Abstract
By Richard F Dods
Chichester: Wiley, 2013
426 pp, Price £66.65 (pbk)
ISBN 978-1-118-35009-6
Written by a distinguished American clinical chemist and researcher, this book intends to address diabetes from a biochemical rather than a clinical perspective. The author states that he aims to achieve a number of significant goals for a wide range of readers. Is he successful in this quest? This review is written from the perspective of a jobbing clinical chemist and diabetes clinician.
The scope of the book is what you might anticipate from the title. In the early sections, the narrative is somewhat stilted with a little too much detail for my liking; much of this information could be put into graphs and tables and not surprisingly has a particular American focus. In the subsequent historical review, the author seems to have got rather more into his stride. However, although the history of scientific discovery is interesting, there may be too much detail on glucose assays for the average reader.
The pace is maintained when moving on to glucose metabolism, although for most biochemists this is fairly basic stuff initially. There is an admirable description of ‘beautiful pathways’ and it is good to behold their mix of elegance and complexity. I liked the strategically placed summary boxes; for those undertaking exams they will be useful revision aids. The narrative continues to flow easily, making sometimes challenging biochemical concepts quite easy to follow. I think I would have grasped these concepts more easily as an undergraduate if I had had this book back in 1978.
The tricarboxylic acid cycle is well described with helpful figures. Although old hands will be confused by the enzyme name changes, this will be of no consequence to younger readers. Although so much detail is useful I am not sure it is strictly necessary for an understanding of diabetes. However, as a primer of carbohydrate metabolism, this material is spot on. It is also provides a good understanding of re-feeding syndrome, although somewhat glucocentric in approach. Further insight to fat metabolism and ketogenesis would have been helpful at this stage; fat metabolism is really only introduced later during the discussion of insulin signalling.
I was not too keen on having to flick back and forth through the pages to remind myself of a previously described pathway. Although the colour plates are nice, placing them in the middle of the book, unrelated to their chapters, is unhelpful. It would have been better had the publisher either sustained the cost of placing these items where they need to be or omitted them altogether.
In general, the clinical diabetes chapters are slightly less well done; there are one or two factual niggles and I am not sure clinicians will grasp ‘diabetes type 1.5’ as a concept. HbA1c should be described as glycated rather than glycosylated, and a picture of diabetic retinopathy would have been a useful addition for the non-diabetologist reader. Creatinine clearance is considered ‘a bit old hat’ these days. Given that estimated glomerular filtration rate (eGFR) has been in use for several years now, it is surprising that it gets no mention, especially as cystatin C does.
In contrast to the detailed description of carbohydrate metabolism, the acute complications of diabetic ketoacidosis and hyperosmolar coma are dealt with in a somewhat perfunctory manner. This is where I think the book has missed a trick. There is a real opportunity here to demonstrate to the reader what happens when normal physiology and biochemistry go wrong. This could then be contextualized by the clinical situation, which would effectively draw all the threads together. More detail here on the issue of lipolysis and protein catabolism would really help the reader understand how carbohydrate, lipid and protein metabolism are interconnected through the action, or lack of action, of insulin. I feel that this was a lost opportunity.
This book is strong on the underlying themes of carbohydrate metabolism but may be a little weaker on clinical aspects of diabetes. Overall, however, it is well balanced and up to date. It would certainly be a good buy for a departmental library. I would encourage our medical library to purchase a number of copies as it is a good reference text for students, especially as an accompaniment to short texts on the clinical aspects of diabetes.