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 Individualized
Diabetes
Management
A Guide for Primary Care
 Individualized
Diabetes
Management
A Guide for Primary Care

Anthony H. Barnett
Jenny Grice
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742

© 2016 by Taylor & Francis Group, LLC

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Version Date: 20160719

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guidance contained in this book is intended for use by medical, scientific 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
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reader is strongly urged to consult the relevant national drug formulary and the
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their websites, before administering or utilizing any of the drugs, devices or
materials mentioned in this book. This 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
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Library of Congress Cataloging.in.Publication Data

Names: Barnett, A. H. (Anthony H.), 1951- author. | Grice, Jenny, author.
Title: Individualized diabetes management : a guide for primary care /
Anthony H. Barnett and Jenny Grice.
Description: Boca Raton : CRC Press, [2017] | Includes bibliographical
references.
Identifiers: LCCN 2016032387 | ISBN 9781498762090 (pbk. : alk. paper)
Subjects: | MESH: Diabetes Mellitus, Type 2-- epidemiology | Diabetes
Mellitus, Type 2--therapy | Precision Medicine | Primary Health Care |
Great Britain
Classification: LCC RC660.4 | NLM WK 810 | DDC 616.4/62-- dc23
LC record available at https://lccn.loc.gov/2016032387

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Contents

Biography
Introduction

1 Type 2 diabetes: epidemiology, complications and costs

Epidemiology
Diabetes complications
Costs
References
2 Challenges to glycaemic control
Type 2 diabetes is a progressive disease
Adherence to management plans
Clinical inertia
Provider barriers
Patient barriers
System barriers
Overcoming clinical inertia
References
3 Barriers to adherence and their solutions
Which patients are most at risk of non-adherence?
Age-related morbidities
Lifestyle challenges
Change in situation
Loss or lack of motivation
Depression
 Ethnicity
Poor perception and knowledge of disease
Problems with therapy
Complexity of dosing regimen
Fear of injections
Safety and tolerability
Lack of knowledge
How to question patients about non-adherence
Tailor adherence solution to non-adherence problem
Conclusions
References
4 Advantages and disadvantages of new therapies
Older therapies
Metformin
Modified-release metformin
Sulphonylureas
Meglitinides
Thiazolidinediones (glitazones)
Alpha-glucosidase inhibitors
Newer therapies
Incretin-based therapies
DPP-4 inhibitors
GLP-1 receptor agonists
SGLT-2 inhibitors
Combination therapy with newer agents
References
5 New insulin developments
Basal insulins
Biosimilar insulins
Insulin degludec
Glargine U300
Rapid-acting insulin analogues
Ultra-rapid-acting insulin analogues
 Inhaled insulin
Conclusions
References
6 Personalised management
Factors to consider in personalised diabetes management
Lifestyle management
Pre-diabetes
Diagnosed type 2 diabetes
Pharmacotherapy
Early and intensive treatment with initial combination therapy
Advantages of a personalised approach
References
7 Organisation of diabetes care
Role of the primary care team in multi-professional care
Aims of integrated care
Personalised care planning
Preparing for a care planning discussion
References

Index
Biography

Professor Anthony H. Barnett is recognised as an international expert

in this area and has written many papers and lectured extensively
nationally and abroad. He has acted as an expert advisor to National
Institute for Health and Care Excellence (NICE) on new drugs and
has worked with the European Medicines Agency and other related
bodies. Indeed, he represented the European Association for the
Study of Diabetes (EASD) at the European Medicines Agency on
diabetes-related drugs between 2006 and 2011. He is presently
listed in the top five researchers in Type 2 Diabetes worldwide.
Jenny Grice is an accomplished medical writer and has supported
Professor Barnett on many of his projects including co-authoring a
bespoke book on new mechanisms in glucose control, published in
2011.
Introduction

Type 2 diabetes is at crisis levels and shows no signs of abating with

no country and no section of society immune to the disease. In the
United Kingdom, 2016 began with the news that the number of
people with diabetes had exceeded four million for the first time
(QOF et al., 2015). The need to tackle this serious health condition
has therefore never been so urgent.
Although we have the evidence and the tools to prevent and
manage type 2 diabetes, these are not routinely employed, and
tragically we continue to see too many people with diabetes
suffering serious complications, and even premature death. The
challenge is to reduce the human and financial costs through early
diagnosis and effective management and to prevent new cases of
diabetes from developing.
The World Innovation Summit for Health 2015 Diabetes Forum
identified three policy goals to both reduce the incidence of diabetes
and better manage established disease and its complications
(Colagiuri et al., 2015):

1. Improve disease management for people with diabetes to

reduce complication rates.
2. Establish effective surveillance to identify and support those at
risk of type 2 diabetes.
3. Introduce a range of interventions that help to create an
environment focussed on prevention.
IMPROVE DISEASE MANAGEMENT
In the past two decades, a greater understanding of diabetes has
facilitated the development of new drug classes that target specific
metabolic pathways such as the thiazolidinediones, dipeptidyl
peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and
sodium–glucose cotransporter type 2 inhibitors, as well as a range of
new insulins (Tahrani et al., 2016). Many of these are now available
as combination treatments allowing us to combine drugs with
different mechanisms of action into simpler treatment regimens. We
are no longer limited in what we can offer to patients, and it is
therefore much easier to develop personalised management
regimens that match treatments to the individual needs of patients
and their stage of disease. The clinical efficacy of a treatment
remains integral, but what is more important to the individual is how
it fits in with his or her daily life, and here ease of use, tolerability
and safety are of great importance. Tailored treatment plans
combined with education improve disease management and help
prevent complications.
Unless personalised management plans suited to the needs of the
individual and well supported by health care professionals are
applied consistently, the rising number of people with diabetes will
have less chance of living long and healthy lives, and health
authorities will become crippled by the avoidable but escalating costs
of treating poorly managed diabetes and its many sequelae. It
should be remembered that the cost of best practice management,
including appropriate drug therapy in diabetes, is a small proportion
of the total cost (most of which is accounted for by the often
preventable long-term complications). It is entirely paradoxical,
therefore, to withhold best practice management from patients
earlier in the disease ostensibly to reduce costs if in the long term
this leads to an increased risk of complications, which account for
the vast majority of the costs of type 2 diabetes. The latter relate to
significantly increased risk of blindness, kidney failure, lower limb
amputation, myocardial infarction and stroke. All too often we (and
particularly health authorities) consider the headline ‘cost’ of a
management regime (particularly as it relates to drug therapy)
rather than its true value.

IDENTIFY THOSE AT RISK

Although there is as yet no cure, type 2 diabetes is largely
preventable – both its onset and its complications. The most
important modifiable risk factors for type 2 diabetes are overweight
and obesity, which have now reached massive proportions in both
the developed countries and the developing world (Aylott et al.,
2008). Indeed, there has been a fourfold increase in the prevalence
of obesity in UK adults over the past 30 years with similar worrying
statistics in children and young people (Aylott et al., 2008). Levels of
physical activity have plummeted in a generation, and the ‘fast food’
culture has taken over.
Primary care is ideally placed to become more directly involved in
diabetes prevention, although this must be supported by appropriate
public health initiatives and resources. We can identify people at risk
of developing type 2 diabetes by looking at their family history, their
ethnicity, their weight, how active they are and what their diet is
like, and offer education and support to those at risk. We can also
identify those people with type 2 diabetes who are not managing
well and focus more resources on these individuals. This will
potentially help enormously in the overall cost of care, by reducing
hospitalisations and complications.

CREATE A PREVENTION-FOCUSED
ENVIRONMENT
This last point is less in the hands of primary care and more in those
of policy makers. To create an environment that encourages healthy
living and prevents diabetes, policymakers need to address risk
factors rather than focus solely on the disease. This requires a wide
variety of interventions to change population behaviour.
In addition, with the record number of people living with diabetes,
there is no time to waste in improving diabetes care and education.
Every delay in diagnosis and treatment can lead to more
complications and more suffering for patients as well as a huge
financial cost to the National Health Service. The increasing
requirement in the United Kingdom to move much of diabetes
practice into the community means that primary care must take on
much of this role. We know what needs to be done, the question is
how to do it? In this bespoke book, the authors focus on how to
personalise care and how advances in treatment are making this
easier to achieve. Although there are many areas involved in
individualised prescribing and management, the book focuses on
those that are within the control of the person with diabetes and his
or her healthcare provider. These include helping people with
diabetes gain the skills to manage their own health, agreeing with
them a care plan that is based on their personal needs, and making
sure that their care is better coordinated. Tackling diabetes is one of
the major health challenges of our time. By ensuring that action is
taken now to offer the best possible care for diabetes, this will be
repaid, in human, social and economic terms, but will require
substantial commitment from all those involved.

REFERENCES
Aylott J, Brown I, Copeland R, Johnson D. Tackling obesities: The
foresight report and implications for local government. Sheffield
Hallam University; 2008. Available from:
http://www.idea.gov.uk/idk/aio/8268011. Last accessed May
2011.
Colagiuri S, Kent J, Kainu T, Sutherland S, Vui S; World Innovation
Summit for Health. Rising to the Challenge Preventing and
Managing Type 2 Diabetes Report of the WISH Diabetes Forum
2015; 2015. Available from:
 https://www.imperial.ac.uk/media/imperial-college/institute-of-
global-health-innovation/public/Diabetes.pdf. Last accessed
March 2016.
Quality and Outcomes Framework, Health and Social Care
Information Centre, Information Services Division Scotland.
Statistics for Wales. Department of Health, Social Services and
Public Safety; 2014–2015.
Tahrani AA, Barnett AH, Bailey CJ. Pharmacology and therapeutic
implications of current drugs for type 2 diabetes mellitus. Nat
Rev Endocrinol 2016;12:566–592.
 1

Type 2 diabetes: epidemiology,

complications and costs

EPIDEMIOLOGY
Changes in lifestyle over the past century have resulted in a dramatic
increase in the incidence of type 2 diabetes worldwide. Once a
disease of Western affluent societies, it has now spread to every
country in the world and is increasingly common among the poor.
Once almost unheard of in children, rising rates of childhood obesity
have rendered it more common in the paediatric population,
especially in certain ethnic groups. Recent estimates from the Global
Burden of Disease Study indicate that diabetes rates around the
world rose 45% between 1990 and 2013, primarily in type 2 diabetes
(Global Burden of Disease Study 2013 Collaborators, 2015).
According to the International Diabetes Federation, diabetes affected
at least 387 million people worldwide in 2014, and that number is
expected to rise to 592 million by 2035, with 77% of all diabetes
cases occurring in low- to middle-income countries (IDF, 2015).
China and India now account for 60% of the world’s diabetes
population. In 1980, less than 1% of Chinese adults had diabetes,
but this increased to almost 12% (113.9 million adults) by 2010
(Diabetes in China, 2014). The epidemic is the result of rapid
economic development, urbanization and lifestyles that are
increasingly sedentary, and poor diets high in saturated fat and
calories derived from refined carbohydrates and sugar. Asian people
are also particularly susceptible to type 2 diabetes compared with
white people and tend to develop the disease at a much lower body
mass index (BMI). The average BMI of Chinese people with diabetes
is 25 kg/m2, compared with 30 kg/m2 in non-Asians.
Recent prevalence figures for the United Kingdom have been
obtained using data from the Quality and Outcomes Framework for
those aged ≥17 years and the National Paediatric Diabetes Audit for
England and Wales and the Scottish Diabetes Survey for younger
individuals. The data show that at the end of March 2014, there were
approximately three million people with a recorded diagnosis of type
2 diabetes, which equates to a prevalence of 4.5% (Table 1.1)
(Holman et al., 2015). Throughout the United Kingdom, 1 in 22
people have diagnosed type 2 diabetes. However, these figures do
not take into account the numbers of people with undiagnosed type 2
diabetes, currently estimated at around 850,000 (Public Health
England, 2014a).
Overweight and obesity are driving the global diabetes epidemic.
They affect the majority of adults in most developed countries and
are increasing rapidly in developing countries. In the United Kingdom,
around 90% of people with type 2 diabetes are overweight or obese
(Public Health England, 2014b). The rising prevalence of obesity in
the United Kingdom and around the world will continue to lead to a
rise in the prevalence of type 2 diabetes. It is estimated that at least
half of all cases of type 2 diabetes could be prevented if weight gain
in adults could be avoided (Knowler et al., 2002). As a consequence,
an epidemic of diabetes-related complications and premature
mortality will follow, with people from deprived areas and some
minority ethnic groups at particularly high risk.
Table 1.1 Current prevalence of diagnosed diabetes in the United Kingdom
DIABETES COMPLICATIONS
Diabetes is a chronic disease that causes substantial premature
morbidity and death. Over time, damage caused by high blood
glucose levels is a major contributing factor to long-term
complications, which can be classified broadly as microvascular
(including retinopathy, nephropathy and neuropathy) (Figure 1.1) or
macrovascular disease (including ischaemic heart disease, myocardial
infarction, heart failure and stroke). Without careful, continued
management of the condition, a person with diabetes faces a
reduced life expectancy of between 6 and 20 years (The Emerging
Risk Factors Collaboration, 2011). According to a report conducted by
the Health & Social Care Information Centre in 2013, there were
around 24,000 premature deaths in England and Wales due to
diabetes (both type 1 and type 2) compared to the general
population. Those with type 1 diabetes were 131% more likely to die
in 2013 than their peers without the condition, and those with type 2
diabetes were 32% more likely to die (National Diabetes Audit:
Complications and mortality, 2015). These additional deaths are
largely preventable and develop after years of exposure to high
glucose, high blood pressure and high cholesterol, which are all signs
of poorly managed diabetes. The report assessed the likelihood of a
person with diabetes being admitted to hospital for each of a range
of diabetes complications, including angina, myocardial infarction,
heart failure, stroke, major amputation, minor amputation and renal
replacement therapy (dialysis or transplantation). Compared to a
person without diabetes, people with diabetes were significantly more
likely to be admitted to hospital with one of the complications (Figure
1.2) (National Diabetes Audit: Complications and mortality, 2015).

Figure 1.1 Examples of type 2 diabetes associated microvascular complications,

including retinopathy and neuropathic ulcer. (a) Hard exudates are visible gathering
around the macular region of the retina suggestive of sight threatening
maculopathy. Retinal microaneurysms can also be seen. (b) Neuropathic ulcer over
the metatarsal head of the big toe.

The increasing prevalence of type 2 diabetes in younger adults will

also have an impact on the incidence of diabetes complications. In
the United Kingdom, the proportion of newly diagnosed people with
type 2 diabetes below the age of 40 years has increased significantly
from 5.9% in 1991 to 12.4% in 2010 (Holden et al., 2013). A
diagnosis of type 2 diabetes at a young age will lead to the
development of complications at an earlier stage of life, and indeed
there is evidence that young-onset diabetes is a more aggressive
disease than that occurring in older people (Rhodes et al., 2012).
Preventing vascular complications from occurring would therefore
have a huge impact on the number of hospital admissions across the
National Health Service (NHS). In the United Kingdom, the National
Institute for Health and Care Excellence (NICE) already recommends
screening for diabetes in high-risk individuals aged 25–39 years
particularly from ethnic minority groups and those with conditions
that increase the risk of type 2 diabetes (NICE, 2012).

Figure 1.2 Additional risk of a person with diabetes being admitted to hospital for
each of a range of diabetes complications compared to somebody without diabetes
over a 1-year follow-up period using the 2011–2012 National Diabetes Audit.
(Adapted from National Diabetes Audit—2012–2013. Report 2: Complications and
mortality. Available from: http://www.hscic.gov.uk/catalogue/PUB16496/nati-diab-
audi-12-13-rep2.pdf, 2015.)

There is also now a substantial body of epidemiological evidence

to suggest that intrauterine exposure to hyperglycaemia is associated
with increased lifelong risks of the exposed offspring for obesity,
metabolic, cardiovascular and malignant diseases. During early
development, the foetus is particularly vulnerable to environmental
factors, and that to benefit the next generation avoiding adverse
nutrition during the pre-conception and intrauterine period may be
much more important for the prevention of adult disease than
preventive measures in infants and adults (Lehnen et al., 2013).
COSTS
With its increasing prevalence and high cost of treatment, diabetes
places an enormous demand on economic resources. In 1993, the
cost of diabetes treatment in China was 2.2 billion (bn) Renminbi
(RMB), but the projected cost for 2030 is 360 bn RMB. In the United
States, it is estimated that approximately 20% of the nation’s
healthcare budget goes towards treating people with diabetes (ADA,
2013). In Europe, preventing and treating diabetes and its
complications is estimated to cost about 90 bn euros (£73 bn)
annually. In the United Kingdom, treating people with diabetes and
its complications cost the NHS £8.8 bn in 2010–2011, equivalent to
around 10% of the NHS budget. By 2035, it is predicted that costs
will have increased to £16.8 bn, 17% of the NHS entire budget.
The cost impact of diabetes affects society, health systems,
individuals and employers, and reflects both direct costs of the
disease such as doctor and hospital visits, medication, laboratory
costs for tests and equipment costs, and indirect costs such as
income losses due to reduced employment chances, early retirement
and lost work hours due to illness. Many people with type 2 diabetes
experience multiple complications, compounding the complexity of
treatment and thus costs. The characteristics of the economic burden
vary from country to country depending on the healthcare system in
place. In high-income countries, the burden often affects government
or public health insurance budgets, whereas in low- and middle-
income countries, where about two-thirds of all individuals with
diabetes live, a large part of the burden falls on the person with
diabetes and their family due to limited or no health insurance
coverage (Seuring et al., 2015).
In 2014/2015, the net ingredient cost for managing diabetes in the
United Kingdom was £868.6 million, according to the NHS
prescription data group the Health and Social Care Information
Centre. This represents 10% of the total primary care prescribing
spend, that is, 10 pence in the pound of the primary care prescribing
bill in England is being spent on managing diabetes. However, around
four-fifths of NHS diabetes spending goes on treating complications
that in many cases could have been prevented. In a recent analysis
from the UK Prospective Diabetes Study (UKPDS), the costs of all
consultations, visits, admissions and procedures associated with
diabetes-related complications during the UKPDS post-trial monitoring
period (1997–2007) were estimated using hospital records for 2791
patients and resource use questionnaires administered to 3589
patients (Alva et al., 2015). Using the example of a 60-year-old man,
the estimated inpatient costs (during the event year) were as follows:
£9767 for non-fatal ischaemic heart disease; £3766 for fatal
ischaemic heart disease; £6379 for non-fatal myocardial infarction;
£1521 for fatal myocardial infarction; £3191 for heart failure; £6805
for non-fatal stroke; £3954 for fatal stroke; £9546 for amputation;
and £1355 for blindness in one eye. Given the fact that most of these
complications are preventable, the costs are wasteful not only in
terms of the quality of human life, but also for NHS budgets. If
nothing is done to halt this epidemic, the double burden of an ageing
population and rising rates of young-onset type 2 diabetes will have
an enormous toll on productivity and healthcare systems. Long-term
cost savings can only be achieved if urgent measures are put in place
to ensure early investment into prevention and better disease
management.

REFERENCES
Diabetes in China: mapping the road ahead. Lancet Diabetes
Endocrinol 2014;2:923.
Alva ML, Gray A, Mihaylova B, Leal J, Holman RR. The impact of
diabetes-related complications on healthcare costs: New results
from the UKPDS (UKPDS 84). Diabetic Med 2015;32:459–466.
American Diabetes Association. Economic costs of diabetes in the
U.S. in 2012. Diabetes Care 2013;36:1033–1046.
The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting
glucose, and risk of cause-specific death. N Engl J Med
2011;364:829–841.
Global Burden of Disease Study 2013 Collaborators. Global, regional,
and national incidence, prevalence, and years lived with
disability for 301 acute and chronic diseases and injuries in 188
countries, 1990–2013: A systematic analysis for the Global
Burden of Disease Study 2013. Lancet 2015;386:743–800.
Holden SH, Barnett AH, Peters JR, Jenkins-Jones S, Poole CD, Morgan
CL, Currie CJ. The incidence of type 2 diabetes in the United
Kingdom from 1991 to 2010. Diabetes Obes Metab
2013;15:8448–8452.
Holman N, Young B, Gadsby R. Current prevalence of Type 1 and
Type 2 diabetes in adults and children in the UK. Diabet Med
2015;32:1119–1120.
International Diabetes Federation. IDF Diabetes Atlas. Epidemiology
and Mobidity; 2015. Available from http://www.idf.org/. Last
accessed 1 March 2016.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM,
Walker EA, Nathan DM; Diabetes Prevention Program Research
Group. Reduction in the incidence of type 2 diabetes with
lifestyle intervention or metformin. N Engl J Med 2002 Feb
7;346(6):393–403.
Lehnen H, Zechner U, Haaf T. Epigenetics of gestational diabetes
mellitus and offspring health: The time for action is in early
stages of life. Mol Hum Reprod 2013;19:415–422.
National Diabetes Audit—2012–2013. Report 2: Complications and
Mortality. Available from:
http://www.hscic.gov.uk/catalogue/PUB16496/nati-diab-audi-12-
13-rep2.pdf. Last accessed November 2015.
NICE. Preventing type 2 diabetes: Risk identification and
interventions for individuals at high risk. London: National
Institute for Health and Care Excellence; 2012.
Public Health England. Diabetes prevalence model 2014a. Available
from: http://www.yhpho.org.uk/resource/view.aspx?RID=81090.
Last accessed 28 September 2016.
Public Health England. Adult obesity and type 2 diabetes 2014b.
Available from:
 https://www.gov.uk/government/uploads/system/uploads/attach
ment_data/file/338934/Adult_obesity_and_type_2_diabetes.pdf.
Last accessed 28 September 2016.
Rhodes ET, Prosser LA, Hoerger TJ, et al. Estimated morbidity and
mortality in adolescents and young adults diagnosed with type 2
diabetes mellitus. Diabet Med 2012;29:453–463.
Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2
diabetes: A global systematic review. Pharmacoeconomics
2015;33:811–831.
 2

Challenges to glycaemic control

Achieving and maintaining adequate glycaemic control remains a

challenge in many people with type 2 diabetes. The most recent
National Institute for Health and Care Excellence (NICE) guidelines
recommend second-line intervention if haemoglobin A1c (HbA1c)
rises to 7.5% (58 mmol/mol) or higher with a combination of
reinforced lifestyle advice and intensified drug treatment. HbA1c
treatment targets are personalised, but in general should be 6.5%
(48 mmol/mol) for diet ± metformin and 7% (53 mmol/mol) after
intensification beyond this (National Institute for Health and Care
Excellence, 2015). Statistics from the UK National Diabetes Audit for
2014/2015 indicate that around one-third of individuals with a
diagnosis of type 2 diabetes in England and Wales have an HbA1c
higher than 7.5% (58 mmol/mol) (National Diabetes Audit,
2014/2015) (Table 2.1), a figure that has hardly changed in the past
5 years. The proportion of people with a serum cholesterol level
higher than NICE recommendations has remained stable, whereas
blood pressure target achievement rates have improved steadily
(Table 2.1).
The maintenance of simultaneous control of hypertension,
dyslipidaemia and hyperglycaemia is the cornerstone of diabetes
care, but this was achieved in only 41% of individuals (Table 2.1)
(achievements would have been even less if ‘best practice’ targets
had been audited, that is, HbA1c <7% [53 mmol/mol], blood
pressure <130/80 mmHg and total and low-density lipoprotein (LDL)
cholesterol <4 and 2 mmol/L, respectively). Compared with its
European counterparts, the United Kingdom appears better at
managing lipids and blood pressure than hyperglycaemia. In a cross-
sectional study that examined the medical records of people with
type 2 diabetes across eight European countries over the period
March 2009–December 2010, the United Kingdom was second lowest
in terms of HbA1c target attainment (defined as an HbA1c <7% [53
mmol/mol]) (Table 2.2) (Stone et al., 2013).
Table 2.1 Percentage of people with diabetes in England and Wales achieving their
treatment targets by diabetes type and audit year

According to the National Diabetes Audit, people aged 65 and over

were more likely to achieve simultaneous control of hypertension,
dyslipidaemia and hyperglycaemia (just under 50% achieved control)
compared with individuals aged 40–64 years old where only a third
achieved control (Figure 2.1) (National Diabetes Audit, 2014/2015).
Managing type 2 diabetes appropriately is critical to control its
progression and to prevent acute and long-term complications, which
are not only detrimental to quality of life and long-term prognosis,
but also account for a disproportionate share of the total cost of
managing the condition (Liebl et al., 2015). Three main factors
continue to challenge glycaemic control: the progressive nature of
the disease, poor adherence to management plans and clinical inertia
(‘the deadly triad’) (Figure 2.2).
TYPE 2 DIABETES IS A PROGRESSIVE DISEASE
Two major pathophysiological abnormalities underlie most cases of
type 2 diabetes: insulin resistance (impaired insulin sensitivity) and β-
cell dysfunction. As cells and organs become gradually less sensitive
to insulin, the body tries to compensate by producing more insulin,
and also by increasing the number of insulin-secreting β-cells. When
insulin resistance is accompanied by β-cell dysfunction, failure to
control blood glucose levels results. Both abnormalities are essential
components of type 2 diabetes pathogenesis, but it is the progressive
loss of β-cell function that is central to the progression of the disease.
The management of type 2 diabetes can be considered a ‘moving
target,’ in that the underlying pathophysiology is constantly changing
and progressing. It is therefore unlikely to respond adequately to any
single therapy in the long term, resulting in complex prescribing
patterns as the disease progresses with regular adjustments required
over time. Furthermore, individuals with type 2 diabetes vary in their
levels of insulin resistance and β-cell dysfunction. This has important
implications for disease management. For example, the more insulin
resistant a person with type 2 diabetes is, the harder it is to manage
the disease with agents whose mechanisms of action are insulin
dependent because more medication is required to provide enough
insulin to achieve target blood glucose levels. The management of
type 2 diabetes therefore requires treatment that is personalised to
specific glucose (and other cardiovascular risk factors) problems and
other health conditions.
Table 2.2 Achievement of type 2 diabetes treatment targets across eight European
countries
Figure 2.1 Percentage of people with type 2 diabetes in England and Wales
achieving all three treatment targets (HbA1c ≤7.5% [58 mmol/mol], blood pressure
≤140/80 mmHg and cholesterol <5 mmol/L) by age group, 2014–2015. (Adapted
from National Diabetes Audit—2013–2014 and 2014–2015: Report 1, Care
processes and treatment targets. Available from:
http://www.hscic.gov.uk/catalogue/PUB19900/nati-diab-rep1-audi-2013-15.pdf.)
Figure 2.2 Challenges to good glycaemic control (all three are intimately
interlinked).

The risk of insulin resistance increases with age, and some

individuals are genetically more susceptible. Lifestyle also plays a
role, with a higher risk in overweight individuals and those with a
sedentary lifestyle. A key feature of any diabetes management
programme is therefore diet and exercise. Dietary carbohydrate is the
major determinant of post-prandial glucose levels, and low
carbohydrate diets can be effective for improving glycaemic control
and achieving weight loss in people with type 2 diabetes (Ajala et al.,
2013). Exercise can dramatically reduce insulin resistance. In addition
to making the body more sensitive to insulin and building muscle that
can absorb blood glucose, physical activity opens up an alternative
pathway for glucose to enter muscle cells without insulin acting as an
intermediary. This reduces the cells’ dependence on insulin for
energy. Although the latter does not reduce insulin resistance itself, it
can help people who are insulin resistant improve their blood glucose
control.
Guidelines stress the importance of diet and exercise in the
treatment of all stages of type 2 diabetes. These lifestyle measures
are cheap and have no long-term side effects, but they demand a
high degree of motivation, which will require ongoing support. Many
people will require intensification of therapy to oral anti-diabetes
Another random document with
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confirmed by King Philip himself. The Stationers’ Company of
England had received its charter from Queen Mary in 1556, or thirty-
three years earlier. The Guild of the Venetian Printers dated from
1548, and was the earliest association of the kind in Europe. The
affairs of the Guild of Milan were managed by a board of directors,
comprising a Prior, a Bursar, and two Councillors. The Board had
charge of the property of the corporation, and was responsible also
for the protection of its privileges under the charter, and for the
defence of any of its members whose rights might be assailed. It
rested also with the Board to see that the regulations of the
Corporation were properly carried out, and in the event of any
assessment being laid upon the organised Printers and Publishers, it
was the duty of the Bursar to apportion the payments equitably
among the members of the Guild.
To the Board was also given authority to adjudicate disputes not
only between members of the Guild, but between the members and
outsiders, and its jurisdiction extended over the entire duchy. From
the decisions of the Board there was, as a rule, no appeal. In case,
however, the issue involved any complicated questions of law, so
that it became necessary for the Board to call in the counsel of a
jurist, an appeal could be made from the decision arrived at to a
special court of arbitration, which was also, however, to be made up
of members of the Guild. The roster of the Guild was in the special
control of the Prior, and this record was of special importance,
because no one whose name was not on this roster as a member in
good standing was permitted to print or to sell books in Milan, under
a penalty for each offence of fifty gold scudi.
No one was eligible for membership who had not served an
apprenticeship of eight years to a printer or book-dealer in Milan.
The fee for admission was, for one born in Milan, thirty lire, for others
one hundred lire.
One purpose of the organisation of the Guild was to prevent the
competition of foreign printers and booksellers from breaking down
the trade of the Milanese. A more legitimate object was to keep the
business of printing, publishing, and selling books in the hands of
trained men of high character, good education, and technical
training, who should conduct their work in a manner worthy of the
repute of Milan. It had been the complaint that many unworthy and
unskilled men had crowded into the business of making and selling
books, lowering the standard of the trade and diminishing the profits.
It was complained also that the paper-manufacturers or paper-
dealers had undertaken to sell books, notwithstanding a specific
statute prohibiting them from so doing. The royal commissioner,
whose sanction was required to validate on behalf of the King the
regulations of the new Guild, stipulated, however, in confirming the
renewal of this prohibition, that the paper-makers should still be
permitted to sell certain special books which had for some years
been in their hands, but that no other publications must be sold by
any paper-dealer who had not secured membership in the Guild as a
properly qualified bookseller.
It is not easy, after an interval of three centuries, to decide whether
this undertaking for the closer organisation of the book-trade was
really prompted, as was contended, by the desire to keep on the
highest possible plane the business of making and selling books, or
whether it was the result of a selfish desire on the part of the older
Milanese dealers to increase their profits and to keep out
competitors. It is probable there was a mixture of motives, but it is
certain that in Milan, as in other book centres, the formation of the
Guild gave an important incentive to printing and publishing,
improved the quality of the work done, and tended to keep the
business in the hands of a good class of men, and it is evident also
that such results must have brought advantages also to the general
public.
The more important of the regulations of the Guild can be
summarised as follows:

1. No member of the Guild shall reprint or shall sell any book

issued by another member, provided such book has not before
been printed in Milan, and provided also that the edition claiming
protection shall itself have been printed in Milan. A book printed
outside of the duchy cannot secure the protection of a Milanese
 privilege. The penalty for infringement is the forfeiture of the
copies printed and the payment of ten gold scudi.
2. Each publication shall bear the imprint of its printer or
publisher (usually, of course, the same person).
3. Apprentices and assistants must be registered on the records
of the Guild.
4. The sale of books in any places other than the registered
shops or places of business is forbidden; and the purchase of
books from apprentices or from any not known to be duly
authorised dealers is also made a misdemeanour.
5. The sale of books on Sundays or holidays, either in the shops
or in the dwellings, is forbidden.
6. No printer or dealer must use for his sign a token identical
with or closely similar to that already in use with an authorised
printer or dealer.

These regulations appear to have had the desired effect of

repressing if not of entirely exterminating the business of the
unauthorised printers and traders. In 1614, however probably for the
purpose of impressing a fresh generation of unauthorised traders,
the Guild secured a fresh royal edict, which again confirmed the
authority of the Guild and enjoined, under heavy penalties, the
strictest obedience to its regulations.
Frommann points out that in the application for this new decree,
the Guild no longer lays stress upon the necessity of upholding the
dignity and honourable standard of the book-trade, but emphasises
the risk to the Church and to the community of believers if
uneducated and irresponsible persons, not familiar with the lists of
forbidden works, should be permitted to print or to sell books.
Experience had evidently made clear to the publishers that with a
government like that of Spain (which might be described as
despotism tempered by the Inquisition) this class of considerations
would be much more influential than any thought of upholding the
dignity of the business of making and selling books.
The petitioners make reference to the decree accompanying the
latest Index Expurgatorius, which forbids any one from carrying on
business as a printer, publisher, or bookseller, who has not taken
oath before the ecclesiastical superiors or the Inquisitor of his district
to conduct his business in full loyalty to the holy Catholic Church,
and to give explicit obedience to all the decrees and enactments of
the Church and of the Inquisitor for the regulation and supervision of
the press.
The petitioners go on to state that this edict of the Church has
largely fallen into disregard because ordinary traders, merzeranii,
uneducated and irresponsible men, not trained to the book-business
and having no knowledge of or no respect for the Index
Expurgatorius, have been allowed to print and to sell books, to the
detriment not only of the legitimate book-trade, but of the Church and
of the community. The King (Philip III.) appears to have agreed with
the Guild that this interference with an organised book-trade (which
from the very fact of its organisation could be and was effectively
supervised by the Church) constituted a very dangerous abuse.
The new edict, with its severe penalties, and with the effective co-
operation of the local inquisitors and other ecclesiastics, appears to
have had the effect desired. We hear no more from the publishers of
Milan about irresponsible competition, and the business prospered
as far as was practicable within the rather narrow limits fixed by the
censorship of the Church. The most noteworthy productions of the
Milanese presses between the years 1500 and 1700, were, as
stated, in the departments of jurisprudence and medicine. The
greater activity of publishing in these two departments may very
possibly have been in part due to the fact that they were less
affected by the ecclesiastical censorship.
Lucca and Foligno.—The little city of Lucca is entitled to
mention in connection with the introduction of printing into Italy, if
only because it was the only city in Italy (and possibly the only one in
Europe), in which the new art secured the direct support and co-
operation of the government in the form, first of a municipal decree in
favour of the printing-press, and secondly of a direct subvention from
the municipal treasury in encouragement of the first printer. The
printer was Clemente, a native of Padua, who was engaged in
business in Lucca as a scribe and illuminator. It was made a
condition of the appropriation (the amount of which is not stated) that
the printer, who was to be classed as a public functionary, was to
hold himself in readiness to teach the art to all who might desire to
learn. Clemente established his press in Lucca in 1477, and printed
there in that year, an edition of the Triumphs of Petrarch. He had
previously printed in Venice a work by John Mesne, of Damascus, on
universal medicine, a large folio of 400 pages.
A still smaller city than Lucca, Foligno in Umbria, enjoys the
distinction of having received as its first printer, Johann Numeister,
who had been a pupil and assistant of Gutenberg himself. After the
death of his master, Numeister came to Italy with the intention of
setting up a press in Rome. He was induced to settle at Foligno at
the instance of Orfinis, a wealthy citizen, who supplied the funds
necessary for the undertaking. The first publication of the Foligno
Press was Leonardi Aretini Bruni de Bello Italico adversus Gothos,
which bears date 1470.
The imprint states that the book was “printed by Numeister in the
house of Emilianus de Orfinis.” The second work selected was an
edition of the Divina Commedia of Dante, the manuscript copy of
which had been collated and corrected for the press by Orfinis.
Orfinis died in 1472, just before the printing of the Commedia was
completed. Numeister paid a tribute to his patron in the last line of
the rhyming imprint:

Nel milla quatro cente septe e due

Nel quarto mese; a di cinque et sei,
Questa opera gentile impresso fue,
Io maestro Johanni Numeister opera dei
Alla dicta impressione, et meco fue,
El Elfuginato, Evangelista mei.

—Humphreys interprets the words “Evangelist mine” as standing for

“the one who made me known to the world.”[450] M. Bernard writes,
“better Evangelist than I am.” The last volume bearing the name of
Numeister was an edition of Torquemada’s Contemplations. With his
death in 1479, the brief record of the press of Foligno comes to a
close.
Florence.—Florence, which for a century or more had been
the centre of the intellectual life of Italy, and which presented in its
great collection of manuscripts, its central position, and its important
trade connections, distinctive advantages for the work of book-
publishing, was comparatively late in giving attention to the new art,
and the issues from the Florentine presses before the close of the
fifteenth century, were much less important than those of Venice and
of Milan.
The first book printed in Florence, a commentary on Virgil, by
Servius, bears date 1471. It was issued by Bernardo Cennino, and
appears to have been his sole publication.
Cennino was by trade a goldsmith, and had been associated with
Ghiberti in the work on the famous gates of the Baptistery.[451] An
enthusiast about the artistic pre-eminence of Florence and of Italy,
he was said to have been jealous of the glory that had come to
Germany through the invention of printing, and he determined to
master the art without German aid.[452] In the colophon to his work,
he describes the labour of the creation of his press, a labour which
included the engraving of the steel punches and the casting of the
type. His publishing venture was costly and probably unprofitable,
and he appears to have printed no second book. He continued,
however, in connection with his trade as a goldsmith, the work of
engraving punches for type.
The German printers speedily found their way to Florence as they
had already done to Rome, Venice, and Milan. In 1472, a certain
Peter, describing himself as “de Moguntia,” (of Mayence) printed an
edition of the Philocolo of Boccaccio, and in the same year, he
issued the Triumphs of Petrarch.
The subscription reads: “Master Peter, son of John of Mayence,
wrote (scripsit) this work in Florence, the 12th day of November,
1472.”
 Humphreys points out that this imprint is an example of the habit
of the early printers of considering their art as a kind of magical
writing rather than as a mechanical contrivance.
The most important of the early printer-publishers of Florence was
Nicholas of Breslau. In 1477, he published Bettini’s Monte Sancto di
Dio, which, according to Humphreys, presents the first example of
illustrations by means of engraved plates. In 1478, Nicholas
published an edition of Dante, the most elaborate that had yet
appeared. Dante had evidently already taken possession of the
intellectual interest of Italy, and as early as 1472, no less than three
editions had appeared. The fact that the poetry of Dante was given
to the public in Italian, secured for it a much wider range of popular
appreciation than was within reach of works written in Latin. The
same was true of the works of Boccaccio and of Petrarch, which,
with the aid of the printing-press, promptly came into the hands of
large circles of readers. Petrarch was first printed in 1470, and
Boccaccio in 1471, and thereafter editions of both authors followed
rapidly.
In 1474, a press was set up in the monastery of San Jacopo di
Ripili, near Florence, by two monks of the Brotherhood of S.
Dominic. The greater part of the books printed by them were
distributed among the monasteries as gifts or in exchange, but as
the reputation of their publications increased, they found it necessary
to accept orders from booksellers and from the outside public. Later,
they added a type-foundry to their plant.
Genoa.—The first printing-office in Genoa was established in
1471 by a German from Olmutz, named Moravus, who associated
with himself, in 1474, an Italian named Michael da Monaco. The
scribes, or manuscriptists, as they called themselves, made a
vigorous protest against the new art. They addressed, in 1471, a
petition to the magistracy in which they prayed to be protected from
the competition of these newly arrived printers, at least as far as the
production of Breviaries, Donati, and Psalters was concerned, as
upon the multiplication of these they depended for their livelihood.
Humphreys states that the original of this petition is still in
existence.[453] The record of the reply given by the magistrates has
not been preserved.
The printers were evidently not forbidden to print these books of
service, as editions were speedily produced. The influence of the
scribes appears, however, in the end, to have been sufficient to
establish a kind of cabal against the printers, and in the course of a
year or two the German gave up the attempt and removed his press
to Naples. There was doubtless in all the Italian cities a large
measure of jealousy and opposition on the part of the old librarii,
stationarii, and scriptores, but Genoa appears to have been the only
city where they were strong enough actually to drive out the printers,
at least for a time.
The first Hebrew Bible printed in Europe was issued in Soncino in
1488, from the press of Abraham Colonto. It is described as a very
fine piece of typography and as note-worthy for the artistic chapter-
headings and for the elaborate decorations of the marginal borders
of the pages.

end of volume i.
 The Question of Copyright
Comprising the text of the Copyright Law of the United States, and a
summary of the Copyright laws at present in force in the chief
countries of the world; together with a report of the legislation now
pending in Great Britain, a sketch of the contest in the United
States, 1837-1891, in behalf of International Copyright, and certain
papers on the development of the conception of literary property
and on the results of the American law of 1891.
COMPILED BY
GEO. HAVEN PUTNAM, A.M.,
Secretary of the American Publishers’ Copyright League.
Second Edition, revised, with additions, and with the record of
legislation brought down to March, 1896, octavo, gilt top, $1.75
Contents.—The law of Copyright in the U. S. in force
July 1, 1895.—Directions for securing Copyright.—
Countries with which the U. S. is now in Copyright
relations.—Amendments to the Copyright Act since July 1,
1891.—Summary of Copyright legislation in the U. S., by
R. R. Bowker.—History of the contest for International
Copyright.—The Hawley Bill of January, 1885.—The
Pearsall-Smith scheme of Copyright.—Report of the
House Committee on Patents, on the Bill of 1890-91, by
W. E. Simonds.—The Platt-Simonds Act of March, 1891.
—Analysis of the provisions of the Act of 1891.—Extracts
from the speeches in the debates of 1891.—Results of the
law of 1891 (considered in January 1894).—Summary of
the international Copyright cases and decisions since the
Act of 1891.—Abstract of the Copyright laws of Great
Britain, with a digest of the same by Sir James Stephen.—
Report of the British Copyright Commission of 1878.—The
Monkswell Copyright bill of 1890, with an analysis by Sir
Frederick Pollock.—The Berne Convention of 1887.—The
Montevideo Convention of 1889.—The Nature and Origin
of Copyright, by R. R. Bowker.—The Evolution of
Copyright, by Brander Matthews.—Literary Property: an
historical sketch.—Statutory Copyright in England, by R.
R. Bowker.—Cheap Books and Good Books by Brander
Matthews.—Copyright and the Prices of Books.—
Copyright “Monopolies” and Protection.—States which
have become parties to the Convention of Berne.—
Summary of the existing Copyright laws of the world
(March, 1896).—The status of Canada in regard to
Copyright, January, 1896.—General Index.
NOTICES.
A perfect arsenal of facts and arguments, carefully
elaborated and very effectively presented.... Altogether it
constitutes an extremely valuable history of the
development of a very intricate right of property, and it is
as interesting as it is valuable.—N. Y. Nation.
A work of exceptional value for authors and booksellers,
and for all interested in the history and status of literary
property.—Christian Register.
Until the new Copyright law has been in operation for
some time, constant resource must be had to this
workmanlike volume.—The Critic.
G. P. PUTNAM’S SONS
New York: 27 West 23d St. London: 24 Bedford St., Strand
 Authors and Their Public In Ancient Times
A Sketch of Literary Conditions and of the Relations with the Public
of Literary Producers, from the Earliest Times to the Fall of the
Roman Empire.
By GEO. HAVEN PUTNAM, A.M.
Author of “The Question of Copyright,” “Books and their Makers
During the Middle Ages,” etc.
Second Edition, Revised, 12º, gilt top $1.50

NOTICES.
The Knickerbocker Press appears almost at its best in the
delicately simple and yet attractive form which it has given to this
work, wherein the chief of a celebrated publishing house sketches
the gradual evolution of the idea of literary property.... The book
abounds in information, is written in a delightfully succinct and
agreeable manner, with apt comparisons that are often humorous,
and with scrupulous exactness to statement, and without a sign of
partiality either from an author’s or a publisher’s point of view.—New
York Times.
A most instructive book for the thoughtful and curious reader....
The author’s account of the literary development of Greece is
evidence of careful investigation and of scholarly judgment. Mr.
Putnam writes in a way to instruct a scholar and to interest the
general reader. He has been exceptionally successful in describing
the progress of letters, the peculiar environment of those who are
interested in the career of the dramatist and the philosopher, and
that habit of mind characteristic of Hellenic life.—Philadelphia Press.
A most valuable review of the important subject of the beginnings
of literary prosperity. The book presents also a powerful plea for the
rights of authors. The beginnings of literary matters in Chaldea,
Egypt, India, Persia, China, and Japan are exhibited with
discrimination and fairness and in a very entertaining way. The work
is a valuable contribution upon a subject of pressing interest to
authors and their public.—New York Observer.
The work shows broad cultivation, careful scholarly research, and
original thought. The style is simple and straightforward, and the
volume is both attractive and valuable.—Richmond Times.
The volume is beautifully printed on good paper.... Every author
ought to be compelled to buy and read this bright volume, and no
publisher worthy of the name should be without it.—Publishers’
Circular, London.
The book is one that will commend itself to every author, while at
the same time it is full of entertainment for the general reader.—
London Sun.
G. P. PUTNAM’S SONS
New York: 29 West 23d St. London: 24 Bedford St., Strand
 Books and Their Makers During the Middle Ages
A Study of the Conditions of the Production and Distribution of
Literature from the Fall of the Roman Empire to the Close of the
Seventeenth Century.
By GEO. HAVEN PUTNAM, A.M.
Author of “Authors and Their Public in Ancient Times,” “The
Question of Copyright,” etc., etc.
In two volumes, 8º, cloth extra (sold separately), each $2.50
Volume I. 476-1500. (Ready April, 1896.)
PART I.—BOOKS IN MANUSCRIPT.
I.—The Making of Books in the Monasteries.
Introductory.—Cassiodorus and S. Benedict.—The Earlier
Monkish Scribes.—The Ecclesiastical Schools and the Clerics as
Scribes.—Terms Used for Scribe Work.—S. Columba, the Apostle to
Caledonia.—Nuns as Scribes.—Monkish Chroniclers.—The Work of
the Scriptorium.—The Influence of the Scriptorium.—The Literary
Monks of England.—The Earlier Monastery Schools.—The
Benedictines of the Continent.—The Libraries of the Monasteries
and their Arrangements for the Exchange of Books.
II.—Some Libraries of the Manuscript Period.
III.—The Making of Books in the Early Universities.
IV.—The Book-Trade in the Manuscript Period.
Italy.—Books in Spain.—The Manuscript Trade in France.—
Manuscript Dealers in Germany.
PART II.—THE EARLIER PRINTED BOOKS.
I.—The Renaissance as the Forerunner of the Printing-Press.
II.—The Invention of Printing and the Work of the First
Printers of Holland and Germany.
III.—The Printer-Publishers of Italy.
 Volume II. 1500-1709. (Ready September, 1896.)
IV.—The Printer-Publishers of France.
V.—The Later Estiennes and Casaubon.
VI.—Caxton and the Introduction of Printing into England.
VII.—The Kobergers of Nuremberg.
VIII.—Froben of Basel.
IX.—Erasmus and his Books.
X.—Luther as an Author.
XI.—Plantin of Antwerp.
XII.—The Elzevirs of Leyden and Amsterdam.
XIII.—Italy: Privileges and Censorship.
XIV.—Germany: Privileges and Book-Trade Regulations.
XV.—France: Privileges, Censorship, and Legislation.
XVI.—England: Privileges, Censorship, and Legislation.
XVII.—Conclusion: The Development of the Conception of
Literary Property.
G. P. PUTNAM’S SONS
New York: 29 West 23d St. London: 24 Bedford St., Strand
 A Literary History of the English People
From the Earliest Times to the Present Day.
By J. J. JUSSERAND
Author of “The English Novel in the Time of Shakespeare,” etc.,
etc.
To be complete in three parts, each part forming one volume.
(Sold separately.)
Part I.—From the Origins to the Renaissance. 8º, pp. xxii + 545.
With frontispiece in photogravure. $3.50.
Part II.—From the Renaissance to Pope. (In press.)
Part III.—From Pope to the Present Day. (In preparation.)
We may say, without contradiction, that the marvellous story of our
literature in its vital connection with the origin and growth of the
English people has never been treated with a greater union of
conscientious research, minute scholarship, pleasantness of humor,
picturesqueness of style, and sympathetic intimacy.—London
Chronicle.
The most important and delightful contribution to the popular study
of English literature since Taine’s volumes were published, is to be
made by M. J. J. Jusserand in his “Literary History of the English
People.” ... Only the most meagre sketch of the pleasure in store for
the readers of M. Jusserand’s volume can be given here. No one
interested in the beginnings of English literature can fail to be
pleased with this delightful study. A thoroughly stimulating book ...
which will arouse fresh interest in the early periods of our literature.
—Literary World.
M. Jusserand is an investigator of keen insight and indefatigable
energy. He has also the quality which gives to him, from his Latin
parentage, synthesis and literary tact.... He paints a picture.... It is
unquestionably true that for this generation, M. Jusserand has said
the last word on this subject.... For the period of Chaucer, he has
summarized what is known with admirable skill.... His work must be
accepted as the authority on the Middle Ages as they were lived in
England.—N. Y. Commercial Advertiser.
The book bears witness on every page to having been written by
one whose mind was overflowing with information, and whose heart
was in abounding sympathy with his work. Mr. Jusserand possesses
pre-eminently the modern spirit of inquiry, which has for its object the
attainment of truth and a comprehension of the beginnings of things
and of the causes that have brought about effects.—N. Y. Times.
After so many excellent works, of which English literature is the
subject, have been issued in England and on the Continent, after
even the epic work of Taine, yet M. Jusserand still contrives to be
original, fresh, and creative. The history of English literature has
been written before, but what he gives us is something new; it is the
literary history of the English people, that is to say, he makes us
follow the historical evolution of the nation in literature, and what that
evolution has created and revealed. He has employed a method
which could not be used with success, except by a man with a
thorough and correct knowledge of literature and the history of the
English people, and of the people themselves, and one who is
worthy of serious consideration by all literary historians.—La Revue
de Paris, July 1, 1894, on the French Edition.
G. P. PUTNAM’S SONS
New York: 27 West 23d St. London: 24 Bedford St., Strand
 INDEX
A
Abbon, Saint, i, 56
Abelard, the philosophy of, i, 198; the lectures of, i, 198; the
influence of, upon the theological school of Paris, i, 198;
considered as the actual founder of the University of Paris, i,
197, 198
Academies, literary, of Italy, i, 322 ff., 344
Academy, of Venice, the, literary undertakings of, i, 423 ff.
—— of France, founding of the, ii, 458
Adagia, the, of Erasmus, the first edition of, ii, 194; the Aldine
edition of, ii, 199
Adamnanus, life of S. Columba, cited, i, 50
Adolph of Nassau, captures Mayence, i, 371
Adrian VI, ii, 29
Aedh, King, presides over the parliament of Drumceitt, i, 49
Aelfric, Homilies of, i, 101; the canons of, i, 101
Agapetus, Pope, i, 22
Agnien, libraire in Paris in the 13th century, i, 271
Agricola, librarian of Heidelberg in 1485, orders books for the
library, i, 297
Aimoin of Fleury, i, 56
Albert, Abbot of Gembloux, makes collection of manuscripts, i,
231
—— of Brandenburg, ii, 229
Alcuin, training of, by Egbert, i, 107; the library of, at York, i, 62;
correspondence of, with Charlemagne, i, 62, 109; the
methods in his scriptorium, i, 66; institutes the imperial
schools in Aachen, Tours, and Milan, i, 109; poem of, on the
library of York Cathedral, i, 108; his imperial pupils, i, 109;
treatise of, on orthography, i, 111; his injunction to pious
scribes, i, 113; list of the writings of, i, 114; death of, at Tours,
 i, 115; describes the journeys of Aelbert, i, 228; the
educational work of, ii, 479 ff.
Aldersbach, monastery of, i, 40.
Aldhelm, Bishop of Sherborn, visits Berthwold in Canterbury, i,
97; imports books from France, i, 97.
Aldi Filii, the name adopted by the son and grandson of the
founder of the firm, i, 438
Aldine classics, the, models for the Elzevirs, ii, 301
—— Press, close of the work of, i, 438; operations of the, in
Rome, i, 441 ff.
Aldus Manutius, work of, in the printing of Greek texts, i, 243;
relations of, to the book trade of Italy and of Europe, i, 415;
earlier life of, i, 417 ff.; letter of, stating his aims, i, 418; first
publications of, i, 420; literary undertakings of, i, 419;
marriage of, i, 420; Greek classics issued by, i, 420; institutes
the Academy of Venice, i, 423; correspondence of, with
France and with Germany, i, 424 ff.; reputation of, in
Germany, i, 430; letter of, to Taberio, i, 430; summary of
publications of, i, 432; financial difficulties of, competition of,
with piratical reprinters, i, 432; secures papal privileges, i,
432; initiates new forms of type, i, 434; attempts to defend his
office against literary loafers, i, 437; death of, i, 438; summary
of the career of, i, 439; ii, 12, 22, 23, 102, 151, 194; privilege
given to, for Greek text, ii, 346; privilege given to, for italic
text, ii, 347; publishes the Letters of Phalaris, ii, 351; ii, 487
Aldus Manutius the second, i, 438; business experience of, i,
441; gives up business as a printer, i, 445
Aleander, Hieronymus, Greek scholar and theologian, i, 422, ii,
12 ff.
Alexander, Bishop of Jerusalem, the library of, i, 147
Alfano, the poem of, on monastery life, i, 127
Alfonso, King of Aragon and Sicily, offers rewards for literary
productions, i, 330
Alfred, King, attends school in Oxford, i, 119; service of, to the
literary interests of England, i, 98; makes English version of
Gregory’s Pastoral Care, i, 99; complains of the ignorance of
Englishmen, i, 99; prepares English translations of certain
 famous books, orders transcripts of the national chronicles, i,
100
Al-hakem, Kahlif, library of, in Cordova, i, 254; pays large sums
for the writing of books, i, 254
Alphonso, King of Naples, the literary circle of, i, 252
Amalasuentha, Queen of the Goths, i, 20
Amandus, Abbot of Salem, i, 85
Ambrose, Saint, Legenda Aurea of, cited, i, 37
Amerbach, Basilius, ii, 238
—— Boniface, ii, 173
—— Johann, editor, printer and publisher of Basel, i, 393, ii,
151; purchases paper stock with an edition of S. Augustine, i,
348; relations of, with Koberger, i, 393; relations of, with
Froben, i, 393
Andreä, Hieronymus, ii, 410
Andreas, Abbot of Bergen, i, 86
Andrews, Bishop, ii, 97, 99
Angus the Culdee, the Festilogium of, i, 46
Anjou, the Countess of, pays, in 1460, a great price for a copy of
Homilies, i, 299
Anna Gray, the monastery of, founded, i, 47
Annales Ecclesiastici, ii, 97
Anne, Queen, the Act of, ii, 472
Anselm, Saint, the Peripatetic, cited, i, 39, 197; recommends to
his pupils the study of an expurgated Virgil, i, 62
Anshelm, Thomas, publisher of Tübingen, ii, 165, 172, 231
Antidotarium, the, i, 196
Antwerp as a publishing centre, ii, 255 ff.; losses of, through the
revolt of the Netherlands, ii, 274
Apologia pro Herodoto, ii, 72 ff.
Aquinas, Thomas, the de Censuris of, ii, 386
Arabian writers, bring to Europe the literature of Greece, i, 181;
medical works of, used as text-books, i, 195
Areopagitica of Milton, the, ii, 474 ff.
Arethas, the scribes of, i, 42
Aretinus, Johannes, librarius, i, 234, 246
Ariosto, the Orlando of, ii, 370
Arminius, the doctrines of, ii, 291
Arnest, Archbishop of Prague, i, 44
Arnold, Abbot of Villers, i, 75
Arts and Industries, bureau of, in Venice, ii, 361
Arundel, Archbishop, ii, 130
—— Earl of, ii, 118, 123
Ascensius, see Badius.
Ascham, Roger, ii, 145
Asser, Bishop, organizes education in the kingdom of Alfred, i,
99
Athalaric, King of the Goths, i, 20
Atkyns, Richard, on the introduction of printing into England, ii,
134
Atticus, relations of, to the book-trade of Italy, i, 416
Auctores Frobeniani, ii, 185
Augsburg, the early printers of, i, 396
Augustine, Saint, writings of, i, 3; literary work of, i, 32, 33; on
the value of ignorance, i, 121; the library of, i, 147
Augustinians, the regulations of, for the care of books, i, 148
Aungerville, Richard (de Bury), i, 308 ff.
Aura, Saint, and scholar, i, 51
Aurelian, Saint, the Rule of, i, 123
Aurispa, Johannes, dealer in manuscripts, i, 242; brings to
Florence his collection of manuscripts, i, 251; correspondence
of, with Filelfo, i, 251; publishing undertakings of, i, 251; fate
of the manuscripts of, i, 253
Austria, censorship in, ii, 249
Author, rights of, in literary production, under the laws of Venice,
ii. 399 ff.
Authors, payments to, by Plantin, ii, 276 ff.; acting as their own
publishers in Germany, ii, 435; in France, ii, 435
Averrhoes, i, 181; the philosophy of, i, 196
Avicenna, i, 181; the medical treatises of, i, 196
Avitus, the Emperor, i, 8
Azo, i, 183