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Atlas of Diabetes Mellitus
is completely revised and updated fourth edition of the Atlas of Diabetes Mellitus provides broad
coverage of all aspects of diabetes mellitus and an extensive collection of common and rare clinical
images. It aims to provide an invaluable resource for anyone interested in the management of this ubiquitous clinical condition, including primary care/family physicians, endocrinologists, physicians in
training, diabetic specialist nurses and other key professionals who are likely to be involved in the care
of patients with diabetes mellitus.
Atlas of Diabetes Mellitus
Fourth Edition
Ian N. Scobie and David Hopkins
Cover images courtesy of Ian N Scobie and David Hopkins
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Fourth edition published 2024
by CRC Press
2385 NW Executive Center Drive, Suite 320, Boca Raton FL 33431
and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor & Francis Group, LLC
© 2024 Ian N Scobie and David Hopkins
ird edition published by Informa Healthcare 2006
is book contains information obtained from authentic and highly regarded sources. While all reasonable eorts have
been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. e publishers wish to make clear that any views or
opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reect the views/opinions of the publishers. e information or guidance contained in this book is intended for
use by medical, scientic or health-care professionals and is provided strictly as a supplement to the medical or other
professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and
the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on
dosages, procedures or diagnoses should be independently veried. e reader is strongly urged to consult the relevant
national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their
websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. is book does
not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the
sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat
patients appropriately. e authors and publishers have also attempted to trace t he copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained.
If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permit ted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized
in any form by any electronic, mechanical, or other means, now known or hereaer invented, including photocopying,
microlming, and recording, or in any information storage or retrieval system, without written permission from the
publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the
Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not
available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identication and explanation without intent to infringe.
ISBN: 9781032379456 (hbk)
ISBN: 9781032379463 (pbk)
ISBN: 9781003342700 (ebk)
DOI: 10.1201/9781003342700
Typeset in Minion
by KnowledgeWorks Global Ltd.
Contents
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Author biographies vii
Foreword ix
Acknowledgments xi
Abbreviations xiii
1 Introduction 1
2 Pathogenesis 7
3 Treatment of type 1 diabetes mellitus 29
4 Treatment of type 2 diabetes mellitus 41
5 Treatment of children and adolescents with diabetes 51
6 Diabetes and surgery: Inpatient and perioperative diabetes care 53
7 Acute complications of diabetes 56
8 Chronic complications of diabetes 63
9 Diabetic dyslipidaemia 98
10 Diabetes and pregnancy 100
11 Living with diabetes 103
12 Future developments in diabetes care 105
Index 111
v
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Author Biographies
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Dr Ian N. Scobie qualied MBChB and MD f rom the
University of Glasgow, subsequently being elected a
Fellow of the Royal College of Physicians of London.
He trained in Internal Medicine and Endocrinology
and Diabetes at the Glasgow Royal Inrmary and
at St omas’ Hospital, London. Dr Scobie was
appointed as Consultant Physician in Medicine and
Endocrinology and Diabetes at Medway Maritime
Hospital, Kent, England, and later Honorary
Senior Lecturer at King’s College London School
of Medicine related to his appointment as Clinical
Sub-Dean responsible for undergraduate students
at his institution. He also served as site director for
e American University of the Caribbean School
of Medicine between 2003 and 2009. Dr Scobie’s
research interest is in his specialty of endocrinology
and diabetes, and he has published extensively in his
eld. He has authored and co-authored chapters in
diabetes and metabolism and textbooks of diabetes.
He has had a longstanding commitment to medical education at both the undergraduate and postgraduate level. Dr Scobie’s current appointment is
Assistant Clinica l Dean, United Kingdom, America n
University of the Caribbean School of Medicine.
Dr David Hopkins is a consultant physician with
more than 30 years of experience in clinical and
academic diabetes. He qualied in medicine in
Liverpool and completed specialty training in
Liverpool and London. For most of his career, he
has been associated with King’s College London and
its associated academic health science partnership,
King’s Health Partners, where he was a Director
of the Institute of Diabetes, Endocrinology and
Obesity from 2014 to 2022 and an Honorary Reader
in Diabetic Medicine. He recently moved to Jersey,
where he is leading the development of diabetes
services for the island. He has held regional and
national leadership positions in diabetes, notably
as the medical chair of the Council of Healthcare
Professionals at Diabetes UK from 2016 to 2023.
He has broad clinical and academic interests
across the whole spectrum of diabetes, with particular focus on diabetes technology and psychosocial
factors in diabetes care. He maintains close academic
links with King’s Health Partners and is diabetes lead
for the Health Outcomes Observatory (H2O), an EU
programme to develop a network of data observatories for long-term conditions across Europe.
vii
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Foreword
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As a third-year medical student, I could not construe
of a more boring disease than type 2 diabetes mellitus. Aer all, if this were merely a side-eect of sloth
and gluttony, why expend eort in learning about it
(and making it a part of one’s career)? Further exposure to the disease and its complications disabused
me of these impressions and also brought home the
realization that a knowledge of diabetes would serve
as a summary of most of internal medicine. With
this in mind, it is certainly my pleasure to write the
Foreword to the fourth edition of Dr Ian N. Scobie’s
Atlas of Diabetes Mellitus, co-authored by Dr David
Hopkins. In doing so, I am following in the footsteps of my teacher, mentor and friend Dr Robert A.
Rizza, to whom I owe the realization that diabetes is
a complex, heterogenous disease with diverse contributions to its pathogenesis.
What is diabetes and why is it important? Let
us answer the latter question rst. Diabetes is well
on its way to becoming, directly and indirectly,
the most economically important chronic disease
of the 21st century. Its contribution to the costs of
care and the burdens of limb loss, blindness, renal
failure and vascular disease are readily appreciated. Although the diagnosis is fairly straightforward, chronic therapy, coupled with the necessity
to change behaviour, means that management can
be anything but. In the past decade, progress has
been made on multiple fronts in the treatment of
this disease. However, the implementation of these
advances is costly and complex, which means that
they are far from becoming universal. Moreover,
newer therapies may make subsets of the disease
easier to treat but are far from curative—the
lessons imparted by the Atlas of Diabetes Mellitus
remain very relevant.
What is diabetes? It is a unique disease dened
by the presence of hyperglycaemia. Although,
broadly speaking, there are two categories of
diabetes—immune-mediated or type 1 diabetes
and type 2 diabetes—it should be apparent that one
is dened by the (imperfect) exclusion of the other.
e complications of hyperglycaemia and hypoglycaemia are nevertheless common to both. Beyond
overlap between type 1 and type 2 diabetes, there
is signicant heterogeneity in the causation of type
2 diabetes. While this may be obvious to the specialist, the generalist may not appreciate the subtle
clues underlying a diagnosis of haemochromatosis- or acromegaly-associated diabetes. Similarly,
specialists usually require years of experience to see
and understand rare conditions, such as lipodystrophy, that are associated with diabetes. For these
cases alone, Atlas of Diabetes Mellitus remains an
invaluable contribution to the literature.
Although, or perhaps because, a picture is ‘only’
worth a thousand words, this book provides a
depth and breadth to an overview of diabetes that
will serve its readers well by facilitating the acquisition of new and useful information. erefore, in
conclusion, I would like to echo the Foreword of
the previous edition where Dr. Rizza stated that ‘…
those of you who choose to add this excellent Atlas
to your library will nd that you will also share my
enthusiasm for this delightful book.’
Adrian Vella MD
Rochester, MN, US
ix
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