In the United States, 20.8 million children and adults, 7% of the population, have diabetes. While an estimated 14.6 million have been diagnosed, 6.2 million have yet to be diagnosed. Worldwide diabetes afflicts 150 million people. The World Health Organization estimates that by 2025 that figure will double. Diabetes is responsible for more deaths than AIDS and breast cancer, combined. It is a leading cause of blindness, kidney failure, amputations, heart complications and stroke. Treatment of Type 1 and Type diabetes has changed radically over the past few years. There are new opportunities for treating the key abnormality in diabetes, increased blood glucose, by effective agents such as new insulin preparations and oral agents. Increasing so-called non-glycemic intervention is of prime importance. Blood pressure lowering therapies, anti-cholesterol strategies, and specific treatment related to complications is becoming increasingly important. Pharmacotherapy of Diabetes is a unique, invaluable guide to all aspects of the pharmacological treatment of diabetes, covering basic concepts and an in-depth review of current and future therapies. This work provides an overview for the new changes in therapies that can be implemented in clinical practice and treatment of the diabetic patient.

(Diabetes Forum Series; Vol. 3)

Few complications of systemic diseases are better understood than diabetic nephropathy. In large part, progress in this area is due to Carl Erik Mogensen's steadfast preoccupation over more than three decades with the disorder's epidemiology, pathogenesis, pathophysiology, clinical diagnosis and evolving strategies of management. Though he sparked progress in each of these areas, he generously opens the forum of discussion to many expert contributors to this latest and most comprehensive edition of this exemplary textbook. In eliciting all relevant and up-to-date views, the reader, whether internist, pediatrician or specialist in endocrinology or nephrology, is assured a thorough review of the entire subject and in a format which is exceptionally well-written, well-illustrated and easy to read. Each of the prior editions have been an essential resource for my own work in this field and the 5th edition will no doubt continue to provide the information I and others will require to move forward in the years ahead. If only the other renal diseases were as masterfully synthesized, how much easier our task would be of achieving a comprehensive vision of all else in clinical nephrology. Barry M. Brenner, M.D., Samuel A. Levine Professor of Medicine, Harvard Medical School

The first sporadic observations describing renal abnormalities in diabetes were published late in the 19th century, but systematic studies of the kidney in diabetes started only half a century ago after the paper by Cambier in 1934 and the much more famous study by Kimmelstiel and Wilson in 1936. These authors described two distinct features of renal involvement in diabetes: early hyperfiltration and late nephropathy. Diabetic nephropathy is, despite half a century of studies, still a very pertinent problem, renal disease in diabetes now being a very common cause of end-stage renal failure in Europe and North America and probably throughout the world. It is a very important part of the generalized vascular disease found in long-term diabetes as described by Knud Lundbaek in his mono graph Long-term Diabetes in 1953, published by Munks gaard, Copenhagen. Surprisingly, there has not been a comprehensive volume describing all aspects of renal involvement in diabetes, and the time is now ripe for such a volume summarizing the very considerable research activity within this field during the last decade and especially during the last few years. This book attempts to cover practically all aspects of renal involvement in diabetes. It is written by colleagues who are themselves active in the many fields of medical research covered in this volume: epidemiology, physiology and pathophysiology, laboratory methodology, and renal pathology. New studies deal with the dia gnosis and treatment of both incipient and overt nephropathy by metabolie, antihypertensive, and dietary invention."

The sum of clinical problems caused by diabetic renal disease has been steadily increasing since the first edition of this book was published in 1988. The years since have seen tremendous progress in research activities. Importantly, this also includes improvement in the treatment programs to prevent end-stage renal failure. It has become clear that the diabetic kidney is extremely pressure-sensitive, responding to effective antihypertensive treatment by retarded progression of disease. Some agents may be more beneficial in this respect than others, although effective blood pressure reduction per se is crucial throughout the stages of diabetic renal disease. However, the prime cause of diabetic renal disease is related to poor metabolic control and it is now documented beyond doubt that good metabolic control is able to postpone or perhaps even prevent the development of renal disease. However, in many individuals we are not able to provide such a quality of control that will prevent complications, and therefore non-glycaemic intervention remains important.Maybe in the future non-glycaemic intervention will become the most important research area in diabetic nephropathy. Much information is now available on the exact mechanisms behind poor metabolic control and development of renal disease. It is likely that a combination of genetic predisposition and metabolic and haemodynamic abnormalities explain the progression to renal disease, seen in about 30% of diabetic individuals. Much of this development probably relates to modifiable genetic factors, such as blood pressure elevation or haemodynamic aberrations. However, mechanisms related to the response to hyperglycaemia are also of clear importance, as is the possibility that these metabolic or haemodynamic pathways may be inhibited. This volume reviews older data as well as the progress seen within the research on diabetic nephropathy over the last five years and describes the state of the art of the development.

We have witnessed a rapid development within the field of the kidney and hypertension in diabetes mellitus. A significant amount of work within the traditional areas has been published, and several new dimensions are now being developed, mostly in the experimental setting. These dimensions are discussed in several chapters of this new edition, The Kidney and Hypertension in Diabetes Mellitus, Fourth Edition. This volume endeavors to cover all aspects of renal involvement in diabetes. It is written by colleagues who are themselves active in the many fields of medical research covered in this volume: epidemiology, physiology and pathophysiology, laboratory methodology and renal pathology.

The first sporadic observations describing renal abnormalities in diabetes were published late in the 19th century, but systematic studies of the kidney in diabetes started only half a century ago after the paper by Cambier in 1934 and the much more famous study by Kimmelstiel and Wilson in 1936. These authors described two distinct features of renal involvement in diabetes: early hyperfiltration and late nephropathy. Diabetic nephropathy is, despite half a century of studies, still a very pertinent problem, renal disease in diabetes now being a very common cause of end-stage renal failure in Europe and North America and probably throughout the world. It is a very important part of the generalized vascular disease found in long-term diabetes as described by Knud Lundbaek in his mono graph Long-term Diabetes in 1953, published by Munks gaard, Copenhagen. Surprisingly, there has not been a comprehensive volume describing all aspects of renal involvement in diabetes, and the time is now ripe for such a volume summarizing the very considerable research activity within this field during the last decade and especially during the last few years. This book attempts to cover practically all aspects of renal involvement in diabetes. It is written by colleagues who are themselves active in the many fields of medical research covered in this volume: epidemiology, physiology and pathophysiology, laboratory methodology, and renal pathology. New studies deal with the dia gnosis and treatment of both incipient and overt nephropathy by metabolie, antihypertensive, and dietary invention."

Diabetes is a huge and growing healthcare worry, especially in Western countries. The treatment of both types - 1 and 2 - of this disease has changed radically over the past few years. This work provides an overview of all the changes that will come to be implemented in clinical practice. Summarizing all aspects of treatment, this book delineates the large amount of research work that has been completed over the last few years into the relief of complications in diabetes and vascular medicine in general.

Few complications of systemic diseases are better understood than diabetic nephropathy. In large part, progress in this area is due to Carl Erik Mogensen's steadfast preoccupation over more than three decades with the disorder's epidemiology, pathogenesis, pathophysiology, clinical diagnosis and evolving strategies of management. Though he sparked progress in each of these areas, he generously opens the forum of discussion to many expert contributors to this latest and most comprehensive edition of this exemplary textbook. In eliciting all relevant and up-to-date views, the reader, whether internist, pediatrician or specialist in endocrinology or nephrology, is assured a thorough review of the entire subject and in a format which is exceptionally well-written, well-illustrated and easy to read. Each of the prior editions have been an essential resource for my own work in this field and the 5th edition will no doubt continue to provide the information I and others will require to move forward in the years ahead. If only the other renal diseases were as masterfully synthesized, how much easier our task would be of achieving a comprehensive vision of all else in clinical nephrology. Barry M. Brenner, M.D., Samuel A. Levine Professor of Medicine, Harvard Medical School