Ringkasan :
The first edition of the Joslin textbook was published in 1916, a single-handed contribution by a man of extraordinary dedication, vision, and energy, Dr. Elliott P. Joslin. Dr. Joslin began his practice in 1898 in the pre-insulin era, and in this setting, developed a unique understanding of the natural history of diabetes. This perspective was clearly evident in the first edition, which was published some five years before the discovery of insulin by Banting, Best, Macleod, and Collip. The third edition, published in 1923 shortly after the discovery of insulin, showed how quickly Joslin grasped the principles of insulin therapy, adopting approaches that would be considered modern even by today's standards. As a student of metabolism, Dr. Joslin was unwavering in his conviction that blood glucose levels should be kept as close to normal as possible, even though the importance and even the existence of chronic complications of diabetes were not appreciated until many years later. He understood the critical role of education for people with diabetes and made it the cornerstone of all treatment programs. His insights into the interaction between diet, exercise, and glucose control were also remarkable, considering how difficult it was to assess control accurately at this time. His descriptions of the symptoms of hypoglycemia are as well defined as can be found anywhere today, and he rapidly determined the small quantity of carbohydrate required to treat insulin reactions. Any serious student of diabetes should spend time with these early editions. The evolution of the Joslin textbook mirrors the development of the field of diabetes and in some ways the development of Joslin Diabetes Center. Although the book was originally written entirely by Dr. Joslin himself, in subsequent editions he included his colleagues in the task, taking advantage of their special expertise. Eventually, substantial contributions to the book were provided not only by the staff of Joslin Diabetes Center, but also by clinicians from the adjacent New England Deaconess Hospital, where most Joslin patients were hospitalized. Patients come to Joslin and its affiliated institutions from all over the world, knowing that whatever problems they have can be addressed by someone who understands the full complexity of diabetes. Thus, the Joslin staff consists of adult and pediatric diabetologists, nephrologists, ophthalmologists and optometrists, and mental health professionals, as well as nurse educators and nutrition specialists. Problems in vascular disease, cardiology, neurology, and in virtually all other areas of medicine, are now managed in collaboration with colleagues at the Beth Israel Deaconess Hospital (BIDMC). Women with diabetes also receive coordinated care between Joslin and BIDMC, and sick children often are hospitalized at Children's Hospital Boston. To meet the challenges of the epidemic of diabetes, Joslin has established Affiliated Centers with 22 sites throughout the United States and our first international Affiliate in Bahrain. Because there are experts at these institutions who have extensive experience in virtually every aspect of diabetes care, some have joined with Joslin staff to write the clinical chapters, describing the characteristics and outcomes of their patients in the context of the broader literature. Research has always been a fundamental focus at Joslin and as such has been reflected in all of the editions. Dr. Joslin himself was a fine clinical investigator who made astute observations about his patients and recorded the information in meticulous fashion, as can be appreciated in his numerous publications. He also recognized the need for a more organized approach to research and appointed Dr. Alexander Marble as the first head of research in 1934. The research programs were greatly expanded when Dr. Albert Renold took over the leadership in 1957, and further enhanced under the leadership of George Cahill, Stuart Soeldner, C. Ronald Kahn, and now George King. Thus, the most recent editions of Joslin's Diabetes Mellitus, including the current edition, reflect not only the practice and experiences of the physicians of the Joslin Diabetes Center, but also the remarkable body of new scientific information that has had such an impact on the field. In addition, we have called upon former fellows and trainees of Joslin, now numbering over 1,200, and our academic colleagues elsewhere, to help present the latest advances in basic and clinical research. The 14th edition is very different from the 13th edition published a decade ago. These differences demonstrate the dramatic advances in knowledge and research. Progress in the basic sciences has been explosive in recent years, particularly in the areas of immunology, insulin signaling, cell and molecular biology, and genetics. This has resulted in a remarkable increase in our understanding of the basic processes underlying type 1 and type 2 diabetes, as well as diabetes complications. Because of this rapid rate of new knowledge, this text, like all modern biomedical texts, must be considered a living document, subject to change and updated regularly. Every reasonable effort has been made to have the 14th edition closely reflect our current understanding of diabetes. In addition, while less emphasis has been given to the local Joslin experience in describing various aspects of diabetes care and more effort has been made to incorporate the experiences of others described in the literature, an effort has been made to retain the flavor of Joslin's clinical strategies and the emphasis on the importance of the team approach. The Joslin Diabetes Center stands today as an institution on the front lines of the world epidemic of diabetes, leading the battle to conquer diabetes in all of its forms through cutting-edge research and innovative approaches to clinical care and education. Our task, of course, is to realize our vision of a world without diabetes and its complications. Disseminating the most current diabetes research and approaches to care is part of our vision and mission. This 14th edition of Joslin's Diabetes Mellitus is dedicated to a number of special individuals—first, to Dr. Robert F. Bradley, who arrived at Joslin in 1950 as a young clinician fresh out of the Navy. By 1968, he had become the Medical Director of the Joslin Clinic, and in 1977, he became President of the fully integrated Joslin Diabetes Center. Under his leadership, Joslin grew steadily in both its clinical and research missions. Perhaps Dr. Bradley's most significant contribution was his role in a major controversy of the mid-1970s over the use of oral drugs in the treatment of diabetes. A large NIH-funded study, the UGDP, suggested that the available oral agents for diabetes, the sulfonylureas, might not be safe. In fact, the study suggested that these agents might cause more deaths by producing certain cardiovascular side effects than they saved through treatment of diabetes. Dr. Bradley found this conclusion contrary to his own experience with thousands of patients with diabetes, and so he challenged this study, not just quietly and privately, but loudly and in the public eye. Consequently the UGDP study was found to be seriously flawed, and thus sulfonylureas, very important drugs for the treatment of type 2 diabetes, remained on the market. As a result, millions of patients with diabetes have benefited from improved diabetes control. During his tenure, Dr. Bradley also edited the Joslin textbook, gave numerous lectures, and served on the first National Diabetes Advisory Board from 1977 to 1980. Bob retired in 1987 and died on October 12, 2003. He will always be remembered as a soft-spoken, highly dedicated leader and for the wonderful legacy he left for Joslin and people with diabetes throughout the world. Second, we dedicate this 14th edition of Joslin's Diabetes Mellitus to all of the patients with diabetes and their families who have allowed us to care for them over the 106-year history of the Joslin Diabetes Center. They are the reason for our existence and the inspiration for working even harder. They inform our search for knowledge and our efforts to improve the lives of people with diabetes across the globe. We also dedicate this 14th edition of Joslin's Diabetes Mellitus to all of those who have so generously supported Joslin with their efforts and funds to support research, clinical care, and education. Without that support, the institution could not survive and continue to work toward the cure, prevention, and improved treatment of diabetes and its complications. Last, we wish to thank all of the individuals who worked together to bring this book to fruition. The authors of the various chapters spent untold hours thinking, researching, and writing to reach the level of excellence expected of a book of this stature. Two individuals, with whom it has been a pleasure to work, have made great contributions to the project. Susan Sjostrom, the Director of Publications at Joslin, was remarkably efficient at keeping track of all the manuscripts, disks, correspondence and e-mail. Nancy Voynow, the editorial assistant in Boston, was thoroughly professional, skilled, and efficient throughout, doing a wonderful job editing this enormous amount of complicated material. We also greatly appreciate the efforts and skill of our publisher, Lippincott Williams & Wilkins. And, of course, most of all, we thank our families for their support and tolerance of the never-ending intrusion of this book into evenings, weekends, and at times even vacations.

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