Diabetes in Childhood and Adolescence
http://www.100md.com
《新英格兰医药杂志》
For several reasons, type 1 diabetes mellitus is a most vexing disease for both the generalist and the specialist. First, as in other autoimmune conditions, the cause of the disease is unknown, and thus no specific cure is available. Second, the current treatment used for most patients is the administration of insulin. Unfortunately, insulin treatment has not undergone important changes since the purification and parenteral administration of insulin began 80 years ago, although there have been considerable improvements in the purity of the drug, in administration devices, and in glucose-monitoring systems. Thus, most patients still have to apply elaborate protocols of insulin, diet, and exercise to maintain relatively normal glucose levels and avoid hypoglycemia. Third, whereas the treatment of motivated adults is difficult enough, the treatment of children and adolescents, for obvious reasons, is even more challenging.
(Figure)
Photomicrograph of Crystallized Insulin.
Dennis Kunkel/Phototake.
Diabetes is one of the most common metabolic diseases of childhood, and therefore it is very important for the clinician to be up to date on this disease. Good textbooks on this subject are always needed to help clinicians hone their skills in the treatment of patients with diabetes. Diabetes in Childhood and Adolescence brings together a series of articles by experts in the United States, Europe, and Israel that cover the spectrum of the disease in this age group. Its 21 chapters are generally succinct, well written, and informative. The editors' aims were to produce a work that would increase physicians' understanding of diabetes in children and adolescents and to summarize the most recent scientific discoveries. To a large extent, they have succeeded. The first several chapters, on the pathogenesis of the disease, susceptibility, and autoimmunity, are complementary and provide good coverage of these areas. The chapters on insulin administration, diet, and exercise are informative. The chapters on complications — including macrovascular disease, neuropathy, nephropathy, and retinopathy — are especially interesting. Also included are complementary chapters on adolescence, neonatal diabetes, maturity-onset diabetes of the young, and type 2 diabetes in childhood.
As with many books of this type, there is room for improvement. Given the general enthusiasm for islet transplantation in certain centers, I believe that there should have been a longer discussion of this subject, as well as a longer discussion of gene therapy and other new approaches to treating type 1 diabetes, such as the use of stem cells. It also would have been helpful to have a chapter on management of the hospitalized patient.
In general, however, I liked this book and can strongly recommend it to physicians in pediatric and family practices who care for young patients with diabetes, as well as trainees in endocrinology and metabolic diseases.
Ira D. Goldfine, M.D.
University of California, San Francisco
San Francisco, CA 94143((Pediatric and Adolescent)
(Figure)
Photomicrograph of Crystallized Insulin.
Dennis Kunkel/Phototake.
Diabetes is one of the most common metabolic diseases of childhood, and therefore it is very important for the clinician to be up to date on this disease. Good textbooks on this subject are always needed to help clinicians hone their skills in the treatment of patients with diabetes. Diabetes in Childhood and Adolescence brings together a series of articles by experts in the United States, Europe, and Israel that cover the spectrum of the disease in this age group. Its 21 chapters are generally succinct, well written, and informative. The editors' aims were to produce a work that would increase physicians' understanding of diabetes in children and adolescents and to summarize the most recent scientific discoveries. To a large extent, they have succeeded. The first several chapters, on the pathogenesis of the disease, susceptibility, and autoimmunity, are complementary and provide good coverage of these areas. The chapters on insulin administration, diet, and exercise are informative. The chapters on complications — including macrovascular disease, neuropathy, nephropathy, and retinopathy — are especially interesting. Also included are complementary chapters on adolescence, neonatal diabetes, maturity-onset diabetes of the young, and type 2 diabetes in childhood.
As with many books of this type, there is room for improvement. Given the general enthusiasm for islet transplantation in certain centers, I believe that there should have been a longer discussion of this subject, as well as a longer discussion of gene therapy and other new approaches to treating type 1 diabetes, such as the use of stem cells. It also would have been helpful to have a chapter on management of the hospitalized patient.
In general, however, I liked this book and can strongly recommend it to physicians in pediatric and family practices who care for young patients with diabetes, as well as trainees in endocrinology and metabolic diseases.
Ira D. Goldfine, M.D.
University of California, San Francisco
San Francisco, CA 94143((Pediatric and Adolescent)