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Clinical Management of Diabetic Neuropathy.
  1. PETER WATKINS

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    Clinical Management of Diabetic Neuropathy. Edited by aristidis veves. (Pp 348, US$125). Published by The Humana Press, New Jersey, 1998. ISBN 0-896-03528-X.

    The neuropathies of diabetes are common (as the chapters in this book repeatedly remind us) and can be very disagreeable. Symptomless neuropathy underlies foot ulceration and sepsis as the commonest clinical consequence of diabetic neuropathy but other extremely unpleasant disorders range from exceptionally severe pain to the whole range of problems resulting from autonomic failure. This book comprehensively covers every aspect of the subject, systematically (and at times exhaustively) from its epidemiology and pathogenesis (exhaustingly) to structural, functional, and clinical problems and their treatment. Most of the authors are well known in the field and their accounts are up to date and authoritiative.

    Unfortunately, struggle as they might, all authorities have difficulty in defining what they mean by diabetic neuropathy and, in this regard, understanding of this complication both in clinical and pathological terms, as well as with regard to treatment, lags far behind that of the other classic diabetic complications, nephropathy and retinopathy. Even its classification presents problems and attempts to do so are found in four different chapters, describing four classifications. Repetition is an unfortunate feature of this book and—quite apart from the confusion over classification—aspects of pathogenesis, structural changes, epidemiology, diagrams, and some reference to treatment (for example, that of pain) appear repeatedly in different chapters in greater or lesser detail.

    This is certainly a book for the specialist and not at all (as the preface suggests) for the family practitioner. There are good reviews of nerve structure, causation, and treatment of painful neuropathies and focal neuropathies. The comprehensive survey of the Diabetes Control and Complications Trial (DCCT) shows in detail the only treatment which is truly effective (diabetic control); and the lengthy description of aldose reductase inhibitor trials establishes that, even after more than two decades of investigation, further trials are still needed.

    Clinical evaluation of somatic and autonomic neuropathies are useful and also, to some extent, comprehensive but lack specificity—that is, normal values for simple tests are difficult to find. The huge subject of the diabetic foot is covered in these chapters and “the impact of micro and macrovascular disease” is compressed into the last nine pages of the book.

    The bibliography is important and often very up to date with references ranging from 33 to 283 per chapter.

    If this book is at times confusing, this reflects the confusion regarding the nature and treatment of the diabetic neuropathies as much as the overlap and repetition found in its different chapters. It is a book of reference for the specialist who will be well served by the comprehensiveness of some of its reviews and their assembly of the appropriate literature.

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