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Diabétesz-Hogyan segíthet a kínai orvoslás?

Szerzők:

• Haynes, Gerstein

Kiadás:

Kiadó: BC Decker Inc
2001
1-55009-124-7

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Fülszöveg

WHY EVIDENCE BASED DIABETES CARE?

Diabetes is a common chronic condition that, in the year 2001, remains incurable. Although defined on the basis of elevated plasma glucose levels, it is clear that diabetes is characterized by many associated abnormalities related to both pancreatic beta cell function and the effects and actions of insulin on fat, protein, and carbohydrate metabolism. These abnormalities can have an acute effect on quality of life and, in the case of Type I diabetes, can even lead to death if not appropriately identified and treated. More significantly, they predispose affected individuals to several serious chronic problems including, but not limited to, blindness, kidney failure, peripheral nerve damage, amputations, coronary heart disease, peripheral vascular disease, and cerebrovascular disease. Indeed, both diabetes and the related metabolic abnormalities that precede the rise of glucose levels into the diabetic range account for a substantial proportion of these problems in the developed world.
These depressing considerations are counterbalanced by a growing body of carefully collected evidence showing that many of these problems can be successfully treated, reduced, or even prevented by the application of emerging therapies and self care behaviors. The major challenge is to communicate the advances identified by such research to health care practitioners, affected individuals, and the family of affected individuals. A related challenge is to identify these infrequent and sometimes "low profile" research results that are most relevant to the day to day care of people affected by diabetes. Another is to distinguish these from the abundant genetic, cellular, physiologic, and preclinical scientific data that are published daily and that are often reported in the lay media.
The rationale for this textbook, then, is to highlight and document the evidence from
applied clinical research regarding the diagnosis, prognosis, and therapy of diabetes  related medical problems. The work is designed for the clinician or researcher who asks questions such as "What is the evidence that laser therapy prevents blindness and bow effective is it? What is the risk of diabetic nephropathy in people with micro albuminuria? Is the degree of hyperglycernia a risk factor for heart disease?" As such, much will be found describing ana
lytic surveys of diagnostic tests, cohort studies relating risk factors to prognosis, and randomized trials of various therapies. Although every attempt has been made to be comprehensive, it is certain that the evidence described herein does not represent an exhaustive search of the literature; rather, it is a survey of much, if not most, of the relevant literature, often summarized in tabular form. Authors have been asked to identify relevant citations in support of their conclusions and to rank the quality of the evidence cited, so as to provide an indication of the strength of the conclusions, which are summarized at the end of every chapter.
In light of this, this textbook is not a comprehensive review of all of diabetes. Little will be found describing pathophysiology and biochemistry as there are many excellent reviews and textbooks covering these areas. Further, this is not a compendium of clinical practice guidelines and should not be used as one. Instead, it may be used as a resource either to assess guidelines or to help develop new ones, but the "evidence base" described herein represents only one ingredient in the guideline development process. Finally, since the content of this textbook spans the breadth of contemporary diabetes care, it will be clear to the reader that there are many "holes" in the evidence base that is currently available. Wherever possible, the absence of clear evidence has been identified and is reflected by low ratings of the cited evidence or by descriptions of empirical approaches to the topic being discussed.
This book is accompanied by a unique electronic database of abstracts of key studies on the cause, course, diagnosis, and therapy of diabetes, along with general descriptions of key information for patients. The Diabetes Mellitus Evidence Database has been collected and prepared by the Health Information Research Unit of McMaster University during the past 10 years, based on the same criteria used for the evidence based journals and database prepared there, including ACPJournal Club, Evidence Based Medicine, and Best Evidence. It provides details and summaries of key studies that are relevant to contemporary diabetes care.
We hope that our approach will help clarify the strengths and weaknesses of the evidence upon which current clinical practice is based, leading to the best match between evidence from research and patients' circumstances and wishes. We also hope that it will stimulate more research and inquiry into optimal diabetes care so that we can eventually reduce or eliminate the health burden associated with this all too common condition.

HCG RBH February 2001