From The New England Journal of Medicine, August 12, 1999
Diabetic Neuropathy has seven sections. The first, which contains seven chapters, provides useful reviews of the management of diabetes and the microvascular and macrovascular complications of the disease. The second section deals with techniques for the quantitative assessment of diabetic neuropathy. The third section reviews the epidemiology of diabetic polyneuropathy and the mechanisms underlying this complication. The remaining four sections deal with the differential diagnosis of diabetic neuropathy, hypoglycemic polyneuropathy, focal and multifocal neuropathies, and, briefly, the autonomic neuropathies.
Quantitative techniques are the primary focus of the book, which -- after the initial review -- immediately immerses the reader in the complex subject of the measurement of diabetic neuropathy. The terms so familiar to those of us who carry out clinical trials are quickly reviewed. For those to whom abbreviations such as NIS (neuropathy impairment score), NSS (neuropathy symptom score), QST (quantitative sensory testing), and CDT (cooling detection threshold) are new, there are follow-up chapters dealing with computer-assisted sensory-examination systems and electrophysiologic testing. Other chapters deal with measurements of cardiac, gastrointestinal, bladder, and sudomotor autonomic neuropathy and erectile dysfunction. Again, the focus is on methods of quantitation rather than on description.
The importance of quantitation is addressed in the excellent discussion of the epidemiology of diabetic neuropathy. The chapter on the pathological assessment of diabetic neuropathy similarly addresses the need for rigorous evaluation of histologic and ultrastructural findings. In section III, there are chapters dealing with potential mechanisms of diabetic polyneuropathy and several pharmacologic agents that have been used in clinical trials. The roles of control of blood sugar, hypoxia and oxidative stress, aldose reductase, and advanced glycation end products receive their own chapters. Additional chapters deal with growth factors, linolenic acid, the treatment of painful neuropathy, and plantar ulcers and Charcot joints.
The rest of the book is devoted to clinical evaluation. For readers interested in the clinical problems posed by diabetic neuropathy, these sections are the high point of the book. There are masterly descriptions of motor neuropathy, sensory neuropathy, and the autonomic neuropathies. Here the authors' skills in clinical description come to the fore, leaving the quantitative formulations introduced at the outset in the background. Individual chapters deal with the differential diagnosis of diabetic neuropathies, hypoglycemic polyneuropathies, cranial neuropathies, truncal radiculoneuropathy, compression neuropathies, and the treatment of the autonomic neuropathies.
As a rule, each chapter is succinct and complete within itself. The editors have done a good job of integrating the individual chapters into a cohesive text, and they contributed to almost a third of the chapters.
We are now in an age of instant information on any topic, easily downloaded into a computer. It becomes ever more difficult to justify the effort to create a specialized textbook that addresses all the issues on a given subject. This second edition of Diabetic Neuropathy clearly succeeds in this effort.
Reviewed by Marc Rendell, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
