Jaypee Brothers Medical Publishers (P) Ltd

4838/24, Ansari Road, Daryaganj

New Delhi 110 002, India

Phone: +91-11-43574357

Fax: +91-11-43574314

J.P. Medical Ltd

83 Victoria Street, London

SW1H 0HW (UK)

Phone: +44-2031708910

Fax: +02-03-0086180

Jaypee-Highlights Medical Publishers Inc.

City of Knowledge, Bld. 237, Clayton

Panama City, Panama

Phone: + 507-301-0496

Fax: + 507-301-0499

Jaypee Brothers Medical Publishers (P) Ltd

17/1-B Babar Road, Block-B, Shaymali

Mohammadpur, Dhaka-1207

Bangladesh

Mobile: +08801912003485

Jaypee Brothers Medical Publishers (P) Ltd

Shorakhute, Kathmandu

Nepal

Phone: +00977-9841528578

Website: www.jaypeebrothers.com

Website: www.jaypeedigital.com

© 2012, Jaypee Brothers Medical Publishers

All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.

Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

This book has been published in good faith that the contents provided by the editors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.

Sixth Edition: 2012, June

Obesity and type 2 diabetes have become global epidemics affecting not only Western populations, but indeed to a highly worrying degree, the Asian populations including those of the Indian citizens. As for type 2 diabetes, there are currently an estimated number of more than 62,000,000 people suffering from this disease in India. Type 2 diabetes is associated with more than a two-fold excess mortality from cardiovascular disease, devastating microvascular complications affecting the eyes, kidneys and nerves, as well as with significant comorbidities including cancer, infections and psychosocial stress. If left untreated, the microvascular complications will ultimately lead to blindness, overt kidney failure, foot ulcers and amputations. There is an enormous challenge for the society and the health care system to organize treatment and management of people with diabetes to reduce its serious impact on health of the individual, as well as to reduce the otherwise extreme expenditure of society to compensate for lost working years as well as for managing blindness, dialysis, amputations, etc. Many landmark achievements within diabetes care have been obtained during recent years, including definitive knowledge that multifactorial pharmacological as well as nonpharmacological intervention targeting physical inactivity, overeating, smoking, reduction of blood pressure and lipids, as well as lowering glucose, significantly improves the most important clinical outcome variables in people with diabetes. Many novel drugs have been introduced targeting different distinct defects of metabolism in diabetes patients, leaving the clinical diabetes specialist with much better tools to tailor a more optimal and individualized treatment strategy in different diabetes patients. The fast generation of knowledge within the field of diabetes, as well as its significant quantitative impact on health within the society, makes it extremely important to have medical doctors with a proper and constantly updated scientific training in diabetes research, to lead the implementation of novel, better and more (cost-) effective treatment and care programs for patients with diabetes. I have had the great pleasure of working together with professor Nihal Thomas and his team on clinical matters, as well as on important translational scientific projects, and in all of our interactions. I have been indeed very impressed about the dedication, level of knowledge as well as enthusiasm in general of Nihal Thomas and his team. I am therefore extremely happy hereby and with great confidence—to be able to give the doctors, councilors teams and patients associated with international community, the most sincere recommendations provided in this book, that would help in leading the fight against diabetes with the sixth edition of “The Practical Guide to Diabetes”.

Diabetes mellitus has reached an astounding global prevalence of 343 million, according to recent estimates. While staggering, these numbers fall short of conveying the full magnitude of the problem. The human impact of diabetes includes devastating complications, economic hardships and reduction in the most creative and productive years of life. Though challenging to implement, optimal diabetes management has been proven to reduce the complications of diabetes. This underscores the vital need for training health care professionals in comprehensive diabetes management, particularly in settings that provide care to the poor.

Diabetes mellitus is an emerging global health problem, and just in India. Fortunately, Indian physicians and researchers are also increasingly taking the lead, when it comes to doing something practical to stem the epidemic and to manage diabetes. Millions are affected by this chronic and potentially life-threatening disease. More than 3 million patients die from the disease on an annual basis. In some urban Indian societies, one out of five adults has diabetes.

In the year 1995, when King et al, published an article in what is at times thought to be the clinical bible of diabetes (Diabetes Care 1998)—he articulated for the very first time that India would house the largest number of patients with diabetes approaching around 20 million. The article had also prophesied that the number of diabetics in the country would stand at 57 million by the year 2025.