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© 2014, Research Society for the Study of Diabetes in India
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RSSDI Textbook of Diabetes Mellitus
Second Edition: 2008
Revised and Reprint: 2012
Third Edition: 2014
9789351520900
Dedication
RSSDI Textbook of Diabetes Mellitus Third Edition
Prof MMS Ahuja was one of the major driving forces behind this textbook. It is unfortunate that he passed away on July 12, 1998, when the first edition of this textbook was in its initial stages of preparation. It took us a great deal of time to pick the threads of editorial process where Prof Ahuja had left them and ultimately put the first edition together. Prof Ahuja was Head of the Departments of Medicine and Endocrinology at the prestigious All India Institute of Medical Sciences for several decades. He combined the qualities of a compassionate physician, an inspiring teacher and an inquisitive researcher—a combination difficult to find in modern times. He was a prolific writer and edited a highly popular series of review books entitled “Progress in Medicine”. In the areas of diabetology, his research work covered epidemiology, ketosis resistant diabetes in young, cardiovascular complications, nutrition and patient education. He has left his distinctive stamp in these fields. Prof Ahuja was one of the founders of Research Society for the Study of Diabetes in India and the major working force behind this society's progress. He founded and edited the ‘International Journal of Diabetes in Developing Countries’ from 1980 onwards, until the time of his collaboration in 1991 with other editors. This textbook continues to bear the stamp of his excellence. We, the editors of this textbook owe a great deal of gratitude to our pioneering colleague, Prof Ahuja and pay him a respectful tribute.6
7Dedication
RSSDI Textbook of Diabetes Mellitus Third Edition
Prof BB Tripathy was a doyen among physicians and diabetologists. He was an outstanding researcher and an astute clinician who produced some of the best epidemiological research at a time when the field of epidemiology was in its nascent stage in India. His work was highly significant in describing the clinical features of an atypical form of ketosis-resistant diabetes which was associated with malnutrition. Prof Tripathy organized a landmark international workshop “Diabetes peculiar to the Tropics” in 1995 at Cuttack. His knowledge was extensive and encompassed the fields of medicine, biochemistry, pharmacology, nutrition and epidemiology. He was Editor-in-Chief of RSSDI Textbook of Diabetes, First and Second editions. He was the Founder Vice President of the Research Society for Study of Diabetes in India (RSSDI) and was connected with this organization till his demise as an Executive Patron. RSSDI is heavily indebted to Prof Tripathy for his contributions and inspiring leadership.8
9Editors
Prof (Dr) Hemraj B Chandalia MD FACP
- Director, Endocrinology, Diabetes and Metabolism, Jaslok Hospital and Research Centre, Mumbai
- Director, Dr Chandalia's Diabetes Endocrine Nutrition Management and Research Centre, Mumbai
- Honorary Professor of Medicine and Diabetes, Grant Medical College and Sir JJ Group of Hospitals, Mumbai (1971–2000)
- Patron and Past President, Research Society for the Study of Diabetes in India
- Founding Editor, International Journal of Diabetes in Developing Countries
- Research Interests: Glycated Hemoglobin, Lactic Acidosis, Nutrition in Diabetes, Patient-Education, Prevention of Type 2 Diabetes.
- RSSDI Textbook—First, Second and Second Revised Edition: Executive Editor
- RSSDI Textbook—Third Edition: Editor-in-Chief
- Chapters authored: 16, 43, 48, 53, 88, 92, 94; Section Editor: Sections 1, 2, 3, 4, 5, 9
Prof (Dr) Gumpeny Ramachandra Sridhar MD DM FACE FRCP (Glasgow)
- Director, Endocrine and Diabetes Centre, Vishakhapatnam
- Adjunct Professor, Bioinformatics, Andhra University, College of Engineering
- President, Research Society for the Study of Diabetes in India (2010)
- President, Endocrine Society of India (2013–2014)
- Founding Editor, Indian Journal of Endocrinology and Metabolism (1997–2000)
- Editor-in-Chief, International Journal of Diabetes in Developing Countries (2013 onwards)
- Research Interests: Clinical Informatics, Computational Biology and Bioinformatics, Psychological Aspect of Diabetes
- RSSDI Textbook—Third Edition: Executive Editor
- Chapters authored: 33, 71, 81, 82, 85; Section Editor: Sections 10, 11, 12, 13, 14, 15
Prof (Dr) Ashok Kumar Das MD PhD FICP FAMS FACP FRCP (London)
- Senior Professor of Medicine and Endocrinology, Head Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry
- Past President, Association of Physicians of India
- Past President, Research Society for the Study of Diabetes in India
- Patron, Research Society for the Study of Diabetes in India
- Immediate Past Dean, Indian College of Physicians
- Research Interests: Cardiovascular Complications of Diabetes Mellitus, Diabetic Neuropathy and Diabetic Foot, Pathogenesis of Type 1 Diabetes Mellitus
- RSSDI Textbook—First, Second, Second Revised and Third Edition: Editor
- RSSDI Textbook—Third Edition; Chapters authored: 14, 20, 23, 44, 58, 67, 76, 90
Prof (Dr) Sri Venkata Madhu MD DM (Endocrinology)
- Professor and Head, Department of Medicine and Head, Division of Endocrinology and Metabolism, University College of Medical Sciences and associated GTB Hospital, Delhi, India
- President elect, Research Society for the Study of Diabetes in India (2014)
- Secretary, Research Society for the Study of Diabetes in India (2008–2013)
- Research Interests: Diabetes Epidemiology, Pathogenesis of Diabetes and its Complications, Stress and Diabetes, Postprandial Lipid Abnormalities in relation to Diabetes and Prediabetes
- RSSDI Textbook—First, Second, Second Revised and Third Edition: Editor
- RSSDI Textbook—Third Edition; Chapters authored: 11, 24, 52, 89
Prof (Dr) Viswanathan Mohan MD FRCP PhD DSc FNA FACP FACE FTWAS
- Chairman and Chief of Diabetology, Dr Mohan's Diabetes Specialities Centre, Chennai
- President and Director, Madras Diabetes Research Foundation
- President, Research Society for the Study of Diabetes in India (2012–2013)
- Research Interests: Epidemiology of Diabetes and its Complications, Genomics of Diabetes, Prevention of Diabetes
- RSSDI Textbook—Second, Second Revised and Third Edition: Editor
- RSSDI Textbook—Third Edition; Chapters authored:12, 21, 27, 28; Section Editor: Sections 6, 7, 8
Prof (Dr) Paturi Vishnupriya Rao MD PhD
- Professor and Head, Department of Endocrinology, Diabetes and Metabolism, Nizam's Institute of Medical Sciences University Hospital, Hyderabad
- Secretary, Research Society for the Study of Diabetes in India (1993–2007)
- Cofounder, DiabetOmics Laboratories, Portland, Oregon
- Research Interests: Epidemiology of Diabetes, Genetics of Diabetes, Biomarkers of Diabetes, Gestational Diabetes, Proteomics in Diabetes
- RSSDI Textbook—First, Second, Second Revised and Third Edition: Editor
- RSSDI Textbook—Third Edition; Chapters authored: 6, 7, 9
- Subrat Kumar Acharya md dm fna scf asc fn
- Professor and Head
- Department of Gastroenterology and Human Nutrition
- All India Institute of Medical Sciences
- Teaching Block, New Delhi, India
- AK Bajaj md (dermatology), ficai
- Former Professor and Head of Dermatology
- MLN Medical College
- Allahabad, Uttar Pradesh, India
- JS Bajaj md frcp (ed) frcp (london) dm (hc karolinska) fams hon dsc (bhu) dsc (hc mgr med univ) dsc (hc gnd univ) hon dsc (madras) hon dsc (punjab univ) dsc (hc univ health sc andhra)
- Former Professor of Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Sarita Bajaj md (medicine) dm (endocrinology aiims)
- Director, Professor and Head
- Department of Medicine
- MLN Medical College
- Allahabad, Uttar Pradesh, India
- Vijayam Balaji md
- Director, Dr V Seshiah Diabetes Research Institute
- Dr Balaji Diabetes Care Centre
- Madras, Tamil Nadu, India
- Samar Banerjee md
- President, Research Society for the Study of
- Diabetes in India (RSSDI)
- Professor of Medicine and Specialist Diabetes Clinic
- Vivekananda Institute of Medical Sciences
- Kolkata, West Bengal, India
- BC Bansal md mams ficp fimsa fiams ffgsi fiacm ficn
- Former Professor of Neurology
- Medical College, Rohtak, Haryana, India
- Debasis Basu md mba(hcs)
- President, Diabetes Awareness and you
- In-charge SUGAR Clinic, Apollo Gleneagles Heart Centre
- Kolkata, West Bengal, India
- Suchitra Behl md abim
- Fellow, Endocrinology and Advanced Diabetes Consultant
- Fortis C-DOC Centre of Excellence for Diabetes,
- Metabolic Diseases and Endocrinology
- Fortis Hospital
- Vasant Kunj, New Delhi, India
- Anil Bhansali dm frcp
- Professor and Head, Department of Endocrinology
- PGIMER, Chandigarh, India
- Sanjay Kumar Bhadada md dm
- Associate Professor, Department of Endocrinology
- PGIMER Chandigarh, India
- Sudip Chatterjee md mnams (Endocrinology) frcp (London) facp
- Hon Professor of Medicine Vivekananda Institute of Medical Sciences and Hon Secretary, Park Clinic
- Kolkata, West Bengal, India
- Swapna Chaturvedi msc foods and nutrition (delhi univ) rd
- Department of Dietetics
- All India Institute of Medical Sciences
- New Delhi, India
- Hemraj B Chandalia md facp
- Director, Endocrinology Diabetes and Metabolism
- Jaslok Hospital and Research Center, Mumbai
- Hon Professor of Medicine and Diabetes (Retd)
- Grant Medical College
- Mumbai, Maharashtra, India
- Shaival H Chandalia mbbs, diplomate american board in internal medicine, fellow endocrinology ut southwestern usa
- Consultant Endocrinologist and Diabetologist
- Jaslok and Bhatia Hospitals, Mumbai
- Consultant Endocrinologist and Diabetologist
- Dr Chandalia's Diabetes Endocrine Nutrition
- Management and Research Centre
- Mumbai, Maharashtra, India
- Arun R Chitale md (path) diplomate of american board of pathology
- Surgical Pathologist, Surgical Pathology Center
- Surgical Pathologist and Electron Microscopist
- Jaslok Hospital Research Center
- Mumbai, Maharashtra, India
- Subhankar Chowdhury dtm h md dm mrcp
- Professor and Head
- Department of Endocrinology
- IPGME & R and SSKM Hospital
- Kolkata, West Bengal, India
- Ashok Kumar Das mbbs md phd dnb fams ficp facp frcp
- Senior Professor of Medicine and Head Endocrinology,
- Jawaharlal Institute for Postgraduate
- Medical Education and Research (JIPMER)
- Puducherry, India
- Sidhartha Das mbbs(hons) md ficn ficp frcp(glasg) frcp(edin)
- Senior Consultant in Medicine and Diabetology
- Head, Postgraduate Department of Medicine
- SCB Medical College and Hospital
- Cuttack, Odisha, India
- Mala Dharmalingam md dm (aiims)
- Professor and HOD, Department of Endocrinology
- MS Ramaiah Medical College, Bengaluru
- Director, Bangalore Endocrinology and
- Diabetes Research Center
- Bengaluru, Karnataka, India
- Prasanth G md internal medicine mbbs
- Senior Resident in Medicine
- Jawaharlal Institute of Postgraduate
- Medical Education and Research
- Puducherry, India
- Leif Groop md phd
- Professor of Endocrinology
- Lund University, Malmö, Sweden
- Sunil Gupta md fiams fiacm ficp (diabetologist)
- Director, Sunil's Diabetes Care in Research Centre
- Lendra Park, Ramdaspeth
- Nagpur, Maharashtra, India
- Daya Kishore Hazra md(agra) msc nuclear medicine phd (london) fnams ficp ficnm fiacm
- Emeritus Professor, SN Medical College, Agra
- Chief Consultant, Boston Medical Centre
- Agra, Uttar Pradesh, India
- Aspi J Irani md (pediatrics) dch
- Honorary Pediatrician: Dr Balabhai Nanavati Hospital and
- Research Center, Mumbai
- In-Charge: Medical Services—Juvenile Diabetes Foundation, Maharashtra Chapter, India
- Sunil M Jain md dm (endocrinology)
- Consultant Endocrinologist
- TOTALL Diabetes Hormone Institute
- Indore, Madhya Pradesh, India
- Sushil Jindal md dm (endocrinolgy)
- Professor of Medicine, People's College of
- Medical Sciences, Bhopal
- Director, Jindal Diabetes and Hormone Centre
- Bhopal, Madhya Pradesh, India
- Shashank R Joshi md dm ficp facp (usa) face (usa) frcp (glsg & edin)
- Endocrinologist, Joshi Clinic, Lilavati and Bhatia Hospital
- President Elect, Association of Physicians of India (API)
- Mumbai, Maharashtra, India
- Sudeep K md dnb (endocrinology)
- Assistant Professor and Consultant Endocrinologist
- Endocrinology Unit, Department of Medicine
- Father Muller Medical College Hospital
- Mangalore, Karnataka, India
- Sanjay Kalra md dm
- Consultant, Endocrinology, Bharti Hospital and BRIDE Karnal
- Executive Editor, Indian J Endocrinology Metabolism
- Bharti Hospital
- Karnal, Haryana, India
- Alok Kanungo md phd
- Chief Consultant Diabetologist,
- Chairman and Managing Director
- Kanungo Institute of Diabetes specialities
- Bhubaneswar, Odisha, India
- Jothydev Kesavadev md
- Chairman and Managing Director
- Jothydev's Diabetes Research Centre
- Trivandrum, Kerala, India
- Romesh Kumar Khardori md phd facp frcp(c)
- Professor of Medicine Endocrinology and Metabolism
- Director, Endocrinology Graduate Training Program
- Division of Endocrinology, and Metabolism
- Strelits Institute for Diabetes Endocrine and
- Metabolic Disorders
- Eastern Virginia Medical School
- Norfolk, Virginia, USA
- Ashok L Kirpalani md (internal medicine) mnams (nephrology)
- Professor of Nephrology, Bombay Hospital
- Institute of Medical Sciences,
- Mumbai Kidney and Blood Pressure Clinic
- Indian Cancer Medical Centre
- Mumbai, Maharashtra, India
- Ajay Kumar md frcp
- Consultant, Physician and Diabetologist
- Diabetes Care and Research Centre
- Patna, Bihar, India
- Kalyanaraman Kumaran dm ffph
- Senior Scientist, Diabetes Unit, KEM Hospital Pune, India
- Senior Lecturer, MRC Lifecourse Epidemiology Unit
- University of Southampton, UK
- KM Prasanna Kumar md dm (endo)
- Consultant Endocrinologist
- Centre for Diabetes and Endocrine
- Care and Bangalore Diabetes Hospital
- Bengaluru, Karnataka, India
- Venkata Ranga Rao Kodali mbbs mrcp (uk) msc (applied nutrition) msc (endocrinology) fracp
- Consultant Endocrinologist and Associate Professor
- Director of Clinical Training
- Geraldton Regional Hospital
- Geraldton, Western Australia WA 6530, Australia
- PS Lamba md dm
- Consultant Endocrinologist
- Endocrine and Diabetes Management Centre
- Mumbai, Maharashtra, India
- Ramchandra Dattatray Lele mbbs (osm) dtm and h (eng) mrcp (edin) frcp (london) fnams hon dsc hon d litt
- Emeritus Director, Nuclear Medicine and PET CT
- Department of Jaslok Hospital and Research Centre
- Emeritus Professor of Medicine (for life) and Ex-Dean
- Grant Medical College and Sir JJ Hospitals
- Mumbai, Maharashtra, India
- SV Madhu md dm (endocrinology)
- Professor and Head, Department of Medicine and
- Head Division of Endocrinology and Metabolism
- UCMS-GTB Hospital Delhi, India
- President Elect, Research Society for the Study of
- Diabetes in India (RSSDI)
- K Madhu ma phd
- Head, Department of Psychology, Andhra University Visakhapatnam, Andhra Pradesh, India
- Thomas Mathew mbbs md dm
- Assistant Professor of Medicine
- St John's Medical College
- Bengaluru, Karnataka, India
- A Rosalind Marita phd
- Assistant Director
- Haffkine Institute for Training,
- Research and Testing, Mumbai
- Formerly Director—Pharmacology Piramal Life Sciences Ltd
- Mumbai, Maharashtra, India
- Suresh D Mehtalia md (bom) fica (usa) ficp (india)
- Hon Diabetologist, Asian Heart Institute, Mumbai
- Hon Diabetologist, Sir HN Hospital
- Mumbai, Maharashtra, India
- Anoop Misra mbbs md
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes Metabolic Diseases and Endocrinology
- Director, Centre of Internal Medicine (CIM), Fortis Hospital
- Vasant Kunj, New Delhi, India Chairman, National Diabetes Obesity and Cholesterol Foundation (N-DOC), India
- Priyanka Modi msc
- Research Associate, Kanungo Institute for Diabetes
- Specialities Hospital, Dumduma Bhubaneswar, Odisha, India
- Sonal V Modi msc rd cde
- Chief Nutritionist, Dr Chandalia's Diabetes Endocrine
- Nutrition Management and Research Centre (DENMARC)
- Lady Ratan Tata Research Centre
- Mumbai, Maharashtra, India
- Viswanathan Mohan md frcp phd dsc fna facp face ftwas
- Chairman, Dr Mohan's Diabetes Specialities Centre
- President, Madras Diabetes Research Foundation
- Chennai, Tamil Nadu, India
- Susana A Moran
- Emory School of Medicine Atlanta
- Georgia, USA
- MV Muraleedharan md dm mrcp
- Former Professor of Endocrinology
- Medical College
- Thrissur, Andhra Pradesh, India
- Nutan Sham Nabar md (ayurveda)
- Ayurvedic Consultant, Mangirish Clinic Bandra (W), Mumbai
- Research Associate, ICMR, Mumbai
- Medical Research Centre, Kasturba Health Society
- Mumbai, Maharashtra, India
- Dukhabandhu Naik md (medicine) dm (endocrinology)
- Assistant Professor of Endocrinology,
- Diabetes and Metabolism
- Christian Medical College
- Vellore, Tamil Nadu, India
- Arun Nanditha md
- Consultant Diabetologist
- Dr A Ramachandran's Diabetes Hospitals
- Chennai, Tamil Nadu, India
- Praveen Namboodiri md dm
- HOD Nephrology, Bishop Benziger Hospital, Kollam
- Consultant Nephrologist, SIMS, Kollam Kizhakillam
- Kerala, India
- KM Venkat Narayan md msc mba
- Ruth and OC Hubert Chair of Global Health
- Rollins School of Public Health, EMORY University
- Atlanta, USA
- Vijay Negalur md
- Hon Asst Professor of Medicine
- Rajeev Gandhi Medical College, Thane
- Diabetologist, Jupiter Hospital, Thane Mumbai, Maharashtra, India
- John Thomas O’Brian md facp face
- Professor of Medicine, Endocrinology and Metabolism
- Associate Director: Endocrinology Graduate Training Program
- Division of Endocrinology and Metabolism
- Eastern Virginia Medical School
- W Brambleton Avenue, Norfolk, USA
- Timothy O’Connor md facs
- Associate Clinical Professor of Surgery/Transplant Surgery
- University of Illinois College of Medicine
- Peoria, Illinois, USA
- MV Padma md dm fams fnasc
- Professor and Head Unit III, Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- NC Panda
- Former Professor of Biochemistry
- SCB Medical College
- Cuttack, Odisha, India
- Ramakrishna Pinjala ms frcsed fics
- Head of the Department of Vascular Surgery
- Nizams's Institute of Medical Sciences
- Hyderabad, Andhra Pradesh, India
- Kaushik Pandit md dnb dm
- Consultant Endocrinologist,
- Belle Vue Clinic, Kolkata and Fortis Hospital
- Kolkata, West Bengal, India
- Sharad P Pendsey mbbs md
- Consultant Diabetologist
- Diabetes Clinic and Research Centre,
- Dhantoli, Nagpur
- Managing Trustee Dream Trust, a registered NGO
- Diabetes Clinic and Research Centre
- Nagpur, Maharashtra, India
- Uday K Phadke md dnb dm(endocrinology) face
- Consultant in Endocrinology and Diabetes
- Ruby Hall Clinic and Instride Pune, Maharashtra, India
- Rajendra Pradeepa msc phd
- Senior Scientist and Head Research Operations
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre
- Chennai, Tamil Nadu, India
- Vijayaraghavan Prathiba mbbs do fedd frcs (glasgow)
- Head of Glaucoma Department
- Dr Mohan's Diabetes Specialities Centre and
- Madras Diabetes Research Foundation
- Chennai, Tamil Nadu, India
- Vijay Panikar md fcps dnb
- Formerly Professor of Medicine
- KJ Somiaya Medical college
- Department of Endocrinology and Diabetes
- Lilavati Hospital
- Mumbai, Maharashtra, India
- P Raghupathy
- Former Professor of Paediatrics
- Christian Medical College Vellore, Tamil Nadu, India
- Paturi V Rao md dipdiab phd frcp (l) face
- Head, Department of Endocrinology and Metabolism
- Nizam's Institute of Medical Sciences University
- Hyderabad, Andhra Pradesh, India
- Ramachandran Rajalakshmi mbbs do fedd phd
- Head—Medical Retina, Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation
- Chennai, Tamil Nadu, India
- Ambady Ramachandran md phd dsc frcp (lond) mnams ficp frcp(edin)
- President, India Diabetes Research Foundation and
- Chairman and Managing Director
- Dr A Ramachandran's Diabetes Hospitals
- Chennai, Tamil Nadu, India
- Sudhaker D Rao mbbs facp face
- Section Head, Bone and Mineral Metabolism, and
- Director, Bone and Mineral Research Laboratory
- Henry Ford Hospital
- Detroit, Michigan, USA
- Murlidhar S Rao md facp (usa) ficp
- Senior Consultant Cardio-Diabetologist
- Matoshree Medical Center, Court Road, Gulbarga
- Former Professor and HOD MR Medical College
- Vithal Nagar, Gulbarga, Karnataka, India
- Radha Reddy mbbs
- Fellow, endocrinology, Diabetes and
- Metabolism (USA)
- Consultant Endocrinology and
- Diabetes-Claremont, USA
- Banshi Saboo md ficp fiacm mnams
- Fellow—American College of Endocrinology
- Diabetologist and Metabolic
- Physician, Diacare—Diabetes Care and Hormone Clinic
- Ahmedabad, Gujarat, India
- Rakesh K Sahay md dm
- Professor of Endocrinology
- Osmania Medical College and
- Osmania General Hospital, Hyderabad
- Consultant Endocrinologist, Mediciti Hospital
- Hyderabad, Andhra Pradesh, India
- Rajesh G Sainani md dnb
- Consultant, Gastroenterologist and Hepatologist
- Jaslok Hospital and Research Centre, Bhatia Hospital
- Mumbai, Maharashtra, India
- Gurmukh S Sainani md frcp (lond & edin) hon fracp phd (poona) dsc (poona) hon d lit facc (usa) fams (ind) facp (usa) fccp (usa) frsm (lond) faiid fiams fise ficp (ind) fimsa ficn fica (usa) ficc (ind) fiacm fgsi hon fisc fcsi
- Director, Department of General Medicine
- Jaslok Hospital and Research Centre, Mumbai
- Emeritus Professor of Medicine (for life)
- Grant Medical College and JJ Hospital
- Mumbai, Maharashtra, India
- Carani B Sanjeevi md msc phd
- Professor, Department of Medicine, Karolinska Institute
- Head, Diabetes Autoimmunity Research Group
- Center for Molecular Medicine, Karolinska University Hospital Stockholm, Sweden
- Krishna G Seshadri mbbs ab (im) ab (endo diab met)
- Professor and Head Endocrinology, Diabetes and
- Metabolism, Sri Ramachandra University
- Senior Consultant, Fortis Malar Hospital
- Chennai, Tamil Nadu, India
- Veeraswamy Seshiah md
- Chairman—Dr V Seshiah Diabetes Research Institute,
- Dr Balaji Diabetes Care Centre
- Chennai, Tamil Nadu, India
- Rupin Shah ms mch (urology)
- Consultant Andrologist and Microsurgeon
- Lilavati Hospital and Research Center,
- Bhatia Hospital
- Mumbai, Maharashtra, India
- Siddharth N Shah md facp
- Bhatia Hospital, Saifee Hospital
- Editor-in-Chief, Journal of Association of Physicians of India
- Emeritus Editor—API Textbook of Medicine, IX Edition Mumbai, Maharashtra, India
- Rekha Sharma msc rd
- Director, Nutrition and Dietetics
- Diabetes Foundation (India)
- Former Chief Dietitian
- All India Institute of Medical Sciences
- New Delhi, India
- Samith A Shetty mbbs mdrc
- Consultant Diabetologist
- Dr A Ramachandran's Diabetes Hospitals
- Chennai, Tamil Nadu, India
- Jitendra Singh mbbs md medicine; fellowship diabetes (aiims ndl)
- MNAMS Diabetes and Endocrinology
- Professor Diabetes and Endocrinology
- Government Medical College
- Jammu, India
- Dhruv K Singh md d diab
- Chief Diabetologist and Medical Director, JUST Diabetes
- Off New Link Road, Andheri (W)
- Mumbai, Maharashtra, India
- Hon Senior Visiting Lecturer, Postgraduate Medical School
- University of Hertfordshire, UK
- Gumpeny Ramachandra Sridhar md dm face frcp
- Director, Endocrine and Diabetes Centre, Krishnanagar Visakhapatnam, Andhra Pradesh, India
- Chamukuttan Snehalatha msc dphil dsc
- Director—Research, India Diabetes
- Research Foundation
- Chennai, Tamil Nadu, India
- Chengjun Sun md
- Scientist, Department of Medicine
- Karolonska Institute Diabetes Autoimmunity
- Research Group
- Center for Molecular Medicine
- Karolinska University Hospital
- Stockholm, Sweden
- Nihal Thomas md mnams dnb (endo) fracp (endo) frcp (edin) frcp (glas)
- Professor and Head, Department of Endocrinology
- Diabetes and Metabolism and Vice-Principal(Research)
- Christian Medical College
- Vellore, Tamil Nadu, India
- BB Tripathy (Deceased)
- Devjit Tripathy mbbs md
- Assistant Professor, University of Texas Health Science Center San Antonio, Texas, USA
- Ashida TS mbbs md dnb
- Interventional Cardiologist, Cardiothoracic Surgeon
- East Coast Hospital
- Puducherry, India
- Ranjit Unnikrishnan mbbs md (gen med)
- Vice-chairman and Consultant Diabetologist
- Dr Mohan's Diabetes Specialities Centre
- Chennai, Tamil Nadu, India
- Rama Ashok Vaidya md phd
- Director, Endocrine and Metabolic
- Disorder Unit, MRC-KHS, Mumbai
- Consulting Reproductive Endocrinologist
- Vasudha Clinic Santacruz (W),
- Mumbai, Maharashtra, India
- Ashok DB Vaidya md phd faim
- Research Director, Medical research Centre
- Kasturba Health Society, Mumbai, Maharashtra, India
- Adjunct Professor, Drexel University, Philadelphia
- Poovazhagi Varadarajan md dch
- Associate Professor of Pediatrics
- Thanjavur Medical College
- Chennai, Tamil Nadu, India
- Premlata K Varthakavi md (internal medicine) dnb (endocrinology)
- TNM College and BYL Nair Charitable Hospital
- Dr AL Nair road Mumbai Central
- Mumbai, Maharashtra, India
- Radha Venkatesan msc phd
- Executive Scientific Officer and Head
- Department of Molecular Genetics
- Madras Diabetes Research Foundation
- Chennai, Tamil Nadu, India
- Stalin Viswanathan md
- Assistant Professor, Department of Medicine
- Indira Gandhi Government Post Graduate Medical Institute
- Puducherry, India
- Vijay Viswanathan md phd ficp frcp (london) frcp (glasgow)
- Adjunct Professor
- The Tamil Nadu Dr MGR Medical University
- Head and Chief Diabetologist
- MV Hospital for Diabetes (P) Ltd
- Chennai, Tamil Nadu, India
- Chittaranjan S Yajnik md frcp
- Director, Diabetes Unit, KEM Hospital,
- Pune, Maharashtra, India
- Visiting Professor, Peninsula Medical School
- Exeter, UK
It gives us great pleasure to bring to you the Third Edition of the RSSDI's Textbook of Diabetes Mellitus.
This textbook has held a place of pride in the diabetes world for the past decade. Conceived by late Prof MMS Ahuja and nurtured by late Prof BB Tripathy, this book is produced by Research Society for Study of Diabetes in India. Due to the prime position RSSDI occupies in India and world over, the involvement of its member-academicians as authors of the book has given this book an exalted status, which has been further vindicated by the fact that the first two editions of the book were very well received by healthcare professionals. The book was originally intended to present Indian data, mostly by Indian authors but has now graduated into a standard textbook of diabetes, useful to readers of all categories and regions involved in the care of people with diabetes. In the present edition, we requested the authors to give a balanced view of data from all parts of the world, in addition to the Indian data. Hence, we expect the book to now find a wider world-wide appeal.
Most authors of this book are either Indians or clinicians of Indian origin. As diabetes is highly prevalent in India, a book originating from India holds great promise. A unique fact about the background of the authors of this book merits attention. The majority of them are working in the academic environment, like medical colleges or institutions of repute. In addition to their academic work, most of them continue to practice diabetes, which makes the approach to the subject immensely practical and outcome-oriented. The information provided is evidence-based, yet its applicability has been examined ingeniously and clear recommendations have been given. These authors have developed clinical approaches that are very useful and practical, at times providing an exciting insight into future practice of diabetology. Many authors have also published valuable research papers on the subjects on which they have agreed to write a chapter in this book.
We have introduced several new chapters in this edition in order to keep the contents abreast of the altered pattern of diabetes and advent of new concepts and treatment modalities. A few examples are Sleep and Type 2 Diabetes Mellitus (Chapter 20); Neonatal Diabetes (Chapter 27); Early-onset Type 2 Diabetes (Chapter 28); Yoga and Relaxation Techniques in Diabetes Mellitus (Chapter 33); Nutrient Blockers and Bromocriptine (Chapter 37); Insulin Pump Therapy (Chapter 39); Glycemic Management in Hospitalized Patients (Chapter 40); Continuous Glucose Monitoring System (Chapter 42); Stem Cell Therapy in Diabetes Mellitus (Chapter 47); Vitamin D and Diabetes Mellitus (Chapter 70); HIV in Diabetes (Chapter 74); Diabetes and Cancer (Chapter 75). The oral anti-diabetic drugs are discussed in four chapters [Insulin Secretagogues (Chapter 34); Insulin sensitizers: Metformin and Thiazolidinediones (Chapter 35), Incretin-Based Therapy (Chapter 36); Nutrient Blockers and Bromocriptine (Chapter 37)].
Some chapters were found to be redundant and hence omitted while others have been amalgamated to enhance continuity and coherence of the subject. We have thoroughly revised all the previous chapters, incorporating literature upto the year 2013 wherever relevant. An additional 22feature is listing of references for Further Reading separately from all references. This feature has been introduced with the assumption that the book will be used both by clinical diabetologists or physicians and research workers. The references for Further Reading are either most current comprehensive reviews or classic research work or research work of lasting impact. These will be highly useful to the clinicians. The exhaustive list of text-linked references will additionally be of use to researchers.
We fervently hope that this book is received warmly by the diabetologists, physicians, diabetes educators and researchers. In that case, we shall consider our efforts amply rewarded.
Hemraj B Chandalia
Gumpeny Ramachandra Sridhar
Ashok Kumar Das
Sri Venkata Madhu
Viswanathan Mohan
Preface to the Third Edition
With explosive increase in its prevalence, diabetes mellitus, as a chronic medical disorder, is to be reckoned on par with hypertension and atherosclerosis. A versatile disease, diabetes, in view of its frequent clinical and epidemiological link with the other two, constitutes a health problem of paramount concern for a very large proportion of the world population.
In the course of the last few decades, India has emerged as the country with the highest number of patients with diabetes. In keeping with this, in India, diabetology has emerged as a major specialty in the practice of both general medicine and endocrinology. Over the last thirty years, several centers have adopted diabetes as a single disease specialty for the state-of-the-art investigations and clinical care.
The idea of compiling a Textbook on Diabetes Mellitus was mooted with the above in view. Bearing in mind the fact that there already exist a number of exclusive books on diabetes on the global scene, this publication was planned keeping several special objectives in view. A large number of primary care physicians as well as an increasing number of specialists are in need of comprehensive knowledge on both basic and applied aspects of the disease. Publications from abroad are very expensive. Prices keep on rising steeply from edition to edition. Further, beginning from 1960s, it has been explicitly shown that problems associated with diabetes in India are in several respects distinct from those in the West, the major source of the available publications. Attempts to cover the special features of diabetes among diverse ethnic groups have been made in the two editions of the International Textbook of Diabetes Mellitus. Yet, it was felt that India needs a book of her own to cater to the needs of the burgeoning number of medical practitioners dealing with diabetes in this country as well as to those of its neighbors in South, Mid and South East Asia.
The Research Society for the Study of Diabetes in India (RSSDI) was founded in 1972 ostensibly for promoting academics and research on the intricate subject of diabetes mellitus. The Society has experienced phenomenal growth in membership and activities during the 90s of the last century. About four and half years back, Professor MMS Ahuja, a pioneer in establishing RSSDI, initiated a proposal for compiling a textbook on diabetes. Some of us quickly got together to process the basics and to set the program in motion. Unfortunately, the sad demise of Professor Ahuja in July 1998 left us high and dry. Records of the initial work were hard to trace out. It took us close to a year to recover from the shock and reorganize the undertaking right from the start.
As is evident from the list of editors, this is a collaborative work of several persons placed at long distances from each other. Professor PV Rao was assigned the pivotal role of keeping the records and looking after the printing, which he has done with great alacrity in the face of numerous difficulties in communication and coordination.
Although only a small body of basic research has originated from modern India, clinical and epidemiological studies have been numerous. These, for sure, are of considerable importance 24for medical practitioners and patients of this country. Only a small number of these works have been published or abstracted in the world literature and therefore most fail to hit books published in the West. The RSSDI Textbook of Diabetes Mellitus is purported to highlight data generated in India wherever relevant. Due scope has been provided for exposition of areas where Indian investigators have contributed valuable original ideas such as on planning of diet with higher carbohydrate content, use of insulin and sulfonylurea in combination, application of Yoga in the management of diabetes, an indigenous inexpensive method for the estimation of glycohemoglobin, identification and analysis of fibrocalculous pancreatic diabetes and malnutrition modulated diabetes mellitus, characterization of the quite common low weight type 2 diabetes as well as elaborate sequential study of epidemiology of diabetes in various social classes of ethnic Indians.
The scope of the textbook was proposed to be wide so as to be of service to general practitioners as well as to broaden their academic outlook. It was scrupulously designed to target the requirements of family physicians, academicians, clinical researchers and diabetes oriented health professionals at large. Diabetes along with its complications is a multiorgan disease covering all subspecialities of medicine as well as pediatrics, ophthalmology, obstetrics, surgery and orthopedics. While keeping all these in view, the contents have been designed and presented in a classic textbook style. Individual chapters are grouped into sections dealing with historical aspects, biochemical basis, pathogenesis, genetics, stages and classes, epidemiology, clinical details, management, complications and prevention. Each chapter is comprehensive and reasonably elaborate. Lists of references are adequate and appropriate. Contributions provided by experienced professors as well as senior and young clinical researchers from all parts of the country and some from abroad, have enriched the contents to the best possible extent. Many of the authors happen to be devoted members of the RSSDI.
Most notable shortcoming is the long delay of nearly three years of gestational period. Due to multiplicity of authors and editors, there is bound to be some overlap among the chapters. A few papers have been modified and even replaced after editorial scrutiny. Care has been taken to refer the papers back to the authors for updating, corrections and finally for reading of the proof copies prior to the final print.
The editors and the executives of the RSSDI are indeed thankful to various authors for devoting a lot of time and energy for preparing their contributions. Our thanks are due to Dr Rachel Thomas-Jacob for proofreading, the printers and numerous other persons who have helped individual editors and Professor PV Rao in the final lap of publication of our most cherished textbook on diabetes.
Publications on diabetes as well as CME and update sessions on the topic have been very popular during the recent decades. Our effort to bring out a comprehensive treatise on this popular subject, we earnestly hope, will receive fond acceptance from the readers. If this book addresses the questions they have in their minds or if it stimulates their thinking on this subject, our purpose would be served.
Sam GP Moses
BB Tripathy
Acknowledgments
The editorial process has been a challenging task. My co-editors, section editors and authors have contributed towards this effort. The authors of first and second edition also need to be thanked, as they had laid down the foundation of the book. In most cases, they have been continued for the chapter authored by them in the previous editions. In case the author has been changed, the previous author's name has been continued as a co-author especially when the contents of the previous chapter have been utilised extensively.
A group of young physicians, diabetologists and diabetes educators deserve profuse thanks by me; not only did they assist in copy-editing but detected important deficiencies and redundancy in some chapters and detected a disconnect between the text and references. Dr Nikesh Jain, Dr Puja Thadani, Dr Shaival Chandalia, Ms Niyati Likhite, Ms Vriti Srivastav and Ms Monisha Joukani were involved at various stages of this book. They formed a cohesive team to complete this stupendous task.
I would also like to give my heartfelt thanks to Dr Puja M Thadani for preparing the abstracts for the e-version of the book.
I would like to thank my family members, especially my wife Leela Chandalia for gracefully absolving me of family responsibilities during the past two years of hectic activities related to this textbook and organisational work of the Research Society for Study of Diabetes in India.
Our publishers, starting from Shri Jitendar P Vij (Group Chairman) and all his associates, Ms Chetna Malhotra Vohra (Senior Manager–Business Development), Ms Sheetal Arora, Sabarish Menon and their production teams have been very patient and supportive. I appreciate their forbearance and co-operation.
Hemraj B Chandalia
Editor-in-Chief