book review: costing diabetes: the case for prevention. idf task force on diabetes health economics....

BOOK REVIEWS

BOOK REVIEWS

Shared Care for Diabetes

by W. Gatling, R.D. Hill and M. Kirby.Isis Medical Media, Oxford, 1997. No.of pages 280. Price £22.50, softback.ISBN 1-899066-25-X.

This book is a practical guide to diabetescare. Its overall philosophy is that ofshared care. It begins by giving an outlineof diabetes and the problems faced byworkers in primary and secondary care.It goes on to provide information onthe diagnosis of diabetes, introduces theconcepts of shared care, healthy eating,how to live with diabetes, and the manage-ment of diabetes and its complications. Itsuggests a way in which long-term dia-betic follow-up should be carried out andoutlines a range of subjects relevant todiabetes care including women’s issuesand eye, kidney, macrovascular and footdisease. Towards the end of the book,chapters deal with planning and audit ofservices and potential future develop-ments. It finishes with a number of casestudies which are discussed.

Shared Care for Diabetes is an excellentand enjoyable read. It is simple, clear,concise and very attractive, with gooduse of flowcharts, tables and algorithms.The use of colour photography is first-class. The style is easy to read andthe practical advice given is, generally,accurate and appropriate. It is written bythree people who deal, or have dealtwith, the problems of diabetes care on adaily basis and are strong proponents ofgood diabetes services as well as sharedcare. This is clear on reading the book,which provides extra ammunition forthose attempting to improve services.Generally, it is well balanced and uncon-troversial. Anecdotes and individual feel-ings are avoided and this carefully meas-ured style of writing added strength tothe book.

Although the beauty of this book is itssimplicity, it is this which lays it open tocriticism. In covering a broad area ofdiabetes knowledge in a small book, itcould be accused of oversimplification.My own feelings are that because ofits general overview of diabetes-relatedtopics, this book is one primarily for theprimary health care team rather than forhospital-based diabetes physicians andnurses. Specific criticism would includea paucity of information on diabeticimpotence (less than 2 pages, of whichone is a pretty illustration). The statementthat urgent referral within 24 hours ofdiagnosis of Type 1 diabetes is essential

705CCC 0742–3071/98/080705–01$17.50 1998 John Wiley & Sons, Ltd. DIABETIC MEDICINE, 1998; 15: 705

would, I suspect, lead to an increase inunnecessary weekend hospital admis-sions. Other criticisms are universallydue to new developments overtaking thepreviously written text and are thereforeunfortunate but inevitable.

My primary question to the authorswould be: who should be reading thisbook? Although it is stated in the prefacethat it should be used as a guide for allhealth care professionals, would it be fairto suggest that it would be more usefulto some groups than others? In a similarvein, do the authors feel that this bookis more of a practical guide for lessexperienced primary care workers ratherthan, as the title suggests, a guide forshared care? I wonder, therefore, why thistitle was chosen.

I am sure that this book will providean interesting and valuable read for manypeople interested in diabetes care.

D. R. MeekingDepartment of Medicine, Queen

Alexandra Hospital, Portsmouth, UK

Costing Diabetes: The Case for Prevention

IDF Task Force on Diabetes Health Eco-nomics. International Diabetes Feder-ation, Brussels, 1997.

The data available on the costs of diabetesmellitus and the cost-effectiveness of dia-betes care are more extensive than formost other communicable diseases. Thisbooklet, produced by the InternationalDiabetes Federation (with the acknowl-edgement of Professors John Turtle andRhys Williams as its principal authors)provides a review of the economics ofdiabetes and argues the case for invest-ment in prevention. It is intended to bea ‘decision-making helpmate for thoseinvolved in health-care policy’, hopingto provide an enabling tool, facilitatingdialogue between decision makers andIDF member associations.

Although a sizeable proportion of anynation’s health budget goes on diabetescare (which can take up to 10 % of thatnation’s budget), an estimated 25 % ofthe countries of the world have not madeany specific provision for diabetes carein their national health plans. The politicalimpetus is difficult to achieve, and easyfor governments to avoid: long-terminvestment in health care will give long-term benefit. In the short-term, it is noteasy to audit ‘the leg not amputated, theeye not blind and the stroke not suffered’.

Costing Diabetes is clearly laid out,concise and easily accessible (with a seriesof highlighted Diabetes Facts inserts),comprehensible to non-medical readers. Itis deliberately free of references, footnotes

and ‘highly specialized scientific data’, butcontains a bibliography which documentsthe research on which the booklet isbased, to which those wishing to do somight refer in greater depth. The contentsof the booklet itself are derived substan-tially from the more extensive and aca-demic WHO/IDF report ‘The Economicsof Diabetes Care’. Following its simpleintroduction ‘Who should use this book-let?’ and ‘How should the booklet beused?’, Section 2 (‘Diabetes costs lives’)sets out a simple explanation of ‘What isdiabetes?’ and ‘What are diabetic compli-cations’. This is followed by the case forprevention. Section 3 (‘Diabetes costsmoney’) discusses simple facts abouthealth economics in general, diabeteshealth economics in particular and theway in which costs of diabetes add up.Specific examples of the latter are sitedfrom a number of countries around theworld. This is followed by a discussionas to why effective intervention is vital indiabetes, not only in a cost-effective sense,but also beneficial in quality of life terms.

The authors stress the important role ofeducation for people with diabetes, aimedat achieving self-care and resulting inimproved quality of life, includingimproved glycaemic control. The resultof reduction in diabetic complicationsthereby produces far-reaching economicbenefits in both the short- and long-term. The training of primary health-care professionals is acknowledged as animportant part of cost-effective prevention.It is also stressed, however, that withoutappropriate training of health-care pro-fessionals, the short-term savings of lesscostly primary care may result inadditional future costs as a consequenceof increased diabetic complications.Training is therefore crucial to the cost-effectiveness of preventative diabetes care.

This booklet provides a clear and con-cise summary of the costs of diabetesand the cost-effectiveness of long-terminvestment in diabetes care. It is aimedat those (politicians, managers, and others)without whose understanding of the issuesinvolved the case for diabetes care isunlikely to be implemented. I believe thatit presents this case well. The effectivenessof its case depends on diabetes healthprofessionals making sure the booklet ispresented to the right people, and bothread and acted on by them.

Jeremy J. BendingEastbourne District Diabetes Centre,

Eastbourne, East Sussex, UK