Foreword

Diabetes mellitus is likely to become one of the most prevalent and economically important diseases of the 21st century largely owing to an increasing incidence of type 2 diabetes mellitus (DM) in the developed nations and many of the developing nations. Every physician will encounter a patient who has diabetes. Multiple factors, both environmental and genetic, contribute to the pathogenesis of the disease. Type 2 DM is particularly common in obese sedentary populations, while type 1 DM can have a dramatic onset and be a major therapeutic challenge.

Rarer conditions such as acromegaly, Cushing's disease and hemochromatosis may cause or exacerbate diabetes. If the hyperglycemia of diabetes is not adequately treated, potentially devastating micro- and macrovascular complications might ensue. It follows that all physicians need to be familiar with this condition and its array of complications and associations. However, owing to the sheer volume of information related to this area of medicine, it is difficult for the busy practitioner to keep up to date.

The third edition of Ian Scobie's Atlas of Diabetes Mellitus, building on the success of the two previous editions, goes a long way towards making this task easier and remains a testimonial to the fact that a picture is indeed worth at least a thousand words. This Atlas begins with a brief overview of the diagnosis, pathogenesis and treatment of diabetes with special reference to the complications of diabetes and the treatment of children and adolescents. Specific chapters cover diabetic dyslipidemia, diabetes and pregnancy and what it is like to live with this chronic condition. These, and other sections, set the stage for the multitude of highly informative illustrations which follow. Most specialists in diabetes have seen real-life examples of the disease processes presented in this book but some may be very unfamiliar to the generalist.

For specialists, however, many years of practice are required to accumulate this experience. How often does a non-specialist see a patient with Prader-Willi syndrome, acromegaly or Rabson-Mendenhall syndrome? A quick glance at Figures 9,12 and 18 will help to imprint the appearances of each of these syndromes. Many physicians caring for people with type 1 DM know of autoimmune destruction of the p-cell, but what exactly does this mean? Figures 27-35 and their legends take the reader through this topic. What is the best way to treat patients with type 1 DM? An important step is to attempt to reproduce the normal fasting and post-prandial insulin profiles. How is this done and what insulin preparations are available to achieve it? Figures 50-62 provide a step-by-step overview aimed at helping the practitioner learn, rather than simply memorize, the requisite information.

Every patient with diabetes should undergo examination of the fundus at least once a year by a physician who is familiar with the manifestations of diabetic retinopathy. This is not always an easy task. How does one distinguish early background retinopathy from the more serious high-risk retinopathy? Figures 81-102, to a large extent, constitute a user's guide to examination of the diabetic fundus. Similarly, Figures 104-34 show excellent examples of other common and not-so-common manifestations of diabetic microvascular and macrovascular complications. A

wide array of skin and other manifestations and associations of diabetes is demonstrated.

Many excellent and comprehensive textbooks of diabetes are available, but I am unaware of any other illustrated text with the scope and breadth of Dr Scobie's Atlas of Diabetes Mellitus. I am delighted to write a foreword to the third edition of this wonderful and successful Atlas and more than delighted to keep my own personal copy. I have no doubt that both my students and I will continue to find this book useful for many years to come. I suspect that those of you who choose to add this excellent Atlas to your library will find that you will also share my enthusiasm for this delightful book.

Robert A Rizza, md Rochester, MN

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