Holt Tim A. - ABC of Diabetes

1. Chapter 01
2. Chapter 03
3. Chapter 04
4. Chapter 05
5. Chapter 06
6. Chapter 07
7. Chapter 08
8. Chapter 09
9. Chapter 10
10. Chapter 13
11. Chapter 15
12. Chapter 17
13. Chapter 18

1. Chapter 01
2. Chapter 02
3. Chapter 03
4. Chapter 04
5. Chapter 05
6. Chapter 06
7. Chapter 07
8. Chapter 08
9. Chapter 09
10. Chapter 10
11. Chapter 11
12. Chapter 12
13. Chapter 13
14. Chapter 14
15. Chapter 15
16. Chapter 16
17. Chapter 17
18. Chapter 18
19. Chapter 19
20. Chapter 20
21. Chapter 21

Seventh Edition

This edition first published 2015, 2015 by John Wiley & Sons, Ltd
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Library of Congress Cataloging-in-Publication Data

Holt, Tim A., author.
ABC of diabetes / Tim Holt, Sudhesh Kumar. Seventh edition.
p. ; cm. (ABC series)
Includes bibliographical references.

ISBN 978-1-118-85053-4 (pbk.)
I.Kumar, Sudhesh, author.II.Title.III.Series: ABC series (Malden, Mass.)
[DNLM: 1.Diabetes Mellitus.WK 810]
RC660.4
616.462dc23

2015018781

A catalogue record for this book is available from the British Library.

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Cover image: AlexRaths/Getty

Aresh Anwar
Royal Perth Hospital, WA, Australia

Gurdev Deogon
Warwick Medical School, University of Warwick; and WISDEM, University Hospital, Coventry, UK

Tim Holt
Nuffield Department of Primary Care Health Sciences, Oxford University, UK

Noreen Kumar
St Jamess Hospital, Leeds, UK

Sudhesh Kumar
Warwick Medical School, University of Warwick; and WISDEM, University Hospital, Coventry, UK

Vinod Patel
Institute of Clinical Education, Warwick Medical School, Coventry; and George Eliot Hospital, Nuneaton, UK

Sailesh Sankar
WISDEM, University Hospital, Coventry and Warwickshire, Coventry, UK

Ponnusamy Saravanan
Clinical Sciences Research Institute, Warwick Medical School, Coventry; and George Eliot Hospital, Nuneaton, UK

When I was a medical student in the late 1970s, diabetes was depicted to us as a disease of the pancreas, present in one per cent of the population and treated mostly in specialist centres by people called diabetologists. Type 1 diabetes was what young people had, and Type 2 was the kind you got when you were old. On my vascular firm, I clerked in a succession of diabetic patients (all smokers) who were booked for amputations. On my ophthalmology firm (in the days before systematic retinal screening), I regularly saw advanced, sight-destroying diabetic retinopathy. On my antenatal firm, I saw a stillborn infant delivered to a mother whose gestational diabetes had gone undiagnosed and (therefore) untreated.

What a long time ago that was!

These days, the prevalence of diabetes in the UK has risen to over 4% of the adult population, and Type 2 diabetes (a vascular disease as much as an endocrine one) occurs in schoolchildren, as well as in old people. It is now managed mainly by the person with diabetes (remember that, as these authors rightly point out at the end of , for most of the time, people with diabetes are not ill), supported by their primary health care team and with occasional input from specialists.

Advances in drug therapies, along with developments in the organisation and delivery of diabetes services (such as: nurse-led education; primary care based registration and surveillance; national programmes of retinal screening and smoking cessation support (together with a social trend of falling smoking rates); pro-active preconception and antenatal care; and fast-track referral services for acute problems), have made the ghastly, life-changing complications of diabetes extremely rare. People with diabetes now expect to live normal lives. Some have ruled countries, made millions, been Bond Girls, swum the Channel or climbed Everest.