Increasingly prevalent in both of its major forms, diabetes mellitus is demanding attention in all corners of the world from most, if not all, of the biomedical sciences. The body of available information is enormous and evolving. The perspectives and demands of the readership are diverse. The editors of this book have correctly perceived that timely, scholarly, concise reviews are critical to the guidance and indeed to the survival of physicians in this environment.

They have assembled a series of monographs dealing with selected topics of current importance in diabetes mellitus, topics ranging from gene transcription through insulin therapy to psychosocial implications. In selecting topics, the editors have attempted to define areas in which new information is available. The 34 chapters are organized into three sections. The first addresses basic issues, including insulin secretion, insulin action, carbohydrate metabolism, and the etiology, genetics, and epidemiology of type I and type II diabetes. Seven chapters then provide a succinct overview of the epidemiology of the long-term complications, economic burden, and mortality associated with diabetes. The final chapters deal with the pathogenesis of vascular and neural disease (for example, glycation, the sorbitol pathway) and the prevention and treatment of diabetes.

Most of the authors are from western Europe or the eastern United States. Many are outstanding authorities in their fields. Contributions have been written since the 1993 report of the Diabetes Control and Complications Trial (DCCT), which strongly supported the "glucose hypothesis" (namely, that uncontrolled hyperglycemia is a major contributor to the long-term complications of diabetes). This may be the first such book to have this perspective, which is reflected in the chapters on treatment and hypoglycemia (an unfortunate consequence of tight control in type I diabetes). It is of interest that the author of the chapter on the management of type I diabetes is critical of the insulin dosage adjustment schedule used in the intensively managed group in the DCCT. The earlier chapters on basic topics are excellent; in particular, the presentation on the structure of insulin flows nicely into the later chapter on the practical aspects of insulin administration and insulin analogs. Contrasting depths of presentation are found in the detailed analysis of insulin action compared with the rather superficial survey of glucose homeostasis. An interesting and perhaps unrecognized pathogenic mechanism is discussed in the chapter on glycation, in which "glyco-oxidative stress" brings together two increasingly well-recognized pathogenic processes. The chapters on proteinuria, pancreas transplantation, and the treatment of type II diabetes will be of particular interest to internists. Those new to the field will find material complementary to the traditional information found in standard textbooks on diabetes.

If a second edition is considered, summaries should be included after each chapter. Figure legends and tables should be reviewed for clarity. Cross-referencing among chapters would help the thoughtful reader, as would guidelines to authors to foster uniform depth of detail. The balance of the book's content would be improved by chapters on nutrition, exercise, treatment of diabetic neuropathies, and lipid metabolism.

This is an ambitious and successful attempt to bridge the gap between standard textbooks and the surprising number of diabetes journals presently available. The contributions are amply referenced, and the references themselves could serve as a resource for many of us in the scientific rationalization of our teaching, practice, and research.

N. Wilson Rodger, MD, FRCPC

St. Josephs' Hospital

University of Western Ontario

London, Ontario, N6A 4V2

Canada