Fundamentals of Diabetes Sarita Bajaj, Kamlakar Tripathi, Anuj Maheshwari, Brij Mohan, Narsingh Verma, Amit N Dwivedi, Richik Tripathi
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1Fundamentals of Diabetes2
3Fundamentals of Diabetes
Editor-in-Chief Kamlakar Tripathi Professor Department of Medicine Institute of Medical Sciences, Banaras Hindu University Varanasi (UP), India
Editor-in-Chief
:
Dr Kamlakar Tripathi
Associate Editors
:
Dr Sarita Bajaj
:
Dr Rishi Shukla
:
Dr Anuj Maheshwari
:
Dr Narsingh Verma
Members of Editorial Board
Dr AR Sircar
:
Dr HB Chandalia
Dr DK Hazra
:
Dr Ashok Chandra
Dr Brij Mohan
:
Dr Ravi Misra
Dr Eesh Bhatia
:
Dr Jitendra Singh
Dr Atul Kulshrestha
:
Dr Dheeraj Kapoor
Dr Mridul Chaturvedi
:
Dr M Sahoo
Dr Pankaj Agrawal
:
Dr Murlidhar S Rao
Dr RR Singh
:
Dr SR Arvind
Dr MK Garg
:
Dr PV Rao
Dr Sushil Upadhyay
:
Dr AR Ramchandran
Dr SK Singh
:
Dr V Balaji
Dr Madhukar Rai
:
Dr C Vishwanathan
Dr NK Agrawal
:
Dr A Moses
Dr Sushil Mishra
:
Dr Siddhartha Das
Dr Sharad Kumar
:
Dr Samar Banerjee
Dr SK Wangnoo
:
Dr AK Singh
Dr SV Madhu
:
Dr SK Singhatna, P
Dr Rajeev Chawla
:
Dr CS Yagnik
Dr Anil Bhansali
:
Dr AG Unnikrishnan
Dr Anant Nigam
:
Dr V Mohan
Dr Arvind Gupta
:
Dr AK Das
Dr Shashank R Joshi
:
Dr HK Singh
Dr Banshi Saboo
:
Dr BK Sahai
Dr Abdul Hamid Zargar
:
Dr V Sesiah
Dr Jamal Ahmad
:
Dr NK Soni
Editors Anuj Maheshwari Professor and Head Department of General Medicine BBDCODS, BBD University Faizabad Road, Lucknow (UP), India Narsingh Verma Professor, Department of Physiology King George's Medical University Lucknow (UP), India Brij Mohan Physician Diabetologist Director BMC Hospital, Kanpur (UP) Brij Medical Centre Pvt Ltd, Kanpur (UP), India Sarita Bajaj Director-Professor and Head Department of Medicine MLN Medical College Allahabad (UP), India Assistant Editors Amit N Dwivedi Associate Professor Department of Radiodiagnosis and Imaging Institute of Medical Sciences Banaras Hindu University Varanasi (UP), India Richik Tripathi Service Senior Resident Department of Oral and Maxillofacial Surgery Faculty of Dental Sciences Institute of Medical Sciences Banaras Hindu University Varanasi (UP), India Forewords HS Bajpai Amulya Ranjan Sircar
4
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Fundamentals of Diabetes
First Edition: 2016
9789352501519
Printed at
5Dedicated to
Prof KN Gaur
MD FRCP (Ed)
Former Professor and Head
Department of Medicine, Sarojini Naidu Medical College, Agra, 1950–1957
Department of Medicine, GSVM Medical College, Kanpur, 1957–1962
Department of Medicine, College of Medical Sciences (now Institute of Medical Sciences),
Banaras Hindu University, Varanasi, 1962–1965
Department of Medicine, Aligarh Muslim University, 1965–1968
The Founder President of Endocrine Society of India
and
Father of Clinical Endocrinology and Diabetes in India
6CONTRIBUTORS 9FOREWORD
Diabetes, a noncommunicable disease, has acquired a status of epidemic since last two decades surpassing all the barriers of race, ethnicity, poverty and affluency. Though type I diabetes has remained a well understood endocrine disorder, type II diabetes still remains a conglomeration of heterogeneous disorders evolving in different forms of metabolic syndrome in different clinical presentation and genetic polymorphism. Initially thought to be the disease of rich people has shown its presence in the progeny of nutritionally starved mothers and famine-affected population. It has substantially contributed amongst younger population as an etiological factor of premature atherosclerosis, coronary artery disease and stroke. Late marriages, postponement of motherhood and artificial reproductive technique have resulted in higher incidences of gestational diabetes than earlier years. Diabetes is responsible for more than 50% of chronic kidney disease and patients on maintenance hemodialysis program.
Many new antiretroviral drugs, antidepressants and antipsychotics have also contributed in insulin resistance and new onset of diabetes.
Increasing awareness in print and electronic media and self-monitoring of blood glucose have also sensitized the common man, and a large section of population is being recognized as prediabetes which are potential targeted population for diabetes control to prevent the new onset of diabetes or delay its full blown clinical picture.
The present generation of internists, diabetologists and endocrinologists have now too many new drugs as oral antidiabetics, insulin analogs and drugs which restore physiology of insulin secretion. Understanding of glucose metabolism, lipid abnormalities, gene polymorphism, preservation of beta cell and its regeneration with stem cell is now the challenge of the day but equally important is the prevention, and many such efforts have now started showing the result. I hope this book, which deals with fundamental principles of diabetes practice, will be an asset to physicians in day-to-day practice and prevention of diabetes as a national goal.
HS Bajpai
MD FICP
Former
Director, Institute of Medical Sciences
Dean, Faculty of Medicine
Professor and Head of the Department of Medicine
Professor and Head, Division of Endocrinology
Medical Superintendent and Consultant, Sir Sunderlal Hospital
Banaras Hindu University, Varanasi, India
Ex-President, The Association of Physicians of India, UP Chapter, India
Ex-President, Endocrine Society of India, India
10FOREWORD
It is a great pleasure for me to write a foreword for this Fundamentals of Diabetes to be released during RSSDI-2015 being held at Lucknow. I must congratulate Dr Kamlakar Tripathi who shouldered this responsibility to compile write ups from faculties of national and international repute and edited those to be useful for diabetes practitioners. I am confident this book will be successful in its aim of making easy-to-understand fundamentals of diabetes for all its readers.
I am happy that RSSDI-UP is endeavoring it, on the occasion of 43rd national conference of Research Society for the Study of Diabetes in India (RSSDI) which now has been the largest organization of doctors practicing diabetes. Prof MMS Ahuja, who started the RSSDI in 1972, may never have visualized such a spectacular growth of this organization. I feel it is a very fitting tribute to the great visionary.
In the past ten years, diabetic population has grown fast throughout the world. India is also not remained untouched of this growth impacting adversely health of the nation. It is the need of the hour that every doctor should know the basics of diabetes. I am sure this book Fundamentals of Diabetes serves the purpose.
I must congratulate Dr Anuj Maheshwari who conceived this idea with Dr Kamlakar Tripathi and facilitated it to become a reality.
With my best wishes
Prof Amulya Ranjan Sircar
Professor and Ex Head of Department of Medicine
King George's Medical University
Lucknow (UP), India
11PREFACE
The idea of writing a book on Fundamentals of Diabetes was conceived during the meeting of Executive members of Organizing Committee of Annual Conference of the Research Society for the Study of Diabetes in India (RSSDI) to be held at Lucknow during 2015 and to commemorate the celebration of annual RSSDI to be held for the first time in the state of Uttar Pradesh. The idea was first moved by Prof Anuj Maheshwari, Prof Narsingh Verma, Dr Brij Mohan and subsequently supported by Prof Sarita Bajaj, the Chairperson of Scientific Committee of RSSDI. I was given the privilege to edit the book for which I am obliged to all the members of organizing committee for their trust and faith in me. The editorial board feels obliged to all the authors who readily accepted my invitation and yielded to my request to send their manuscripts in time.
I am thankful to Associate editors Dr Amit Nandan Dwivedi and Dr Richik Tripathi for reviewing the manuscript and Dr Vinay Kumar BR, for his untiring efforts in formatting the text and adding his valuable contribution to some of the chapters on genetics, chronic kidney disease and epidemiology.
The secretarial assistance provided by Dr RK Misra was the most difficult job for transcripting some of the manuscripts and modifying the text to suite the publisher's specification.
In the last, I am indebted to the publishers M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India for on-time publication and adding a lot of glamour to the book.
Kamlakar Tripathi