RV Jayakumar MBBS MD DM MNAMS FRCP
Professor Department of Endocrinology Amrita Institute of Medical Sciences
Kochi 682 041, Kerala, India
Nisha Bhavani MD DNB (Endocrinology)
Clinical Associate Professor Department of Endocrinology Amrita Institute of Medical Sciences
Kochi 682 041, Kerala, India
Praveen V Pavithran DM
Clinical Additional Professor Department of Endocrinology Amrita Institute of Medical Sciences
Kochi 682 041, Kerala, India
Forewords
Harish Kumar
Vasantha Nair
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44-2031708910
Fax: +02-03-0086180
Email: info@jpmedpub.com
Jaypee Medical Inc.
The Bourse
111 South Independence Mall East
Suite 835, Philadelphia, PA 19106, USA
Phone: + 267-519-9789
Email: joe.rusko@jaypeebrothers.com
Jaypee Brothers Medical Publishers (P) Ltd
Shorakhute, Kathmandu
Nepal
Phone: +00977-9841528578
Email: jaypee.nepal@gmail.com
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: + 507-301-0496
Fax: + 507-301-0499
Email: cservice@jphmedical.com
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
Email: jaypeedhaka@gmail.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2013, 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 contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure the 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.
Diabetes in Children and Adolescents / Eds. RV Jayakumar, Nisha Bhavani, Praveen V Pavithran
First Edition: 2013
9789350903001
Printed at:
5Contributors
EDITORS
- RV Jayakumar MBBS MD DM MNAMS FRCP
- Professor
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Nisha Bhavani MD DNB (Endocrinology)
- Clinical Associate Professor
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Praveen V Pavithran DM
- Clinical Additional Professor
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
CONTRIBUTING AUTHORS
9Foreword
- Kadambot M Anish Ahamed MBBS MD DNB MNAMS SCE ENDO
- Consultant Endocrinologist
- EMS Hospital and Research Center
- Perinthalmanna 679 322, Kerala, India
- Tulsi Jay Bsc
- Chief Dietician
- Department of Nutritional Services
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Aparna Jayaraman MD
- Assistant Professor
- Department of Pediatrics
- Sree Balaji Medical College and Hospital
- Chromepet, Chennai 600 004, Tamil Nadu, India
- Jeena John MBBS PGD Diab
- Resident
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Judy J Meleppuram MBBS MSc Diabetes and Diabetic Foot Surgery
- Resident
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Arun S Menon MD MRCP CCT Endocr FRCP
- Consultant Endocrinologist
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- V Usha Menon MBBS MRCP Fellowship in Diabetology PhD
- Associate Professor
- Department of Endocrinology and Diabetes
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Tittu Oommen MBBS MD
- DM Resident
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Sulfia Jabbar P MSc
- Diabetes Educator
- Department of Endocrinology and Diabetes
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Mini G Pillai DNB MNAMS
- Consultant Endocrinologist
- Lakshmi Hospital
- Cochin 682 016, Kerala, India
- PVS Memorial Hospital
- Kaloor, Cochin 682 017, Kerala, India
- Binu P Pillai MD
- DM Resident
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Ajish T Prasanna MBBS MD DM
- Consultant Endocrinologist, Assistant Professor
- Travancore Medical College
- Kollam 691 509, Kerala, India
- Jayaprakash Puravoor MD DM
- Consultant Endocrinologist
- Medical Trust Hospital
- Kochi 682 016, Kerala, India
- Bharath Ramji MD DNB
- Assistant Professor, Consultant Endocrinologist
- Department of Endocrinology
- Chettinad Superspecialty Hospital
- Kelambakkam, Chennai 603 103, Tamil Nadu, India
- Shaktivel Sivasubramanian MBBS MD FDE
- DM Resident
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Sandeep Sreedharan MBBS MD
- Fellow, Diabetology
- Department of Endocrinology and Diabetes
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Sangeetha P Sukumar MBBS PGD Diab
- Resident
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Ambika G Unnikrishnan MD DM MNAMS
- Professor
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
- Muraleedharan M Vadakkeeveettil MD DM MRCP
- Professor
- Department of Endocrinology
- Amrita Institute of Medical Sciences
- Kochi 682 041, Kerala, India
Harish Kumar MBBS MRCP
Professor and Head, Department of Endocrinology
Amrita Institute of Medical Sciences,
Kochi, Kerala 682 041, India
Some years ago, our understanding of diabetes was quite simplistic; we essentially had type 1 and type 2 diabetes, and a few other miscellaneous and secondary causes. However, in the last few years, new insights gained through developments in genetics have helped us define and better classify various new subgroups of diabetes. A number of these relatively recently clarified types of diabetes like maturity onset diabetes of the young (MODY), neonatal diabetes, etc. are largely or exclusively seen in children. In fact, the entire spectrum of diabetes is now seen in children. The increasing number of type 2 diabetes among children has been documented from all countries and cultures across the world. So our earlier impression that childhood diabetes is very rare in India is incorrect, and the previous simplistic approach—if it is a child, it must be type 1 diabetes—does not hold good any more.
It is in this context that, this book, which has covered the breadth and the depth of different types of diabetes in children and also discussed therapeutic and social aspects in detail, is very relevant and timely. The approach is very practical, and is oriented to help the practising clinician. I am very sure that this book will be very useful for pediatricians, diabetologists, and endocrinologists who deal with children with diabetes and help them to better understand the various newly understood subtypes and treat the child scientifically according to the underlying diagnosis.
11Foreword
Vasantha Nair MBBS FACP ABIM
Professor, Department of Endocrinology
Amrita Institute of Medical Sciences,
Kochi, Kerala 682 041, India
Compared to a decade back, diabetes mellitus is being increasingly diagnosed in children and adolescents. Even though type 1 diabetes still remains the most common type of diabetes in children, other types, such as type 2 diabetes, monogenic diabetes, mitochondrial diabetes, etc. are also becoming much more common in children and adolescents in the present-day world. Managing diabetes in children is far different from that of adults and is a real challenge for the clinicians. It includes making a correct diagnosis of the type of diabetes, managing the erratic eating habits and activities in the children, and proper dosing of insulin and/or medications. Management of diabetes in a child should involve not only the patient but also the family, peers, school authorities, and the society as a whole. Most of the guidelines for management of diabetes in children are from the Western literature, while the Indian scenario is much more different.
This book on diabetes in children and adolescents has come out at the most appropriate time when India is going to be declared as the diabetes capital of the world. The brunt of this epidemic is going to fall on children as well. So all the practising physicians, pediatricians, and endocrinologists should be well prepared to face the rising burden of diabetes in children. India, being a resource poor country, should devise its own strategies to deal with diabetes in children.
I am sure, this book will go a long way in helping all those who are involved in the care of diabetes in children, including doctors, diabetes educators, social workers, dieticians, and other team members of the diabetes care group. I congratulate all the authors for their wonderful contribution to the book.
13Preface
The prevalence of diabetes mellitus is rapidly increasing throughout the world in general and the Indian subcontinent, in particular, because of the lifestyle changes which have occurred. Even children have not been spared from this epidemic. Until about 10–15 years ago, any diabetes occurring in a child was considered as insulin dependent type 1 diabetes and managed as such with insulin therapy, without any special investigations for finding out its etiology. The situation has changed a lot during the last 2 decades, and at present, the diabetes seen in children and adolescents can be of any category: type 1, type 2, maturity onset diabetes of the young, genetically determined, neonatal diabetes, etc. The incidence of type 1 diabetes mellitus per se is also on the rise. Hence, the pediatricians and physicians involved in the management of diabetes in children would like to have a book, which mainly focuses on this disease entity.
The needs of the practising physicians were taken into consideration when the content of the book was prepared. Starting from the definition and classification of diabetes in children, all types of diabetes seen in children are discussed in detail. The management approach to these clinical entities is given at length in each chapter.
The book has been prepared with the intention of giving the practising physicians all the information he or she requires for the day-to-day management of diabetes in children. However, the views of the reader will be known only after the book is published. We hope the shortcomings might be left in this first edition to be incorporated in the next edition after getting your feedback.
RV Jayakumar
Nisha Bhavani
Praveen V Pavithran