Diabetes and its Management [antikvár]

Preface to the Sixth Edition A new energy and commitment to treatment entered the field of diabetes at the beginning of the 21st century. The introduction of new technologies and new medications raise expectations for better outcomes. They bring potential for improvements to the health of diabetic patients and diminish the impact of its complications. New standards of care have been established as a result of the two hugely influential trials of the 1990s, the North American Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS), each demonstrating the effectiveness of tight blood glucose (and, for UKPDS, blood pressure) control in retarding complications in Type 1 and Type 2 diabetes respectively. Prospects of cell therapy for Type 1 diabetes, and of prevention strategies for Type 2 diabetes are tantalizing prospects for the future. Government now acknowledges the impact of diabetes as a major public health problem, perhaps especially because of the projected increase in the prevalence of Type 2 diabetes. The UK's National Service Framework for diabetes, announced in 2002, sets out in detail the requirements for modern diabetes care and following this important statement it is to be hoped that appropriate resources for its implementation will follow. Already a national eye screening scheme has been established in Wales, providing a model for its extension to the rest of the UK. In many ways, the field of diabetes care has led the way for modern management of chronic diseases by early establishing the teams of professionals needed to offer complex programmes for the optimal care of those with diabetes and starting the integration of primary and secondary care. The role of specialist nurses remains one of the linchpins of diabetes care and the recent establishment of consultant nurses gives them a new impetus. It is appropriate in this sixth edition to introduce new authors for this book, namely Professor Stephanie Amiel, R.D. Lawrence Professor of Diabetic Medicine, and Mrs Eileen Turner, Nurse Consultant, both at King's. At the same time we acknowledge the earlier contribution of Dr Paul Drury who now heads diabetes services in Auckland, New Zealand. The book has been extensively rewritten. Our aims remain those of the original authors, namely that it should be of practical help for doctors caring for patients both in hospital and in general practice and to the growing number of diabetes specialist nurses who have committed themselves to this work. It is intended as an aide-memoire for the experienced and as a guide for those in training, including those preparing for higher examinations. It is also intended that it should help interested students who would like to expand their knowledge of diabetes beyond that of standard textbooks. We hope that many other specialists—obstetricians, ophthalmologists, renal physicians and cardiovascular physicians and surgeons, involved in the care of diabetic patients—^will also find helpful information in this book. Throughout, our inspiration has come from those who first conceived and delivered this book. We hope that the thoughtfulness and wisdom of the late Drs Wilfrid Oakley, David Pyke and Professor Keith Taylor, all of whom made immense contributions to the study of diabetes and to the care of their many patients, will live permanently in its pages. King's Diabetes Centre King's College Hospital London SE5 9RS Peter WnfA-i/is Stephanie Aniiel Simoti Howell Eileen Turner vii