[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

[IP] Read this book review about treating kids with diabetes

Clinical Management of the Child and Teenager With Diabetes
by Leslie Plotnick and Randi Henderson, 268 pp, $24.95 paperback, 
Baltimore, Md, Johns Hopkins University Press, 1998.
Reviewed by
  David E. Goldstein, MD
 If one were to conduct a survey of 100 top pediatric endocrinologists in 
the United States regarding their approach to the management of 
congenital virilizing adrenal hyperplasia in children, the responses 
would likely differ little among the endocrinologists. Such 
intradisciplinary harmony would not be evident regarding management of 
diabetes mellitus because no one knows how to manage the disease 
satisfactorily. The fundamental inadequacy of our treatments has led to 
a wide variety of approaches, each with its champion who is firmly 
convinced that his or her approach is best. Regardless of the reason, 
the end result is something close to chaos when unsuspecting patients 
with diabetes change physicians.

The authors explain that this book is intended for primary care 
clinicians who, in the face of expanding managed care, will be 
responsible by necessity for diabetes management. The book is divided 
into an introduction and 13 chapters that cover the full range of 
patient care issues as well as more basic aspects of diabetes, including 
up-to-date information about the causes, classification, and diagnosis 
as well as "hot" research topics such as new insulin delivery systems 
and clinical trials on prevention of type I diabetes. The writing style 
is easy to follow with numerous case histories to illustrate the 
concepts. The text is replete with good illustrations and tables. In 
addition, the appendix has useful forms for home record keeping, sample 
letters for schools, a sample clinic assessment form, and a sample 
hospital clinical path form for management of diabetic ketoacidosis and 
for routine management. In addition, the appendix includes an excellent 
list of references and useful resources including diabetes-related Web 
sites. The chapters on medical presentation and initial management 
(chapter 2) and on psychological issues (chapters 11 and 12) are 
particularly well done.

The book does have notable gaps. The section on management of 
ketoacidosis does not even mention the use of serum -hydroxybutyric acid 
determinations for diagnosis and monitoring and the sections on sick-day 
management and insulin therapy do not provide enough specific 
information. Primary care clinicians may want to know just how to begin 
insulin treatment for a patient even though there are not many different 
ways to give insulin. I could not find any discussion of the American 
Diabetes Association Recognition Education Program or of the newer 
Provider Recognition Program; these are important to mention because 
reimbursement for diabetes care will likely require that the clinician 
and his or her hospital or clinic participate in the programs. The 
section on glycosylated hemoglobin is a bit outdated and should have 
included information on the National Glycohemoglobin Standardization 
Program, the American Diabetes Association–endorsed program for 
standardizing test results to Diabetes Control and Complications Trial 
values (the important Diabetes Control and Complications Trial results 
are well described). On a more philosophical note, I do not agree with 
the authors' contention that by age 10 years, children should be 
responsible for most of their diabetes care.

I would recommend the book to anyone who provides medical care for 
children with diabetes. Medical students, resident physicians, primary 
care clinicians, pediatric endocrinologists, nurse educators, 
dietitians, and behaviorists would benefit from reading the book.

Does the book achieve the goals stated in the preface, to provide 
information to help primary care clinicians care for children and 
adolescents with diabetes? My answer is a qualified yes; qualified 
because after reading this book, no intelligent primary care clinician 
would be willing to be responsible for the management of such a 
complicated medical condition.
David E. Goldstein, MD
Department of Child Health
Division of Diabetes and
University of Missouri Health
Science Center
One Hospital Drive, M766
Columbia, MO 65212
© 1999 American Medical Association. All rights reserved.
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml