Preliminary Pages

1Step by Step Diabetology

23Step by Step Diabetology

Sudip Chatterjee MBBS MD FRCP (Lon) MNAMS FACP Honorary Professor of Medicine Vivekananda Institute of Medical Sciences, University of Calcutta Founder-Secretary, Park Clinic, Kolkata Sanjay Chatterjee MBBS MD Consultant Diabetologist Apollo Gleneagles Hospitals Kolkata Kaushik Pandit MBBS MD DNB Consultant Endocrinologist Park Clinic and Wockhardt Hospital Kolkata

4 Published by

Jitendar P Vij

Jaypee Brothers Medical Publishers (P) Ltd

EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India

Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Fax: +91-11-23276490, +91-11-23245683

e-mail: jaypee@jaypeebrothers.com

Visit our website: www.jaypeebrothers.com

Branches

2/B, Akruti Society, Jodhpur Gam Road Satellite

Ahmedabad 380015 Phone: +91-079-30988717
202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East Bangalore 560 001, Phones: +91-80-22285971, +91-80-22382956, +91-80-30614073 Tele Fax : +91-80-22281761 e-mail: jaypeemedpubbgal@eth.net
282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road Chennai 600 008, Phones: +91-44-28262665, +91-44-28269897

Fax: +91-44-28262331 e-mail: jpchen@eth.net
4-2-1067/1-3, Ist Floor, Balaji Building, Ramkote Cross Road

Hyderabad 500 095, Phones: +91-40-55610020, +91-40-24758498 Fax: +91-40-24758499 e-mail: jpmedpub@rediffmail.com
1A Indian Mirror Street, Wellington Square, Kolkata 700 013

Phones: +91-33-22456075, +91-33-22451926 Fax: +91-33-22456075

e-mail: jpbcal@cal.vsnl.net.in
106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital Parel, Mumbai 400 012 Phones: +91-22-24124863, +91-22-24104532, +91-22-30926896 Fax: +91-22-24160828

e-mail: jpmedpub@bom7.vsnl.net.in
“KAMALPUSHPA” 38, Reshimbag

Opp. Mohota Science College, Umred Road, Nagpur 440 009 (MS)

Phones: +91-712-3945220, + 91-712-2704275

e-mail: jpmednagpur@rediffmail.com

Step by Step Diabetology

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.

This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.

First Edition: 2006

9788180616945

Typeset at JPBMP typesetting unit

Printed at Paras Press

5PREFACE

Diabetes is a disease as old as civilization itself. The first recorded references are in the Ebers Papyrus which is 7000 years old. In India diabetes was described in very clear terms by Susruta around 600 BC and a distinction was made between what we now know as type 1 and type 2 diabetes. In India today diabetes is increasing at a rapid rate in our urban population centers. The incidence clearly rises as one moves from the rural to the semiurban and finally to the urban setting. A study has shown that 10% of urban Indians have diabetes versus a figure of 2% from the rural areas. As one transits from a rural to an urban setting, several changes occur. More of simple sugar is consumed as well as processed fast food and refined carbohydrates. Total food intake increases with advancing prosperity and exercise which was near mandatory in a rural setting becomes optional in a urban setting. As urbanization is a hall mark of civilization, diabetes can truly be called a disease of civilization itself.

Why are we concerned about diabetes ? It is because diabetes increases disability and shortens life. Type 2 diabetes has been calculated to shorten life by about 10 years. In an US study of 14,374 persons followed for 22 years, diabetes accounted for 5.1% of the cohort but for 10.6% of the deaths. The increased death rate was attributable to cardiovascular disease, i.e. heart disease 6and stroke. In fact 80% of type 2 diabetic patients are destined to die of cardiovascular causes. The cost of treating this excess of cardiovascular disease is enormous. The loss to the nation in terms of productive lives cut down in their prime is incalculable. Luckily research data suggests that aggressive management of all risk factors can cut down excess cardiovascular disease.

Experience has shown that no disease can be controlled by treatment alone. The essence of control lies in disease prevention. Again research has shown that life style modification can prevent diabetes, although it is easier said than done.

In the last decade or so, many exciting new discoveries have been made that have revolutionized diabetes care. The fruits of most of these discoveries are available in India today. In this handbook the medical student is provided with a core knowledge of diabetes with stress on the latest evidence based research. By the time he or she matures into a practicing physician, India will have the world’s largest population of diabetes patients. These patients will bring in their wake the world’s largest epidemic of cardiovascular disease. If action is not taken today India faces a health care disaster that will shorten many lives and careers. Hopefully this book will play a small role in stemming the tsunami.

Sudip Chatterjee

Sanjay Chatterjee

Kaushik Pandit

7ACKNOWLEDGEMENTS

This book came to be written because of the enthusiasm of my close friend and senior colleague, Dr Sanjay Chatterjee, whose considerable and unrelenting power of persuasion were brought to bear upon me. Once my consent was secured, we persuaded, our younger colleague, Dr Kaushik Pandit to join us. The chapters have been individually written and then discussed by all of us. I am grateful to my co-authors for the time and trouble they have taken.

Mr Dulal Das, my secretary, has been extremely helpful in readying the manuscript. Mr Sabyasachi Hazra, the local representative of the publishers has been perfect in his courtesy, energy and reliability. It was a pleasure to work with him.

The field of diabetes is moving rapidly. Indeed while this book was being written, exenatide was approved for clinical use and important data have been published on it and on genetic polymorphisms in type 2 diabetes. I hope, readers of this book will be able to take the science of diabetes forwards and alleviate in some way, the enormous suffering diabetes can cause.

Chapter Notes