Beating Diabetes: Lower Your Blood Sugar; Lose Weight, and Stop Diabetes and It's Complication in Their Tracks. New York: McGraw-Hill; 2005. 259 pages, paperback, $15.95.
Introduction. The purpose of the book is to promote a practical understanding of the role of lifestyle in developing and treating diabetes mellitus, and to improve the health of those at risk for diabetes. The authors emphasize the importance of an individual's behavioral choices, while recognizing the important role of the environment in these choices. The intended audience is individuals at risk for developing diabetes (ie, "prediabetic") or those already diagnosed. There are 13 chapters and 6 appendices.
Description. The first 2 chapters provide foundational information on normal metabolism, digestion, the role of calories in weight gain and loss, and reasons for the increasing rates of diabetes in the United States and globally. Chapter 3 provides a description of scientific methods, explaining the importance of well-designed studies in developing the current state of knowledge about causes and treatments of diabetes. The authors give a detailed description of the landmark Diabetes Prevention Program (DPP), a nationwide, multisite clinical trial that demonstrated a significant reduction in rates of developing type 2 diabetes mellitus among those with prediabetes who made lifestyle changes in diet and exercise over a 3-year period. Also summarized in Chapter 3 are several studies about cardiovascular risk reduction. Chapter 4 summarizes typical treatments for diabetes (types 1 and 2), emphasizing how glycemic control helps prevent early cardiovascular disease. Chapter 5 has extensive information about activity and exercise, including aspects of special concern to people with diabetes, that is, care of the feet, dealing with hypoglycemia, etc. Chapters 6 through 10 provide detailed information about how to change and maintain changes in one's daily health behaviors. The authors use the well-known "Stages of Change Model" (Transtheoretical Model, developed by Prochaska and DiClemente) as a framework to analyze and change behavior and prevent relapse, with an emphasis on problem solving and overcoming barriers to change. The last 3 chapters provide information about popular weight-loss programs, more details about the DPP study, and why it worked so well, including case examples of participants who were successful in making and maintaining changes in eating and activity. The 6 appendices provide additional detail about scientific studies on nutrition and weight loss, cookbook suggestions, sample shopping lists, meal plans, snack ideas, and recipes. Throughout the book there are helpful tables that summarize information, enhancing comprehension.
Detailed evaluation. Beating Diabetes provides a valuable resource for individuals who have diabetes or prediabetes, giving them accurate and detailed information about eating and activity-the 2 most difficult areas of lifestyle to change and maintain. The authors are a physician (DM) and a dietician (LD) from Harvard Medical School who participated in the DPP study, and have education and experience as clinicians and scientists. Although the content and language require a well-educated reader, the book provides comprehensive information mostly in lay language that provides helpful information and approaches for tackling complicated lifestyle changes. Consistent with their educational level, the authors tend to err on the side of providing a bit more scientific rationale than most individuals may want. However, they balance the science with a great deal of practical information and offer many helpful strategies. Appendix A, a summary of types of research designs, is an example of somewhat extraneous information. However, it is an appendix, and therefore seen by most readers as optional. Most of the book is eminently practical and useful to the layperson who is seeking information about diabetes treatment and prevention. It is difficult to find references to specific sources used by the authors; that is, although sources are at times mentioned in the text, there is no list of references, making it difficult for readers to follow up on topics of interest. Overall, the author's use of a problem-solving approach provides a valuable source for the well-educated individual looking for guidance about preventing and/or managing diabetes.
Sharon W. Utz, PhD, RN
Associate Professor of Nursing University of Virginia School of Nursing Charlottesville