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Fundamentals of Diabetes
Sarita Bajaj, Kamlakar Tripathi, Anuj Maheshwari, Brij Mohan, Narsingh Verma, Amit N Dwivedi, Richik Tripathi
CHAPTER 1:
History of Diabetes
INTRODUCTION
DIABETES MELLITUS AND THE ISLETS OF LANGERHANS
DISCOVERY OF INSULIN
Banting's Idea
Testing on Humans
The Nobel Prize
CHAPTER 2:
Epidemiology of Diabetes
INTRODUCTION
THE GLOBAL BURDEN
EPIDEMIOLOGICAL CONCEPT IN DIABETES
Genetics, the Epidemiological Factor
Diagnosis of Diabetes Mellitus
Screening for Non-insulin-dependent Diabetes Mellitus
PREVENTION AND CONTROL
Primordial Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
CHAPTER 3:
Pancreas Islet Cells and Its Development
INTRODUCTION
DEVELOPMENT OF THE PANCREAS
DEVELOPMENT OF ENDOCRINE PANCREAS CELLS
Factor Information (Fig. 4)
FINDINGS
MICROSCOPIC FEATURES
Acini
Islets of Langerhans
DEVELOPMENTAL ANOMALIES AND HETEROTOPIA
DEVELOPING PANCREATIC ISLETS
Model of Endocrine Cell and Vessel Organization in Human Islets
ADULT PANCREATIC ISLETS
Alpha-Cells (Fig. 17)
Beta-Cells (Figs 18A to D)
Molecular—Nkx6.1—NK2 Homeobox 6.1
Delta-Cells
F-Cells
ABNORMALITIES
CHAPTER 4:
Physiology of Glucose Metabolism, Biochemistry of Cotransporters and Its Clinical Relevance
INTRODUCTION
DIGESTION OF CARBOHYDRATES: SALIVARY AND PANCREATIC AMYLASE
APPLIED PHYSIOLOGY
Disaccharidases
Dietary Fiber, although not Digestible, Benefits Gastrointestinal Function
Absorption of Carbohydrates (Fig. 2)
GLUCOSE-GALACTOSE MALABSORPTION
Glucose Transport Pathways
SGLT Family
GLUT Family
Class I Sugar Transport Facilitators
Class II Sugar Transport Facilitators
Class III Sugar Transport Facilitators
GLUCOSE TRANSPORTERS AS COMPONENTS OF THE GLUCOSENSING MACHINERY
CHAPTER 5:
Interpretation of Genetics in Diabetes Mellitus
INTRODUCTION
CANDIDATE GENES AND LINKAGE STUDIES
IDDM1
INS (Insulin)
CTLA-4 (Cytotoxic T-lymphocyte-associated 4)
TYPE 2 DIABETES MELLITUS
PPARG
KCNJ11
WFS1
HNF1B
GWA Studies
CLINICAL APPLICATION OF GENETIC INFORMATION IN DIABETES
Predicting Risk of Developing Diabetes
Monogenic Diabetes
Neonatal Diabetes
MONOGENIC DIABETES DETECTED IN ADOLESCENCE OR ADULTHOOD
Glucokinase Monogenic Diabetes
Hepatocyte Nuclear Factor Monogenic Diabetes
Maternally Inherited Diabetes and Deafness
Status of MODY Genetics in India27
CHAPTER 6:
Classification and Diagnosis of Diabetes
INTRODUCTION
HISTORY OF DIABETES CLASSIFICATION
CURRENT CLASSIFICATION OF DIABETES
Type 1 Diabetes (β-Cell Destruction, Usually Leading to Absolute Insulin Deficiency)
Immune-mediated Diabetes
Idiopathic Diabetes
Type 2 Diabetes (Ranging from Predominantly Insulin Resistance with Relative Insulin Deficiency to Predominantly Insulin Secretory Defect with Insulin Resistance)
Other Specific Types of Diabetes
Genetic Defects of the β-Cell
Genetic Defects in Insulin Action
Diseases of the Exocrine Pancreas
Endocrinopathies
Drug and Chemical-induced Diabetes
Infections
Uncommon Forms of Immune-mediated Diabetes
Other Genetic Syndromes sometimes Associated with Diabetes
Gestational Diabetes Mellitus
DIAGNOSIS OF DIABETES
Diagnostic Tests
Current Diagnostic Criteria
Diabetes Mellitus
Impaired Glucose Tolerance
Impaired Fasting Glucose
Use of HbA1c as a Diagnostic Test for Diabetes
Diagnosis of Gestational Diabetes Mellitus
CONCLUSION
CHAPTER 7:
Management of Type 1 Diabetes
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY AND PATHOGENESIS OF TYPE 1 DIABETES
Genetic Factors
Identifying Susceptibility Genes in Type 1 Diabetes
Viral Infections and Toxins
Environmental Factors
Nutrition and Dietary Factors
C-peptide Assay for Assessment of Pancreatic Beta-cell Reserve
Immune-mediated Destruction of Pancreatic Beta Cells
The Pathogenesis of Type 1 Diabetes
PHASES OF TYPE 1 DIABETES
RECOMMENDED CARE
Preclinical Diabetes
Risks of Progression to Diabetes
Presentation of Type 1 Diabetes
Nonemergency Presentations
Emergency Presentations
Diagnostic Difficulties Leading to Late Diagnosis
Partial Remission or Honeymoon Phase in Type 1 Diabetes
Chronic Phase of Lifelong Dependence on Insulin
MANAGEMENT OF TYPE 1 DIABETES
Aims of Diabetes Management
Hospital versus Ambulatory Stabilization
Relative Contraindications to Ambulatory Initiation of Insulin Therapy include
The basic elements of type 1 diabetes management are:
INSULIN THERAPY
Rapid-acting Insulin
Immediate-acting Insulin
Long-acting Insulin Analogues
Biphasic or Premixed Insulins
Combination of a Basal Insulin with an Ultra-long Duration of Action and a Mealtime Insulin
STORAGE CONDITIONS
INSULIN REGIMEN AND DELIVERY
Insulin Regimens
TOTAL DAILY INSULIN DOSAGE AND DISTRIBUTION
INSULIN ADMINISTRATION
Insulin Absorption
Insulin Delivery Devices
Insulin Syringes and Pens
Practical Aspects of Insulin Administration
Insulin Adjustment
Side Effects of Insulin Therapy
Alternative Insulin Therapies
Glycemic Control
Indicators of poor Glycemic Control
Glycemic targets need to take into account additional factors
Blood Glucose Monitoring
Medical Nutrition Therapy
Goals in Type 1 Diabetes
Calories
Carbohydrate
Sucrose
Fiber
Protein
Fat
Exercise
Exercise guidelines in type 1 diabetes
Prevention of Diabetic Ketoacidosis: Sick-day Rules
Never Omit Insulin
Prevent Dehydration and Hypoglycemia
Monitor Blood Glucose Frequently
Monitor for Ketones
Provide Supplemental Fast-acting or Rapid-acting Insulin
Treat Underlying Precipitating Factors
Behavioral Issues
Care of Children and Adolescents with Type 1 Diabetes in the School and Day Care Setting
CHAPTER 8:
Management of Type 1 Diabetes Mellitus in Children
INTRODUCTION
INITIAL MANAGEMENT
ON GOING CARE
Age Appropriate Care
Toddler (1–3 years)
Preschool (3–6 years)
School (7–11 years)
Adolescence (12–18 years)
GLYCEMIC CONTROL
BLOOD GLUCOSE MONITORING
Self-monitoring of Blood Glucose
Continuous Glucose Monitoring
Insulin in Type 1 Diabetes
Glycemic Control and HbA1c in Intensive Insulin Therapy
Insulin Pump
Disadvantages of an Insulin Pump1,29–31
DOSE OF INSULIN
Honeymoon Phase
Inhaled Insulin
Other Modalities of Treatment
Metformin
Incretin-based Treatment
SGLT-2 Inhibitors
Transplantation
Nutrition
Exercise
Psychosocial Issues
HYPOGLYCEMIA
SICK-DAY RULES1,2
CONCLUSION
CHAPTER 9:
Management of Type 2 Diabetes Mellitus
INTRODUCTION
MEDICAL NUTRITION THERAPY IN DIABETES
ORAL ANTIDIABETIC AGENTS
History
Biguanides (Metformin)
Mechanism of Action
At Cellular Level
Drugs
Indications
Contraindications
Adverse Effects
Thiazolidinediones
Metabolic Effects of Thiazolidinediones
Therapeutic Applications
Troglitazone
Rosiglitazone
Dosage
Adverse Effects
INSULIN SECRETAGOGUES
Sulfonylureas
First Generation Sulfonylureas—(Not Available)
Second Generation Sulfonylureas
Third Generation Sulfonylureas
Therapeutic Applications
Glimepiride versus Other Sulfonylureas
Sulfonylurea Failure
Primary Failure
Secondary Failure
Nonsulfonylurea Secretagogues (Glinides)
Repaglinide
Nateglinide
Inhibitors of Gastrointestinal (GI) Tract Glucose Absorption α-glucosidase Inhibitors
Adverse Effects and Contraindications
Dosage
Bromocriptine
INSULIN THERAPY IN TYPE 2 DIABETES MELLITUS
History
Metabolic Effects of Insulin Therapy
Anticatabolic Effects of Insulin (Inhibits)
Rationality of Insulin in Type 2 Diabetes Mellitus
Indications for Insulin Therapy
Practical Aspects of Insulin Therapy
Special Situations
Intensive Insulin Therapy
Problems with Insulin Therapy
Newer Long-acting Insulin (Insulin Degludec)
Insulin Therapy in Future
Incretin-based Therapy
The Incretin Effect
The Incretin Hormones
Exenatide
Precautions
Liraglutide
Adverse Effects
DPP-IV Inhibitors (Incretin Enhancers)
NOVEL ANTIDIABETIC DRUGS
Sodium-Glucose Cotransporter Inhibitors (SGLT-2 Inhibitors)
Amylin Analogs (Pramlintide)
Physiological Actions of Amylin or Pramlintide
Administration
SUMMARY
CHAPTER 10:
Acute Metabolic Complications in Diabetes
INTRODUCTION
DIABETIC KETOACIDOSIS
Pathophysiology
Precipitating factors for diabetic ketoacidosis with established diabetes include infection and other acute illnesses
Clinical Presentation
Laboratory Evaluation and Diagnosis
Prevention and Management
Elements of Therapy
HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC STATE (HHNS)
Pathophysiology
Clinical Presentation
Laboratory Evaluation and Diagnosis
Prevention and Management
Elements of Therapy
HYPOGLYCEMIA
Clinical Presentation
Laboratory Evaluation and Diagnosis
Prevention and Management
Elements of Therapy
Metabolism of Glucose during Shock Septicemia and Trauma in Diabetes
Long-term Impact of Acute Complications of Diabetes
CHAPTER 11:
Diabetes and Its Complications— An Overview
INTRODUCTION
GLOBAL BURDEN: FACT SHEET2
DIABETES-RELATED COMPLICATIONS IN INDIA1,4
Acute Complications of Diabetes Mellitus5,6
Pathogenesis
Chronic Complications of Diabetes
Pathogenesis10,11
Mechanisms underlying impaired endothelium-derived vasodilatation
Pathogenesis of Diabetic Neuropathy9,13–15
Pathogenesis of Diabetic Nephropathy17
Diabetic Retinopathy18,19
Coronary Artery Disease and Diabetes20
Pathogenesis of CAD21
Peripheral Arterial Disease and Diabetes24
Pathogenesis
Cerebrovascular Disease and Diabetes
Pathogenesis
CHAPTER 12:
Pharmacology of Insulins
INTRODUCTION
STRUCTURE OF INSULIN
BIOSYNTHESIS OF INSULIN
INSULIN SECRETION
MECHANISM OF ACTION OF INSULIN
METHODS OF INSULIN PRODUCTION
PHARMACOKINETICS OF INSULIN
FUTURE DEVELOPMENTS
U300
Pegylated Lispro
CHAPTER 13:
Diabetic Eye Disease and Its Complications
INTRODUCTION
Epidemiology and Trends of Diabetic Retinopathy in India and Worldwide
PATHOGENESIS OF PROLIFERATIVE AND NONPROLIFERATIVE DIABETIC RETINOPATHY
Terminologies, Definition of Diabetic Retinopathy and Types
CLINICAL FEATURES OF DIABETIC RETINOPATHY
DIABETIC MACULAR EDEMA (Fig. 4)
Lenticular Changes in Diabetes
DIABETES RELATED COMPLICATION IN ANTERIOR CHAMBER
DIABETES RELATED COMPLICATION IN POSTERIOR SEGMENT
Vitreous Hemorrhage
Tractional Retinal Detachment
TREATMENT OPTIONS
MEDICAL MANAGEMENT
LASER TREATMENT
SURGICAL TREATMENT
MODERN TREATMENT OPTIONS
SCREENING
CONCLUSION
CHAPTER 14:
Management of Diabetic Neuropathy
INTRODUCTION
CLINICAL MANIFESTATIONS
FOCAL NEUROPATHY
Mononeuropathy
Entrapment Syndromes
DIFFUSE NEUROPATHY
Proximal Motor Neuropathy
Distal Symmetrical Polyneuropathy
AUTONOMIC NEUROPATHY
PAINFUL DIABETIC NEUROPATHY
ACUTE PAINFUL NEUROPATHY
CHRONIC PAINFUL NEUROPATHY
SMALL-FIBER NEUROPATHY
LARGE-FIBER NEUROPATHY
DIAGNOSIS
MANAGEMENT
Control of Hyperglycemia
PHARMACOLOGICAL THERAPY
Aldose Reductase Inhibitor
α-Lipoic Acid
γ-Linolenic Acid
Protein Kinase C-β Inhibition
Aminoguanidine
Human Intravenous Immunoglobulin
Neurotrophic Therapy
Pain Control
C-fiber Pain
Capsaicin
Clonidine
Aδ-fiber Pain
Insulin
Nerve Blockers
Tramadol and Dextromethorphan
Antidepressants
Antiepileptic Drugs
Adjunct Management and Treatment of Complications
Analgesics
Calcitonin
MANAGEMENT OF SMALL-FIBER NEUROPATHIES
MANAGEMENT OF LARGE-FIBER NEUROPATHIES
CHAPTER 15:
Management of Cardiovascular Disorders in Diabetes
INTRODUCTION
HYPERTENSION
LIFESTYLE MODIFICATIONS
PHARMACOLOGICAL INTERVENTIONS
PREGNANCY AND ANTIHYPERTENSIVE MEDICATIONS
DYSLIPIDEMIA/LIPID MANAGEMENT
Lifestyle Intervention
Initiating Statin Therapy Based on Risk
Treatment of Other Lipoprotein Fractions or Targets
ANTIPLATELET AGENTS
CORONARY HEART DISEASE
CHAPTER 16:
Oral Complications of Diabetes Mellitus and Their Management
INTRODUCTION
ORAL CANDIDIASIS
Pseudomembranous Candidiasis
Atrophic Candidiasis
Hyperplastic Candidiasis
Erythematous Candidiasis
Angular Cheilitis
Management
PERIODONTITIS
Management
XEROSTOMIA
Management
DENTAL IMPLANT FAILURE
NONHEALING ORAL WOUNDS
DENTAL CARIES
CHAPTER 17:
Imaging of Macrovascular Complications and Comorbid Conditions in Diabetic Patients
INTRODUCTION
MACROVASCULAR COMPLICATIONS AND NEED FOR IMAGING
Cardiovascular Disease
Cerebrovascular Disease
Peripheral Artery Disease
IMAGING IN CARDIOVASCULAR DISEASE: CORONARY ARTERY DISEASE
Coronary Calcium Score
Cardiac Magnetic Resonance Imaging
IMAGING IN CEREBROVASCULAR DISEASE
Ruling Out Intracranial Hemorrhage
Diagnosing Ischemic Stroke
Determining Large Artery Occlusion
Assessing Viable Ischemic Brain Tissue
IMAGING IN LOWER-EXTREMITY ARTERIAL DISEASE
Duplex Ultrasonography
Computed Tomography Angiography
Magnetic Resonance Angiography
SPECIAL IMAGING CONCERNS IN DIABETICS
Atherosclerosis
Renal Function Impairment
Implanted Metal DeviCES
SUMMARY
CHAPTER 18:
Dermatological Manifestations of Diabetes Mellitus
INTRODUCTION
CLASSIFICATION OF SKIN MANIFESTATIONS
LESIONS ASSOCIATED WITH BUT NOT SPECIFIC FOR DIABETES MELLITUS
Pruritus4
Necrobiosis Lipoidica Diabeticorum (Fig. 1)5,6
Granuloma Annulare (Fig. 2)7
Diabetic Dermopathy (Fig. 3)9–11
Scleroderma-like Syndrome/Waxy Skin Syndrome13
Acanthosis Nigricans14
Diabetic Bullae
Fournier Gangrene
LESIONS DUE TO DIABETIC COMPLICATIONS
Diabetic Foot (Fig. 5)11
Cutaneous Infections Associated with Diabetes15
Furunculosis
Carbuncle (Fig. 6)8
Candidiasis
Dermatophytosis (Figs 7 and 8)6,16,17
Erythrasma (Fig. 9)
Xanthomatosis
Xanthelasma (Fig. 11)
Phycomycetes20
Malignant Otitis Media
LESIONS ASSOCIATED WITH NEUROVASCULAR COMPLICATIONS
Macroangiopathy
Microangiopathy
Diabetic Neuropathy21
DERMATOLOGICAL MANIFESTATIONS DUE TO TREATMENT OF DIABETES
Oral Hypoglycemic Drugs
Insulin
ENDOCRINE SYNDROMES WITH SKIN ALTERATIONS AND DIABETES MELLITUS
Glucagonoma
DERMATOSIS REPORTED TO BE MORE COMMON IN DIABETICS THAN NONDIABETICS
Perforating Dermatosis
Vitiligo (Fig. 13)8
Lichen Planus (Fig. 14)8
Kaposi's Sarcoma (Fig. 15)8
Bullous Pemphigoid
Dermatitis Herpetiformis
CHAPTER 19:
Oral Hypoglycemic Agents: Drug Interaction and Toxicity
INTRODUCTION
METFORMIN
SULFONYLUREAS
THIAZOLIDINEDIONES
DIPEPTIDYL PEPTIDASE-4 INHIBITORS
ALPHA-GLUCOSIDASE INHIBITORS
SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS
SUMMARY
CHAPTER 20:
Chronic Kidney Disease and Diabetes
INTRODUCTION
CLINICAL DEFINITION
PATHOLOGICAL FINDINGS
PATHOPHYSIOLOGY
Acute Phase Response, Proinflammatory Cytokines and Metabolism
Insulin/IGF-1 Resistance and Upregulation of Glucocorticoids—Cachexia
GH-IGF-1 Axis
Renin-Angiotensin-Aldosterone System and Angiotensin II
Adipocytokines
Leptin
Adiponectin
Ghrelin
Vitamin D
Glucocorticoids
APPROACH TO MANAGE DIABETES IN CKD
DIAGNOSIS OF CHRONIC KIDNEY DISEASE
Measurement of Glycemic Control
GOALS OF TREATMENT
PHARMACOLOGICAL TREATMENT OF HYPERGLYCEMIA
Insulin
Oral Agents
Sulfonylurea
OTHER ASPECTS OF TREATING DIABETIC KIDNEY DISEASE
Nutritional Considerations in Diabetes and CKD
HYPERTENSION
HYPERLIPIDEMIA
Hyperphosphatemia and Secondary Hyperthyroidism
CHAPTER 21:
Metabolic Syndrome: Pathophysiological Lessons for the Diabetes Practitioner
INTRODUCTION
IMMEDIATE AND LONG-TERM BENEFITS OF TIGHT CONTROL OF HYPERGLYCEMIA
OXIDATIVE STRESS IN DIABETES
PATHOGENESIS OF DIABETIC RETINOPATHY
ROLE OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN DR
Blood Pressure Control
Lipid Lowering
PRACTICAL MANAGEMENT IMPLICATIONS
CONCLUSION
CHAPTER 22:
Diabetic Foot and Its Complications
INTRODUCTION
PATHOPHYSIOLOGY OF DIABETIC FOOT1
COMPLICATIONS OF DIABETIC FOOT2
ULCERATION
Infection
Amputation
MANAGEMENT OF DIABETIC FOOT AND ITS COMPLICATIONS
History
Physical Examination
Investigations
TREATMENT GOALS FOR ADULTS WITH DM3
NUTRITIONAL RECOMMENDATIONS FOR ADULTS WITH DM3
PREVENTION OF DIABETIC FOOT
TREATMENT OF DIABETIC FOOT4
CHAPTER 23:
Psychiatric Evaluation in Patient with Insulin Resistance
INTRODUCTION
DEPRESSION
The Relationship between Depression and Insulin Resistance
Pathophysiological Link between Depression and Insulin Resistance
Hypothalamic-Pituitary-Adrenal Hyperactivity
Increased in Immunoinflammatory Cytokines
SCHIZOPHRENIA
The Mechanisms Underlying the Increased Prevalence of Diabetes
Obesity
Lipid Profile
Hereditary Factors
Lifestyle
Antipsychotic Medication
BIPOLAR DISORDER
ANTIPSYCHOTIC DRUGS ASSOCIATED WITH INSULIN RESISTANCE
Treating your Diabetes and Depression
Adverse Outcomes Linked to Untreated Depression in Diabetes
Diabetes Disease Process and Treatment Options
NOVEL DRUGS FOR DIABETES
Hydroxychloroquine
Bromocriptine
CHAPTER 24:
Diabetes in Pregnancy
INTRODUCTION
Gestational Diabetes Mellitus
DIAGNOSTIC CRITERIA AND SCREENING OF GESTATIONAL DIABETES MELLITUS
World Health Organization Procedure
American Diabetes Association Procedure
The International Association of the Diabetes and Pregnancy Study Groups4
Disadvantages of the IADPSG Guidelines
Evidence-based WHO Criterion
Short-term Outcome
Evidence-based
Long-term Outcome
New WHO Criteria
Procedure
Advantages of the DIPSI procedure are:
PHYSIOLOGY OF PREGNANCY AND GLUCOSE METABOLISM AND INSULIN RESISTANCE IN GDM
Maternal and Fetal Adaptations in Pregnancy
Fuel Metabolism in Normal Pregnancy
Early Weeks of Gestation
Later Weeks of Gestation
PATHOGENESIS OF GLUCOSE INTOLERANCE DEVELOPING DURING PREGNANCY
Genetic Factors
Gestational Factors
Islet Secretion
Insulin Resistance and Hormones of Gestation
GDM AND ITS PREVENTION
Medical Nutrition Therapy
Insulin Treatment
Ultrasound Fetal Measurement
Target Blood Glucose Levels
Oral Antidiabetic Drugs
Monitoring Glycemic Control
Measuring Other Parameters
A1c Levels
MANAGEMENT OF DIABETES IN PREGNANCY
Pre-gestational Type 1 and Type 2 Diabetic Women
Insulin Requirement in Pre-GDM
OBSTETRIC CONSIDERATIONS
FETAL EVALUATION
Mid-pregnancy (16–20 Weeks) to Detect Fetal Anomalies
Late Pregnancy (28 week to delivery) to Assess Fetal Wellbeing
INTRAPARTUM DIABETIC MANAGEMENT
PREEXISTING METABOLIC DISORDERS AND DIABETES IN PLANNING OF PREGNANCY AND ITS MANAGEMENT
Consequences of Diabetes on the Fetus
First Trimester
Second Trimester
Third Trimester
NEONATAL COMPLICATIONS
Hypoglycemia
Hypocalcemia
Respiratory Distress Syndrome
Polycythemia
Hyperbilirubinemia
Macrosomia
CONSEQUENCES OF DIABETES ON THE PREGNANT MOTHER
SUMMARY
CHAPTER 25:
Continuous Glucose Monitoring and Its Role in Management of Diabetes
INTRODUCTION
WHAT IS CGMS?
CGMS (Continuous Glucose Monitoring System)
HOW CGMS IS PERFORMED?
WHERE TO INSERT SENSOR?
WHICH GLUCOSE IS MEASURED BY CGMS?
HOW CGMS SENSOR WORKS?
TYPES OF CGMS
Professional CGMS
Personal CGMS6
AVAILABLE OPTIONS IN INDIA
NEED OF SMPG DURING CGMS: CONCEPT OF CALIBRATION7,8
CLINICALLY USEFUL INFORMATION FROM CGMS
Personal CGMS
Professional CGMS
ROLE OF CGMS IN DIABETES THERAPEUTIC DECISION MAKING12,13
CGMS AS EDUCATION TOOL
CGMS DURING EMERGENCIES AND HOSPITALIZED PATIENTS19
CGMS TECHNOLOGY IN INDIA VERSUS DEVELOPED COUNTRIES
Future of CGMS
CHAPTER 26:
Management of Diabetes in Geriatric Population
INTRODUCTION
EPIDEMIOLOGY
ETIOPATHOGENESIS OF DIABETES IN OLDER ADULTS
CLINICAL PRESENTATION OF ELDERLY PATIENTS WITH DIABETES
DIAGNOSIS OF DIABETES IN THE ELDERLY
SCREENING FOR DIABETES
COMORBIDITY BURDEN
TREATMENT OF DIABETES IN OLDER ADULTS AND THE COMORBIDITIES
MANAGEMENT
Lifestyle Modification
Oral Antidiabetic Drugs (Oral Hypoglycemic Agents)
Biguanides (Metformin)
Sulfonylureas
Meglitinides (Repaglinide)
Glitazones (Thiazolidinediones)
Alpha-Glucosidase Inhibitors
Dipeptidyl Peptidase-4 Inhibitors (Gliptins)
GLP-1 Therapies
Pramlintide
Sodium-Glucose Transporters-2 Inhibitors
Insulin
Methods of Insulin Administration
Comprehensive Geriatric Screening for Vascular Complications17
Microvascular
Macrovascular/Cardiovascular Complications
Lipid Lowering in Older Diabetics
Blood Pressure Control in Elderly Diabetics
Aspirin use in Older Adults with Diabetes
Recommendations
SUMMARY
CHAPTER 27:
Diabetes Education as a Pillar of Prevention and Care
PRESENT STATUS OF DIABETES IN INDIA
ROLE OF DIABETES EDUCATION IN MANAGEMENT OF DIABETES
Barriers in Diabetes Management
Components of Diabetes Health Education
Education about the Disease Process
Lifestyle Modification13
Self-care Behavior
Self-monitoring of Blood Glucose
Skill Development
Compliance with Medications
Elimination of the Misconceptions
Essential Aspects of Diabetes Prevention Program Development7
Working Model for a Diabetes Education Program8
Sustaining the Advantage of the Diabetes Education
DIABETES EDUCATION IN INDIA: ESSENTIAL COMPONENTS
CONCLUSION
CHAPTER 28:
Future Research and Newer Advancement in Diabetes
INTRODUCTION
MORE HOPE FOR FUTURE ADVANCES
GENE RESEARCH TOOL IN TYPE 2 DIABETES
INNOVATIVE INSULIN PATCH-PEN
ARTIFICIAL PANCREATIC TISSUE FOR ISLET CELL TRANSPLANTS
IMPLANTABLE GLUCOSE SENSOR
GLUCOSE SENSING TATTOO TO MONITOR GLUCOSE
CELL REPRODUCTION BY IMPLANTED CELL POUCH
RESEARCH ON VACCINATIONS
ARTIFICIAL PANCREAS RESEARCH
NEWER ANTIDIABETIC DRUGS
Global Diabetes Drug Market
In the Pipeline
Newer Drugs
Facilitating Glucose Regulation
Controlling the Inflammation
Early Diabetes Breakthroughs
CONCLUSION
INDEX
TOC
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