Each chapter has plentiful tables thatsummarise key points. This proves tobe very helpful, especially if the text isused as a quick reference guide.Indications and contraindications fordrug therapies, criteria for diagnosis,criteria for adequate diabetes control,patient instructions for adjustingmedication or diet in response toexercise or intercurrent illness all areexamples of table contents.

Shortcomings are few, and do notsignificantly detract from the overalleffectiveness of the volume. There isconsiderable overlap of material inmany chapters regarding risk factorreduction. Some readers may befrustrated by reference to studies forwhich the citations are never given. Anannotated bibliography does followeach chapter, but it does notnecessarily include the study noted inthe text of the chapter. There isinconsistent use of trade versus genericnames of drugs. An introductorychapter preceding the six chapters onmedications used in type II diabeteswould have been helpful. Errors arerare, though the one in which NIDDM

is referred to as type Idiabetes in the introductoryparagraph of the chapter onhyperosmolar, hyperglycae-mic, non-ketotic coma wasalarming.

DeFronzo laments inhis preface that themorbidity and mortalityfrom diabetes mellitus isunacceptably high becausemost diabetics remainpoorly controlled. Everyphysician who treatsdiabetes needs to treat itmore effectively. DeFronzohas enhanced the possibilityof achieving this byproviding the informationand recommendations fordiabetes management in askilfully packaged, highlyreadable, and very practicalbook. It is a book thatbelongs in the office examroom.

Laura M MumfordDepartment of Medicine,Johns Hopkins University,School of Medicine,Baltimore, MD 21287, USA

This book is one of the volumesof the Current Therapy Series.43 chapters are presented by 61

contributing authors. Every chapter iswell written. Each begins with a briefreview of the pertinent patho-physiology or pharmacology, followedby clinical management issues. Theissues include clinical manifestations,therapeutic options, and, importantly,specific recommendations fortreatment with explicit criteria fortreatment goals.The entire spectrum ofdiabetes management is presented infive sections. They include diagnosticcriteria and classification, type I andtype II diabetes in the adult and child,complications of the disease, and thespecial problems of gestationaldiabetes, diabetes in pregnancy, anddiabetes in the perioperative period.

Ralph DeFronzo has succeededadmirably in meeting his goals ofsimplicity and pragmatism for this guideto the comprehensivemanagement of thediabetic patient in all agegroups. This volume is avaluable addition to thelibrary of all primary carephysicians and otherproviders. The emphasis ison practicality andspecificity. Recommenda-tions for intervention areprecise and include drugdosage, and diet andexercise guidelines. Thechapters on the use ofinsulin in type I and type IIdiabetes cover all clinicalsituations that the prac-titioner faces. They providedetailed and comprehen-sive management of eachsituation. Similarly, theauthors effectively presentthe practical use of the oralagents, including the non-sulphonamides now avail-able (Rezulin [troglitazone],Glucophage [metformin],Precose [acarbose]), aloneand in combination. Theyalso cover the combination

THE LANCET • Vol 351 • June 6, 1998 1743

DISSECTING ROOM

DISSECTING ROOM

Robert De Niro Philip Benson, David Perrett

The figure on the left is an original photograph of the actorRobert De Niro, the one on the right a computer-generatedcaricature.They feature in a unique exhibition that exploresthe science of face perception. Each theme in the exhibitionuses computer-manipulated graphics in the reproduction ofportraits from the collections of the Scottish NationalPortrait Gallery, Edinburgh, UK, where the exhibition isbeing held.The displays are juxtaposed and integrated withportraits of many famous and historical people in variousartistic styles including works by Richard Dadd, AlexanderMoffat, and Anthony Van Dyck. The Science of the Face endson Aug 2, 1998.

Deconstructing diabetes

therapy of insulin with oral agents.Importantly, the authors state explicitlywhat the clinical criteria are forconsidering each therapeutic option.Similarly, the measures of therapeuticsuccess are precise. This readily allowsthe reader to have the confidence to trydifferent drug regimens and to attemptto achieve the stringent expectationsadvocated by the authors for idealdiabetes control (fasting glucose <140mg/dL and HgbA1C <7·0%).

DeFronzo also used the sameapproach of providing practical man-agement algorithms with specificrecommendations for treatment end-points or drug dosing in the chaptersabout the complications of autonomicand peripheral neuropathy, diabetic eyediseases, and concurrent hypertensionor dyslipidaemia. He wrote the chapteron diabetic nephropathy and the use ofurine microalbumin, and this chapter isespecially well done.

Current Therapy of Diabetes MellitusRalph A DeFronzo. St Louis, MO: Mosby. 1998. Pp 273. $59.95.ISBN 0-8151-2757-X

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