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Preface

While a week may be a long time in politics, the decade that has elapsed since the original publication of Clinical Dilemmas in Diabetes could be considered to be a very (very) long time given the developments in clinical practice that occurred. New therapeutics for the treatment of dyslipidemia and diabetes have appeared. Progress in the development of an artificial pancreas and in sensor technology has improved the care of type 1 diabetes and some diabetes medications may directly alter cardiovascular outcomes. However, the original motivations behind the book—translating trial data into clinical practice—remain very relevant. The astute clinician will need to balance risks and benefits, convenience and cost with changing clinical needs, comorbidities, and patients’ social structures.

As before, the topics covered deserve discussion and debate to avoid making every square peg fit into the round hole of an algorithm or guideline. There has been an expansion in the areas covered, reflecting my initial desire for a book that reflects the growing facets of metabolic care.

I would like to express my gratitude to Dr. Robert A. Rizza MD, who served as a co-editor for the first edition of the book and as always serves as a sounding board for many of my ideas. None of this would have been possible without him. Of course, the other important characters in this saga would be my parents—especially my father, who has now retired from General Practice—but whose approach to problems I have always tried to emulate. Last, but not least, I am very grateful to my wife Elsa, who hung on gamely while I edited proofs of the first edition during our honeymoon, and to our children Katie and Lucy, who are always along for the ride.