Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome: The Primary Care Guide to Diagnosis and Management
http://www.100md.com
《新英格兰医药杂志》
I have worked all my professional life in a metabolic clinic. The referring doctors in the community know what we do there, but our patients are often confused. "Diabetes, and thyroid, you know," make for a simpler explanation to give to patients than going into detail about endocrinology and unusual hormones. The concept of the metabolic syndrome is even less well understood by the public. The word "metabolic" comes from the Greek word metabolikos, meaning "changeable" or "involving transition"; according to modern medicine, metabolism is the process in an organism by which nutritive material is built up into living matter (anabolism) or broken down into simpler substances (catabolism). The definition of the metabolic syndrome should therefore be obvious to those of us who work in the field of metabolism, but unfortunately, it is not. The concept arose from a cardiologic, lipidologic, and epidemiologic background, rather than from among diabetologists, who remain skeptical of it. In 2005, a joint statement by the American Diabetes Association and the European Association for the Study of Diabetes called for a critical appraisal of the syndrome: "Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the `metabolic syndrome'" (Kahn R, et al. Diabetologia 2005;48:1684-99).
So what of Codario's book on the subject? It is certainly topical, and I suspect it will be bought by doctors and nurses, as Neil S. Skolnik, the series editor, suggests in the introduction, "to update and improve their knowledge in the field of diabetes and the newly emerging science of the metabolic syndrome." It is not a textbook, although it is well referenced to the recent literature. Instead, the book is a guide for the practicing doctor whose informed patient has read something, or found something on the Web, about this new disorder called the metabolic syndrome. Such patients are very common in general practice; in the United States, according to the Third National Health and Nutrition Examination Survey (1988–1994), the prevalence of the metabolic syndrome among adults was 21 percent for the whole population and rose to 43 percent among those 60 years of age or older (Ford ES, et al. Prevalence of the metabolic syndrome among U.S. adults. JAMA 2002;287:356-9).
Edwin Gale, a professor of diabetic medicine at the University of Bristol, in England, in a satirical editorial (Diabetologia 2005;48:1679-83) likens the search for a definition to a blind man's exploration of an elephant. But it is rather strange that the currently widely used, though not identical, definitions come from the U.S. National Heart, Lung, and Blood Institute, the American Heart Association, and the National Cholesterol Education Program's Adult Treatment Panel. The members of these organizations are not blind, but they see things differently from the way diabetologists do.
Codario's readers will find an educational component in this book, either on the printed page or in the value-added eBook/PDA that can be downloaded from the accompanying CD-ROM. The book is didactic, well laid out, and written in short sentences, each containing one fact, which is usually referenced. It focuses on all the points raised by the experts who are trying to define the metabolic syndrome, but it ignores the call for a critical appraisal. The book certainly gives a current answer to specific clinical questions that will arrive in any consulting room. The title starts with "type 2 diabetes" (although this, too, has been difficult enough for diabetologists to define) and includes a new term, "pre-diabetes." Were these two terms put into the title to attract the reader? Pre-diabetes is not actually mentioned in the book, although the index lists impaired glucose tolerance — another problematic term for the definition experts.
Perhaps the most important part of the title is the subtitle, "the primary care guide to diagnosis and management." The book is exactly that, and, with its engaging practicality and its focus on day-to-day therapeutic problems (to say nothing of the continuing medical education questions that follow each chapter), it will provide a guide for doctors and nurses meeting a patient who mentions the metabolic syndrome. These doctors may well be cardiologists, lipidologists, or even epidemiologists, but they still need to know what to do, and this book will help. What Gerald Reaven, professor emeritus of medicine at Stanford University (who is perhaps thankful that his name is no longer attached to this conceptual can of worms), makes of these new concepts is uncertain, although he concludes in his own recent review of the evidence, "the diagnosis of the metabolic syndrome does not bring with it much in the way of pathophysiologic understanding or clinical utility."
Those of us on the front line of today's clinical practice will be happy to use this relatively brief, authoritative, and clearly written book to guide our medical decision making. No doubt, by the time a definition of the metabolic syndrome is agreed upon, the book will be out of date.
David R. Hadden, M.D.
Royal Victoria Hospital
Belfast BT12 6BA, United Kingdom((Current Clinical Practic)
So what of Codario's book on the subject? It is certainly topical, and I suspect it will be bought by doctors and nurses, as Neil S. Skolnik, the series editor, suggests in the introduction, "to update and improve their knowledge in the field of diabetes and the newly emerging science of the metabolic syndrome." It is not a textbook, although it is well referenced to the recent literature. Instead, the book is a guide for the practicing doctor whose informed patient has read something, or found something on the Web, about this new disorder called the metabolic syndrome. Such patients are very common in general practice; in the United States, according to the Third National Health and Nutrition Examination Survey (1988–1994), the prevalence of the metabolic syndrome among adults was 21 percent for the whole population and rose to 43 percent among those 60 years of age or older (Ford ES, et al. Prevalence of the metabolic syndrome among U.S. adults. JAMA 2002;287:356-9).
Edwin Gale, a professor of diabetic medicine at the University of Bristol, in England, in a satirical editorial (Diabetologia 2005;48:1679-83) likens the search for a definition to a blind man's exploration of an elephant. But it is rather strange that the currently widely used, though not identical, definitions come from the U.S. National Heart, Lung, and Blood Institute, the American Heart Association, and the National Cholesterol Education Program's Adult Treatment Panel. The members of these organizations are not blind, but they see things differently from the way diabetologists do.
Codario's readers will find an educational component in this book, either on the printed page or in the value-added eBook/PDA that can be downloaded from the accompanying CD-ROM. The book is didactic, well laid out, and written in short sentences, each containing one fact, which is usually referenced. It focuses on all the points raised by the experts who are trying to define the metabolic syndrome, but it ignores the call for a critical appraisal. The book certainly gives a current answer to specific clinical questions that will arrive in any consulting room. The title starts with "type 2 diabetes" (although this, too, has been difficult enough for diabetologists to define) and includes a new term, "pre-diabetes." Were these two terms put into the title to attract the reader? Pre-diabetes is not actually mentioned in the book, although the index lists impaired glucose tolerance — another problematic term for the definition experts.
Perhaps the most important part of the title is the subtitle, "the primary care guide to diagnosis and management." The book is exactly that, and, with its engaging practicality and its focus on day-to-day therapeutic problems (to say nothing of the continuing medical education questions that follow each chapter), it will provide a guide for doctors and nurses meeting a patient who mentions the metabolic syndrome. These doctors may well be cardiologists, lipidologists, or even epidemiologists, but they still need to know what to do, and this book will help. What Gerald Reaven, professor emeritus of medicine at Stanford University (who is perhaps thankful that his name is no longer attached to this conceptual can of worms), makes of these new concepts is uncertain, although he concludes in his own recent review of the evidence, "the diagnosis of the metabolic syndrome does not bring with it much in the way of pathophysiologic understanding or clinical utility."
Those of us on the front line of today's clinical practice will be happy to use this relatively brief, authoritative, and clearly written book to guide our medical decision making. No doubt, by the time a definition of the metabolic syndrome is agreed upon, the book will be out of date.
David R. Hadden, M.D.
Royal Victoria Hospital
Belfast BT12 6BA, United Kingdom((Current Clinical Practic)