In 1991, I wrote with Eberhard Standl in a book on pharmacology of diabetes: “Treatment of diabetes hasbecome an increasing challenge to the clinicians in recent years. A rapid development has taken placewithin a number of pharmalogical areas, both with respect to insulin-dependent and non-insulin-dependentdiabetes, and also within the prevention and treatment of complications of both types of diabetes.”
    This is even more true today. Since then we have observed a rapid development in the area with newdrugs for treatment of hyperglycemia – both oral agents and new insulin preparations. Indeed, within thearea of complications, there are also many new perspectives in the treatment strategy. Combination treatmentwith agents that treat hyperglycemia is more and more important, also in combination with severalagents controlling the complications has become more and more common. It is not unusual that patientsreceive four or five or six or even more drugs.
    Problems within diabetes treatment can usually be divided into two phases, namely (i) acute and short-termtreatment of patients and related to well-being and near-perfect physical abilities for professional andleisure activities, most often related to good metabolic control. (ii) On the other hand, the long-term perspectiveis preventive treatment of complications, both microvascular and vascular complications. Underspecial situations such as pregnancy, treatment is critical. A number of co-morbid situations are important:heart disease (although not always specifically related to diabetes), obesity (an increasingly importantproblem), and lipid management (very common). Since 1991, we have seen a rapid development in thetreatment of one important issue, namely treatment of erectile dysfunction, which is even more importantin diabetic than in nondiabetic individuals.
    The so-called metabolic syndrome is also becoming more and more pertinent and an increasingnumber of patients fulfill that criterion (although it may not be a true syndrome); therefore, multifactorialintervention is important. Indeed, this book is meant as a working guide and a source for morebasic knowledge regarding pharmacological treatment, for the practising diabetologist, the internist,and the general physician.
    It has been a great pleasure for me to work with many colleagues, most of them personal and/orprofessional friends that I have known for many years. They represent, I believe, the clinical excellencein diabetes treatment, and it has been possible to collect all the chapters within a few months,which is quite remarkable when you have some experience in editing books.Finally, I would like to thank the publishers – Springer, who are very much involved in diabetestreatment in general. It has been a pleasure to work with them throughout the whole process – fromcreating the idea to seeing the book on the street.
Edwin Gale, Bristol, UK
    Why should anyone bother to put a textbook together? I have often wondered about this, even while doingthe job myself. All those who have engaged in this activity will tell you that the work will be harder thanyou can imagine, that chasing reluctant authors is a depressing business, and that there are easier ways ofmaking money. Worse still, the book you produce will typically have many competitors, and is destined tosuffer from built-in obsolescence. All these are questions for those who create a textbook. For you, thereader, the question is: should you consider looking further into this one?
    I think you should. The reason, I suggest, is that physicians treat patients, and that this is a book abouttreatment. Therapy for diabetes is life-long, monotonous, demanding, and has benefits that are mostlydeferred into a distant future. Pleasing though it is for patients to learn that their cholesterol, blood pressure,or glycated haemoglobin have fallen within the target range, the fact is that they often feel no betterin consequence, and may sometimes actually feel worse. The main argument we can offer them in defenceof a demanding diabetes regimen is that—as Maurice Chevalier said of old age – it is so very preferable tothe alternative.
    A celebrated physician once remarked that it is not the disease that has the patient, but the patient thathas the disease, that matters. Nowhere is this more true than for diabetes, for which no treatment will workunless the patient is committed to its success. Insulin is often its own argument, since patients feel somuch better for it that they are often reluctant to stop. This is not the case when it comes to pills: peoplelike to ask for them, but are less enthusiastic when it comes to swallowing them on a regular basis—andno medication will work if the patient is not taking it.
    Doctors are, or should be, passionate advocates for the benefits of the treatment they offer. Their passionand their advocacy provide the core element in therapy. However, how do we know which treatmentis best? Guidelines are necessary and useful, but choosing the right set of treatments, with the help of theperson who will have to take them, is the essence of good medicine. And here the choices become evermore complex. Since diabetes is so intimately involved with lifestyle, especially in the overweight, behaviourchange is the necessary prelude to any other intervention. Beyond this point, the options proliferate.There are currently nine classes of glucose lowering medication in development or on the pharmacist’sshelf, each with its advantages and disadvantages. Further choices as to lipid-lowering and antihypertensiveagents will have to be made, with the possible addition of anti-obesity medication. And behindthese routine elements of therapy come all the special situations, pregnancy, foot ulcers, erectile dysfunction,and so forth. The diabetes physician must be equipped to deal with all of these, and this is abook which covers them all, which is refreshingly up to date, and currently seems to have no competitors.
    It might seem that there is no lack of good advice about medication for diabetes. Specialist associationsissue an unending stream of guidelines, and government agencies are increasingly guided by advisorybodies such as the National Institute for Clinical Excellence (NICE) in the UK, bodies which review theevidence and advice as to how money for health care should be spent. Meanwhile, big Pharma continues togenerate new therapies, at ever-increasing cost to the consumer. According to one analysis, global drug costsof US$3.8 billion dollars for diabetes in 1995 expanded to an estimated US$17.8 billion in 2005, and areprojected to hit US$27.9 billion by 2010 [1]. As these estimates reveal, we have entered a realm ofunsustainable costs and diminishing returns. And it is here, at the cutting edge of pharmacological intervention,that evidence-based medicine lets us down, for the sources of information are controlled bythose who wish us to invest in their therapy.
    How then do we make the best choice for the patient sitting in front of us? At the end of the day, thewisest advice will usually come from experienced, impartial, and critical clinicians, which is what thisbook has to offer.
Section: Overview
1. Pharmacoepidemiology of Diabetes 
Jørgen Rungby and Andrew J. Krentz
2. New Definitions of Diabetes: Consequences 
Knut Borch-Johnsen
Section: Pharmacotherapy of Diabetes
3. The Insulin Resistance Syndrome: Concept and Therapeutic Approaches
Gerald M. Reaven
4. Medical Emergencies – Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemia 
Niels Møller and K. George M.M. Alberti
5. Notes on the Use of Glucagon in Type 1 Diabetes.
Carl Erik Mogensen
6. Insulin and New Insulin Analogues, Insulin Pumps and Inhaled Insulin
in Type 1 Diabetes 
Kjeld Hermansen
7. Insulin and New Insulin Analogues with Focus on Type 2 Diabetes 
Sten Madsbad
8. The Place of Insulin Secretagogues in the Treatment of Type 2 Diabetes
in the Twenty-First Century
Harald Stingl and Guntram Schernthaner
9. Metformin – from Devil to Angel 
Guntram Schernthaner and Gerit Holger Schernthaner
10. The Glitazones, Lessons so Far 
Monika Shirodkar and Serge Jabbour
11. Antidiabetic Combination Therapy 
Henning Beck-Nielsen and Jan Erik Henriksen
12. The Incretin Modulators – Incretin Mimetics (GLP-1 Receptor Agonists)
and Incretin Enhancers (DPP-4 Inhibitors) 
Michael A. Nauck, Wolfgang E. Schmidt, and Juris J. Meier
13. The Role of Alpha-Glucosidase Inhibitors (Acarbose) 
Markolf Hanefeld and Frank Schaper
14. Multifactorial Intervention in Type 2 Diabetes
Oluf Pedersen
Section: Treating the Comorbid Patient
15. Obesity and Pharmacological Treatment 
Bjørn Richelsen
16. Management of Diabetic Dyslipidaemia
D. John Betteridge
17. Coronary Intervention and Ischemic Cardioprotection in Diabetic Patients
Torsten Toftegaard Nielsen
Section: Diabetic Complications and Side-effects
18. ACE-I and ARB and Blood Pressure Lowering, Including Effect on Renal Disease.
Treatment of Advanced Diabetic Renal Disease
Per Løgstrup Poulsen and Johan V. Poulsen
19. Aspirin and Antiplatelet Drugs in the Prevention of Cardiovascular
Complications of Diabetes 
Alberto Zanchetti
20. Glycosylation Inhibitors, PKC Inhibitors and Related Interventions
Against Complications 
Aino Soro-Paavonen and Mark Cooper
21. Diabetic Foot Ulcers 
Andrew Boulton and Frank Bowling
22. Pharmacotherapy in Diabetic Neuropathy 
Anders Dejgaard and Jannik Hilsted
x Contents
23. Pregnancy – Pharmacological Problems
Elisabeth R. Mathiesen and Peter Damm
24. Pharmacotherapy of Diabetic Retinopathy 
Toke Bek
25. Pharmacotherapy in Diabetic Sexual Dysfunction
Niels Ejskjaer
26. A Bone Perspective
Lars Rejnmark
Section: Notes from Major Pharmaceutical Companies
(all major companies asked to participate)
27. Achieving Guideline Control with New Pharmacotherapies:
Albumin-Binding by Acylation of Insulin and GLP-1 
Mads Krogsgaard Thomsen
28. Pharmacotherapy of Diabetes.
Post Scriptum by the Editor
Index .

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