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Am Fam Physician. 1998;58(5):1224-1227

The Johns Hopkins Guide to Diabetes: For Today and Tomorrow

By Christopher D. Saudek, Richard R. Rubin and Cynthia S. Shump. Pp. 422. Price, $16.95. Johns Hopkins University Press, 2715 N. Charles St., Baltimore, MD 21218-4319, 1997.

In this book, the authors bring together the essence of the Johns Hopkins Diabetes Center's teaching program. Each author is an expert in the field and is qualified to discuss the issues facing the patient with diabetes mellitus and his or her interactions with family and employment. Organized into six sections, the book takes the reader through “Understanding Diabetes,” “Controlling Diabetes,” “Living with Diabetes Mellitus,” “Complications,” “Sexuality—Pregnancy & Genetics,” and “The Future of Care.”

The audience for this book is broad and could include the patient with newly diagnosed diabetes, patients with long-established diabetes, their families, and physicians who may feel uncomfortable with caring for this heterogenous population of patients. It presents the care of diabetes in a very positive manner, one that engages the patient to learn about his or her illness and to take the responsibility for its day-to-day as well as long-term management. Each chapter begins with a series of quotations from patients who have attended the Diabetes Center and develops a discussion of the issues relevant to these patient concerns. These vignettes help the reader to identify with the issues discussed in the book.

The chapters that work best are those that deal with the psychologic issues attendant to diabetes. These are highly engaging, easy to read and understand, and convey direct positive advice. Included are chapters on helping the patient take control of doctor visits by coming with a list of prioritized issues, and to work constructively with the physician to obtain advice and recommendations for management and support. In particular, the discussions of denial, obsession, anger, frustration, fear and guilt are handled positively.

The chapters dealing with the pathophysiology and pharmacology of diabetes are somewhat more difficult to digest. Admittedly, this is an extremely broad area to cover and is difficult to explain to patients as well. The intricate balance of diet, medication and exercise; the impact of obesity, stress, infection, and cyclical variation in the body's hormonal milieu; and the variability of medication programs cannot be explained in a simple discussion. Nor can there be a discussion of hypo-and hyperglycemia without generating an inordinate amount of fear and trepidation. Perhaps this is as good as can be done in any format: present the facts in an objective manner and encourage discussion relevant to the patient's needs.

The book contains a few diagrams to help the reader grasp these interrelationships. Although the discussion of a nutritional diet is well done, there is little emphasis placed on carbohydrate counting.

Tremendous advances in diabetes care were made in 1996 and 1997. For that reason, some sections of the book already seem out of date. There is little discussion about combinations of different classes of oral agents. Lispro is covered, although not in great detail. Discussion of therapies for impotence do not mention alprostadil suppositories or sildenafil (Viagra). The authors readily admit that much is yet to be learned in diabetes management. Indeed, their chapter on Diabetes Research is full of promising hints of advances poised in the wings.

The early chapters dealing with controlling diabetes are more difficult for physicians to read. Perhaps this comes from the perspective of a physician who deals with these complex issues in his or her way on a daily basis. As physicians, we tend to lose sight of the notion that this information is all new to many of our patients. If nothing else, these chapters will serve as a springboard for patient-physician dialogue.

The last chapter, “The Prognosis,” is very positive. I thought that this chapter would have made a better introduction to the book. Imagine having the patient who is scared to death about the dreaded diagnosis of diabetes read a very upbeat and supportive description of what his or her life can be like. This chapter sets the framework that forms the basis for all of the discussions in the book. If you recommend this book to your patients, be sure to have them start at the end!

Practical Guide to the Care of the Medical Patient

Edited by Fred F. Ferri. Pp. 1138. Price, $32.95. 4th ed. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318, 1998.

Comprehensive is the best way to describe the fourth edition of Care of the Medical Patient, a volume in the Practical Guide series. First published 10 years ago, the manual has greatly increased in size, now containing more than 1,000 pages, not including the index.

Aimed at the physician-in-training who needs practical information immediately, this spiral-bound book is also useful for practicing physicians and other health care providers. Approximately 600 pages are devoted to discussions of various organ systems and their diseases. These chapters emphasize the clinical presentations, evaluations and treatments of certain conditions, with less emphasis on pathophysiology and epidemiology. The treatments recommended are, as acknowledged in the preface,“conservative,” but are generally adequate. The book often includes helpful suggestions on what to consider if the proposed therapeutic regimen does not improve the patient's condition within a certain length of time.

Other chapters will be appreciated by medical students and residents, as they discuss the approach to the medical patient, cardiopulmonary resuscitation and how to evaluate various data, such as urine sediment and chest radiographs. A section on differential diagnosis is a list of possible causes of 65 symptoms and signs from halitosis to coma. These lists do not always present the possibilities in order of likelihood, and so they may encourage a “shotgun approach” in the work-up, rather than a more considered evaluation of a symptom or sign.

Some chapters are lacking. For example, the chapter on dementia has tables to aid in differentiating delirium from dementia, and it discusses the initial evaluation of dementia. However, although neuroimaging is mentioned as a test to consider, no guidance is given on when to consider it. Of more concern is the absence of treatment recommendations for those diagnosed with Alzheimer's disease or other dementing illnesses. Whether this represents therapeutic nihilism or whether a decision was made to include this information in the Practical Guide to the Care of the Geriatric Patient is unclear. At any rate, it is a conspicuous omission in a book that covers as much ground as this one does.

The manual organizes much of its information in tables, charts, drawings and full color figures, all of which are quite clear and useful. Text is presented in outline form, making it easy to find information. A formulary presents available forms, recommended dosages, indications, contraindications and side effects of many medications. There are also tables comparing different medications in a class. Finally, a section on interpretation of laboratory results provides normal values as well as lists of situations in which a test may be elevated or decreased.

If a resident or a student is limited to a single portable resource on a busy general medicine service, this is it, although it should be kept in mind that it will take up a lab coat pocket on its own.

Also Received

A Delicate Balance: Living Successfully with Chronic Illness

By Susan Milstrey Wells. Pp. 280. Price, $27.95. Insight Books, 233 Spring St., New York, NY 10016, 1998.

Activity-Based Costing and Activity-Based Management for Health Care

Edited by Judith J. Baker. Pp. 416. Price, $76.00. Aspen Publishers, 200 Orchard Ridge Dr., Ste. 200, Gaithersburg, MD 20878, 1998.

Advanced Nutrition: Micronutrients

By Carolyn D. Berdanier. Pp. 236. CRC Press, 2000 Corporate Blvd., NW, Boca Raton, FL 33431, 1998.

Basic Family Therapy

By Phillip Barker. Pp. 297. Price, 36.50. 4th ed. Oxford University Press, 198 Madison Ave., New York, NY 10016, 1998.

Beauty and the Beam: Your Complete Guide to Cosmetic Laser Surgery

By Deborah Sarnoff and Joan Swirsky. Pp. 318. Price, $23.50. Quality Medical Publishers, 11970 Borman Dr., Ste. 222, St. Louis, MO 63146, 1998.

The Challenge of Fetal Alcohol Syndrome

Edited by Ann Streissguth and Jonathan Kanter. Pp. 284. Price, $17.95. University of Washington Press, P.O. Box 50096, Seattle, WA 98145-5096, 1998.

Conquering Headache

By Alan Rapoport and Fred Sheftell. Pp. 98. Price, $17.95. 2d ed. Empowering Press, 4 Hughson St. South, P.O. Box 620 LCD1, Hamilton, Ontario L8N 3K7, 1998.

The Diabetes Eye Care Sourcebook

By Donald S. Fong and Robin Demi Ross. Pp. 278. Price, $30.00. Lowell House, 2020 Avenue of the Stars, Ste. 300, Los Angeles, CA 90067, 1998.

Her Healthy Heart: A Woman's Guide to Preventing or Reversing Heart Disease Naturally

By Linda Ojeda. Pp. 352. Price, $14.95. Hunter House, P.O. Box 2914, Alameda, CA 94501, 1998.

Living with Heart Disease

By Marie R. Squillace and Kathy Delaney. Pp. 288. Price, $30.00. Lowell House, 2020 Avenue of the Stars, Ste. 300, Los Angeles, CA 90067, 1998.

Physicians' Current Procedural Terminology

Edited by AMA CPT Editorial Staff. Pp. 588/327. 4th ed. AMA, 515 N. State Street, Chicago, IL 60610-9986, 1998.

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