Editor-in-Chief
Kamlakar Tripathi
Professor Department of Medicine Institute of Medical Sciences, Banaras Hindu University
Varanasi (UP), India
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
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 |
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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
- Amit Kumar Singh
- Resident
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Amit Nandan Dwivedi
- Associate Professor
- Department of Radiodiagnosis and Imaging
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Amita Diwaker
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Anuj Maheshwari
- Professor and Head
- Department of General Medicine
- BBDCODS, BBD University
- Faizabad Road, Lucknow (UP), India
- Arpit Agrawal
- Resident
- Department of Endocrinology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Ashutosh Jain
- Resident
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Asim Siddiqui
- Apollo Centre for Obesity,
- Diabetes and Endocrinology
- Indraprastha Apollo Hospital
- Sarita Vihar, New Delhi, India
- Banshi Saboo
- Dia Care − A Complete Diabetes Care Centre
- Gandhi Park Nehru Nagar Road, Ambavadi
- Ahmedabad (Gujarat), India
- Bhavana Sole
- Consultant Diabetologist- Division Hospital
- Bengaluru, Karnataka, India
- DK Hazra
- Boston Medical Centre, Soami Bagh
- Agra (UP), India
- Dheeraj Kapoor
- Senior Consultant Endocrinology
- Artemis Health Institute
- Gurgaon, Haryana, India
- Dheeraj Kishore
- Associate Professor
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Jamal Ahmad
- Director and Professor
- Rajiv Gandhi Centre for Diabetes and Endocrinology
- Faculty of Medicine
- Aligarh Muslim University
- Aligarh (UP), India
- Kamlakar Tripathi
- Professor
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Madhukar Rai
- Professor, Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- MK Singh
- Professor, Department of Ophthalmology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Mumtaz Ahmad Ansari
- Professor, Department of General Surgery
- Institute of Medical Sciences
- Banaras Hindu University
- Murlidhar S Rao
- Former President
- Association of Physicians of India, RSSDI and HIS
- Former Professor and HOD of Medicine
- M R Medical College
- Gulbarga, Karnataka, India
- Nandita Hazra
- Boston Medical Centre
- Soami Bagh
- Agra (UP), India
- Narsingh Verma
- Professor
- Department of Physiology
- King George's Medical University
- Lucknow (UP), India
- Neeraj Agrawal
- Professor and Head
- Department of Endocrinology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Niti Singh
- Assistant Professor
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Padmamalika Khanna-Hazra
- Boston Medical Centre
- Soami Bagh
- Agra (UP), India
- Pankaj Kanaujia
- Resident, Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Prasanna Kumar KM
- Consultant Endocrinologist
- Bangalore Diabetes Hospital and CDEC
- Bengaluru, Karnataka, India
- Prashant Bhushan
- Associate Professor
- Department of Ophthalmology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Radhika Jindal
- Apollo Centre for Obesity,
- Diabetes and Endocrinology
- Indraprastha Apollo Hospital
- Sarita Vihar, New Delhi, India
- Rajeev Chawla
- Senior Consultant
- Diabetologist and Director
- North Delhi Diabetes Centre
- Delhi, India
- Rajgopal Acharya
- Resident
- Department of General Surgery
- 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
- RK Singh
- Resident
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Royana Singh
- Professor
- Department of Anatomy
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- RP Maurya
- Assistant Professor
- Department of Ophthalmology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- S Singh
- Resident
- Department of Endocrinology
- Institute of Medical Sciences
- Banaras Hindu University
- Samar Banerjee
- Professor and Immediate
- Past President RSSDI;
- President, Association of Clinical Diabetology
- Immediate Past President DIPSI;
- Editor-in-Chief, Journal of Clinical Diabetology;
- International Advisory Board Member,
- Davidson's Text Book of Medicine
- Sanjay Kalra
- Executive Editor
- Indian J Endocrinology and Metabolism
- Executive Editor
- J of Social Health in Diabetes (JoSH Diabetes)
- Bharti Hospital and BRIDE
- Karnal, Haryana, India
- Santosh Kumar Yadav
- Research Scholar, Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Sarita Bajaj
- Director-Professor and Head
- Department of Medicine
- MLN Medical College
- Allahabad (UP), India
- Satvik Khaddar
- Resident
- Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- SC Mohapatra
- Professor
- Department of Community Medicine
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- Shivi Jain
- Service Senior Resident
- Department of Radiodiagnosis and Imaging
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- SK Singh
- Professor
- Department of Endocrinology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- SS Pandey
- Professor, Department of Dermatology
- Dean, Faculty of Medicine and
- Director, Institute of Medical Sciences
- Banaras Hindu University, Varanasi (UP), India
- Subhash Kumar Wangnoo
- Apollo Centre for Obesity,
- Diabetes and Endocrinology
- Indraprastha Apollo Hospital
- Sarita Vihar, New Delhi, India
- Suchi Dwivedi
- Consultant Psychiatrist and Medical Officer
- CHC, Jamalpur, Mirzapur, India
- Sunil M Jain
- Total Diabetes Hormone Institute
- BCM Health Islands D-44, Scheme 54
- Indore (MP), India
- Tanushree Chawla
- Department of Medicine
- MLN Medical College
- Allahabad (UP), India
- V Balaji
- Director and Senior Consultant Diabetologist
- Dr V Balaji Diabetes Care Centre
- Dr V Seshiah Diabetes Research Institute, Chennai, Hon. Secretary—Diabetes in Pregnancy Study Group, India (DIPSI)
- Member: WHO Expert Committee for Consultation on Diagnosis and Screening for GDM, Expert Group Committee on GDM, Ministry of Health Govt. of India
- Vinay Kumar BR
- Resident, Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University, Varanasi (UP), India
- Vipul Garg
- Senior Resident, Department of Medicine
- Institute of Medical Sciences
- Banaras Hindu University, Varanasi (UP), India
- Vivek Srivastava
- Assistant Professor, Department of General Surgery
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi (UP), India
- VP Singh
- Professor, Department of Ophthalmology
- Institute of Medical Sciences
- Banaras Hindu University,
- Varanasi (UP), India
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