RSSDI Textbook of Diabetes Mellitus Viswanathan Mohan, Hemraj B Chandalia, Gumpeny Ramachandra Sridhar, Ashok Kumar Das, Sri Venkata Madhu, Paturi Vishnupriya Rao
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1RSSDI TEXTBOOK OF DIABETES MELLITUS2
3RSSDI TEXTBOOK OF DIABETES MELLITUS
Third Edition
Editor-in-Chief Hemraj B Chandalia Executive Editor Gumpeny Ramachandra Sridhar Editors Ashok Kumar Das Sri Venkata Madhu Viswanathan Mohan Paturi Vishnupriya Rao
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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
Printed at:5
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
Prof (Dr) Gumpeny Ramachandra Sridhar MD DM FACE FRCP (Glasgow)
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Prof (Dr) Ashok Kumar Das MD PhD FICP FAMS FACP FRCP (London)
Prof (Dr) Sri Venkata Madhu MD DM (Endocrinology)
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Prof (Dr) Viswanathan Mohan MD FRCP PhD DSc FNA FACP FACE FTWAS
Prof (Dr) Paturi Vishnupriya Rao MD PhD
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13Contributors
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21Preface to the Third Edition
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
Paturi Vishnupriya Rao23
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
Hemraj B Chandalia25
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
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