Complications of Diabetes Rajeev Chawla
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1Complications of Diabetes2
3Complications of Diabetes
Rajeev ChawlaMD, FIAMS, FIACM Senior Consultant Diabetologist Director, North Delhi Diabetes Centre, New Delhi. Foreword SV Madhu
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Publisher: Jitendar P Vij
Publishing Director: Tarun Duneja
Editors: Maheshweta Trivedi, Eti Dinesh, Naren Aggarwal
Cover & Layout Design: Sachin Dhawan, Seema Dogra
Complications of Diabetes
First Edition: 2012
9789350255124
Printed in India
5Foreword
SV Madhu md, dm
Professor of Medicine and Head
Division Of Endocrinology and Metabolism
Dept. Of Medicine, University College Of Medical Sciences and GTB Hospital, Delhi.
Diabetes Mellitus is now a major challenge for all the physicians and diabetologists in our country. We are in the midst of an epidemic of diabetes, and are faced with a huge burden of diabetes related complications. A large proportion of in-hospital deaths are either directly or indirectly related to diabetes-related complications. Similarly, diabetes related illness accounts for a significant number of hospitalised patients and is the underlying factor in several patients admitted with cardiovascular or kidney disease. Blindness, foot disease and erectile dysfunction that severely incapacitate patients are commonly secondary to underlying diabetes. The practising physician must be empowered to meet this challenge of recognising and managing all the complications of diabetes in time so that the morbidity, mortality and disability due to this condition can be significantly reduced. There is a need for a concise book specifically dedicated to the complications of diabetes to address these important issues.
I must congratulate Dr. Rajeev Chawla for responding to the current scenario of diabetes in our country and coming up with this very concise book on complications of diabetes. The book will be very useful to physicians as well as students to serve as an important resource to enrich their practice of diabetes care. All complications of diabetes have been comprehensively covered with equal emphasis on acute metabolic and chronic microvascular and macrovascular complications. The book is written in a simple language that is easily understood, the style is extremely reader-friendly with a number of excellent illustrations, flow charts and clinical pearls in each chapter.
I must compliment Dr. Rajeev Chawla once again for this wonderful effort, and am sure this book will go a long way in enhancing the knowledge and skill of doctors that would lead to better diabetes care in the country.
6Dedicated to
My parents, as their blessings have made this possible;
My wife Dr Rachna for her unconditional, endless patience, and spirit behind me;
My children Aastha and Aastik for their encouragement, understanding, and forgiving me for having stolen precious time from them.
7Preface
Rising prevalence of diabetes mellitus especially type 2 DM in urban populations is a serious concern. The countries having the largest number of people with diabetes are India, China, and the US, and this is likely to continue so until 2025.
With the increasing prevalence of diabetes especially in the middle age group populations who are commonly affected in India, the chances of developing micro- and macrovascular complications are very high. This will cause enormous burden on the family, society, and the healthcare providers involved in the management of diabetes due to its high morbidity and mortality.
Hyperglycemia is a well known risk-factor for vascular complications both microvascular and macrovascular in diabetes. However, unlike the clear and linear relationship of hyperglycemia with microvascular disease, relationship with macrovascular disease and mortality is clouded by many confounding risk factors like obesity, hypertension, dyslipidemia, and hyperinsulinemia.
Unfortunately, many type 2 diabetics present with various micro- and macrovascular complications right at the time of diagnosis. This deprives these patients of primary prevention from microvascular complications.
Hence, any strategy is likely to be more effective in primary than in secondary prevention. Secondary prevention can only yield good results if emphasis is on picking up complications early by regular screening for complications in all diabetics periodically as suggested by ADA also, e.g., fundoscopy for diabetic retinopathy, microalbuminuria for diabetic nephropathy, monofilament test and biothesiometry for peripheral neuorpathy, ABI measurement for peripheral vascular disease (PVD) and lipids estimation for coronary artery disease (CAD).
This book is designed to offer a balanced overview of complications for both the starter and those seeking to research in detail. Every attempt has been made to break the monotony of text by placing Clinical Pearls and Fast Facts in each chapter.
This book, hence, is an humble effort to sensitise all physicians involved in management of diabetic patients to pick up these complications early, so that this enormous burden could be prevented or their progression be halted.
Rajeev Chawla
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9Acknowledgments
At the outset, I express my sincere gratitude to Dr Eti Dinesh without whom this book of mine would not have seen the light of the day. She has put enormous efforts not only in researching all the references but also in drafting this manuscript so meticulously. Her commitment and dedication to this endeavor are praise worthy.
I am indebted to my friend Dr Naren Aggarwal, who actually prompted me to write this book and served as catalyst throughout. He provided me with the editorial support and helped me to shape my writings into a concrete book. Without his encouragement, my long-cherished desire of writing a book would not have been a reality.
I am also grateful to Dr Neeraj Choudhary for providing me editorial support, illustrations, and images to beautifully shape this book.
I take this opportunity to thank Dr Atul Mohan Kochhar, Senior Specialist at LNJP Hospital, for providing me with original pictures in the chapter on Infections in Diabetes. I am also thankful to Prof (Dr) Archna Singhal, Department of Dermatology at GTB Hospital, for reviewing the chapter on Infections in Diabetes.
I shall be failing in my duty if I don't thank Mr JP Vij and his publication team for putting their tireless efforts to make this project possible.
I am equally grateful to all my patients who have given me an opportunity to master over these complications.