Second edition. Arnold Bloom and John Ireland. 137 pages. St. Louis, Missouri: Mosby Year Book, Inc.; 1992. $59.95.

Caring for diabetic patients is a time-intensive undertaking because of the acute metabolic complications and the chronic complications that may involve any organ in the body. The idea behind the graphic presentation of the clinical and histologic manifestations of diabetes is that a picture is worth a thousand words (or the time involved in reading that much). Strong sections of the book include histologic sections of diabetic pancreas and kidney that help visualize the pathologic process resulting in the clinical manifestations. Clinical findings shown in the chapter on eye disorders as well as the skin and connective tissue changes in diabetes were clear and helpful in identifying unusual disorders that may present in a general medical practice.

Overwhelming this useful information is the irritation resulting from reading a simplistic text alongside pictures which range from normal appearing children and adults to complicated pathologic processes only occasionally demonstrated by arrows. Although the text has been expanded from the first edition, it is nothing more than a briefly descriptive listing of topics, which is not referenced for further reading. The chapter on management is new but suffers from the same general survey approach found in other chapters. Practical use of information in the text is severely limited by a lack of depth rather than decreased scope. Although conceived to be brief, the text is too superficial for any medical student and provides no direction for obtaining additional information.

A minor problem with the book is the large number (10% to 15%) of useless illustrations such as patients with pheochromocytoma and cirrhosis or normal appearing diabetic children, adults, twins, and even parents of diabetic persons; in addition, there are 21 separate photographs of foot ulcers. Although these pictures hammer home that diabetics appear normal, they waste the time of readers who search the illustrations trying to decipher why they were included in the book.

Finding the gems in this atlas is not easy. The complex mixture of simplistic text, repetitive illustrations with no information, and detailed histologic photoµgraphs makes recommendation of this text to any single group of diabetic care-givers impossible. The reader is left with a survey approach to diabetes that is too unbalanced to provide useful general information.