in obesity on the western edges of the
African diaspora (an astonishing 15 % of
African women in Maywood, USA have
a body mass index over 39 km m?2), and
of the associated changes in hypertension
rates. Their chapters report work still in
progress with many questions still to be
answered. Are we seeing the effects of a
selection of thrifty genotypes engineered
by the horrendous mortality in the slave
ships? Or will native Africans display the
same exceptionally high rates of obesity
if and when they adopt western lifestyles?
Paul McKeigue?s chapter on the metabolic consequences of obesity draws on
lessons from migrant studies. He illustrates
the greater susceptibility to NIDDM of
Asian and Afro-Caribbean migrants, and
highlights the distinction between the high
rates of lipid disturbance and CHD in the
former, and the lower rates in the latter.
Combining this with the data on hypertension rates in the Caribbean studies gives
a graphic picture of the emerging health
burden that will affect nations under
Most of the remaining chapters are in
the more classic mould of the Western
centric view of obesity, and as such are
less original though no less informative.
Bjo?rntorp outlines his complex theories
to describe the linkage between obesity
and NIDDM, but some of the discussants
clearly favoured simpler explanations.
Shaper gives an authoritative record of
the associations between obesity and
blood pressure, and touches on the paradox that incidence of stroke is declining
in spite of rapidly escalating obesity. He
attributes this to concurrent declines in
cigarette smoking, but does not address
the suggestion that obesity-related hypertension is more benign than essential
hypertension, and that the risks of obesity
may therefore be exaggerated in this
context. Bouchard provides a brief update
on the genetics of obesity, a field which
has been revolutionized (since his chapter
was written) by leptin, B3 receptors, and
UCP2 to name but a few.
Jackson examines the possibility that
obesity is programmed by nutrition in
utero. He cites the well-known follow-up
studies from the Dutch hunger winter by
Ravelli, but fails to convince that there is
substantive new evidence for an important
role of programming in terms of overall
adiposity. Blundell covers appetite, Astrup
examines the evidence for metabolic
defects, Ferro-Luzzi looks at physical
DIABETIC MEDICINE, 1997; 14: 892?893
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