better beings by building bridges - ahmedabad...

NOVEMBER - 2015 7Vol.10

Yoga ShibirNational Healing SeminarSeminar on Financial AwarenessMedico's Listeners' Club ProgrammeLadies Club ProgrammeIMA Young Doctors ConventionLadies Club Programme (Yogasan)MMACON - 2015

Yoga ShibirNational Healing SeminarSeminar on Financial AwarenessMedico's Listeners' Club ProgrammeLadies Club ProgrammeIMA Young Doctors ConventionLadies Club Programme (Yogasan)MMACON - 2015

01-12-2015 to 10-12-201506-12-201513-12-201513-12-201518-12-201520-12-201525-12-2015 & 26-12-201526-12-2015 & 27-12-2015

01-12-2015 to 10-12-201506-12-201513-12-201513-12-201518-12-201520-12-201525-12-2015 & 26-12-201526-12-2015 & 27-12-2015

Imm. Past President - DR. SMITABEN B. SHAH

BETTER BEINGS BY BUILDING BRIDGES

DR. ASHOK D. KANODIAHon. Secretary - AMA

DR. BRIJAN H. CHOKSIPresident - AMA

DR. ASHOK D. KANODIA,

HIGHLIGHTS

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A.M.A. BULLETIN INDEXContent Page No.

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Ahmedabad Medical AssociationAMA House, First Floor, Opp. H. K. College, Ashram Road, Ahd-009 Ph : (079) 26588775

Fax : 079-2658 74 98, e-mail : [email protected] website : www.ahmedabadmedicalassociation.com

AHMEDABAD MEDICO NEWS

PRESIDENT

DR. CHOKSI BRIJAN H.

C. : 2539 6568 M.: 9824265642

VICE PRESIDENTS

DR. SHETH PANKAJ KANTILAL

C. : 2764 3738 M.: 9824195362

DR. PATEL PARTH NAVINCHANDRA

C. : 2764 2001 M.: 9913363762

HON. FINANCE SEC.

DR. PANCHAL DIVYESHKUMAR N.

M.: 9714632100

MANAGING COMMITTEE MEMBERS

OTHER THAN P.G.P.G.

BULLETIN COMMITTEE

DR. BHOJAK ASHISH ASHOKBHAI

9909904571 GHATLODIA

DR. DESAI PARTH MAHENDRABHAI

9898797963 MEMNAGAR

DR. GAJJAR MAITREY DAMODARDAS

9723814598 SOLA ROAD

DR. KALYANI AMITKUMAR MOHANLAL

9898244366 SABARMATI

DR. MODI NIRAV VINODCHANDRA

9825887812 GURUKUL ROAD

DR. PATEL GAURANGKUMAR JAGDISHCHANDRA

9724319934 SOLA CIVIL

DR. PATEL JAYESH DINESHBHAI

9825037891 SHAHIBAUG

DR. PATEL MITESH KALIDAS

9426585877 SABARMATI

DR. PATEL SAUMIL BHIKHABHAI

9825606501 NARANPURA

DR. ROHIT PINAKIN PURUSHOTTAM


DR. SHAH PRATIK JASHWANTILAL

9825010972 SHAHPUR

DR. VAGHELA SHIVPALSINH DHARMENDRASINH


DR. DESAI GOPAL ARJUNBHAI

9925467838 SATELLITE

DR. MEHTA DHIREN RAMNIKLAL

9898854158 MANINAGAR

DR. MISTRY AMIT KALIDAS


DR. MODI ASHOK BABUBHAI

9825347657 NAVA VADAJ

DR. PANDYA SATISH MADHUSUDAN


DR. PATEL RAMESH ISHWARLAL

9426495264 PALDI

DR. PATEL VASANT B.

9428018840 ODHAV

DR. PATEL VISHNUBHAI N.

9825165294 GHATLODIA

DR. RAJGOR JAGDISH BHANABHAI


DR. SHAH JAYESH C.


DR. SHAH RAKESH NAVANITLAL


DR. VARMA KUNDAN KUBERDAS

9825689093 VEJALPUR

HON. SECRETARY

DR. KANODIA ASHOK D.

C. : 2545 3267 M.: 9428405746

HON. JT. SECRETARY

DR. SHAH MANISH G.

C. : 2532 8249 M.: 9099962094

DR. GANDHI ATUL J.

C. : 2660 4009 M.: 9824047636

HON. LIBRARY SECRETARY

DR. SACHDE JAYESH P.

M.: 9824018848

IMM. PAST PRESIDENT

DR. SHAH SMITABEN B.

C. : 2754 1859 M.: 9898219859

DR. K. R. SANGHAVIDR. BANKIM SHAHDR. PRANAV SHAH

DR. ASHUTOSH DAVEDR. PURVI BHAGATDR. ALPESH SHAH

DR. NEEL BHAVSARDR. SURESH K. ZAVERIDR. JITENDRA H. PARIKH

YEAR : 2015-2016

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From President's & Hon. Secretary's Desk

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27-8-2015

Dear Friends,

Just as these words ring true under all circumstances, we are

humble enough to accept the fact that we have just embarked on this

erstwhile journey and are taking fledgling steps to take this association

to newer heights.

Our aim is primarily to bridge the gap between the medical

fraternity and the common man and alleviate the misconceptions and

fear regarding the illnesses that have gripped the society in today's fast

paced world.

We are truly overwhelmed by the response of the members of

the association as well as of the society whenever we have extended a

helping hand to serve them to the best of our capacity.

Programmes like the on Swine flu and Dengue

was well attended and the orators made sure that the attendees were

properly briefed on the nitty gritty of the disease and its effects.

The diwali festival is a period of enjoyment, entertainment and

celebrations for one and all but with a few exceptions. Our salutations

to all doctors who took upon them the onus to respond to all

emergency calls during those days and really brought light into the

lives of those who received treatment.

CME update

In this day, when all doctors are hard pressed for time and are

always on the run responding to the call of duty day in and day out, it

becomes imperative for them to spare a few hours to enjoy their life

and spend a few fruitful and joyous moments with family and friends.

So AMA leaves no stone unturned to organize such programmes for the

doctors. No doubt such events are well received. The annual

celebrations and programmes were very

successful in their own right and the medical fraternity enjoyed

themselves to the hilt and let their hair down and grooved to the latest

beats in town. Both the events were a spectacle to behold.

Every year the is religiously held at AMA.

A lecture by Sadhu Vivekjivandas under the aegis of was the

highlight of this event. The event witnessed a considerable turnout.

This was the first time that such a lecture was initiated at AMA during

the pujan ceremony.

One important thing happened in last month was

call given by I.M.A. Headquater for 16 November in relation to many

demands you all know about it. We all as usual, shown solidarity for

that and we are thankful to all of you for your wholeheartly support for

that and expect same type of unity in future.

In the pipeline ahead are two programmes that will be of

immense help to all members. This includes the by st thprominent yoga gurus from the 1 December to the 10 December as

well as a spiritual lecture by for the thbenefit of the members on 6 December, 2015.

th thOn 27 & 28 December there is Annual Conference of

at New Delhi

Long Live AMA….

Jai AMA….

Navratri

Diwali get together

Dhanvantari Pujan

“G” speaks

"Satyagrah"

Yoga Shibir

Avdhoot Baba Shivanandji

IMA NATCON


"Coming together is a beginning. Keeping together is progress.

Working together is success."

- Henry Ford

DR. BRIJAN H. CHOKSIPRESIDENT

[email protected]

HON. SECRETARY

[email protected]

Dr. ASHOK D. KANODIA

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Ahmedabad Medical Association(Branch of Indian Medical Association)

in association with Shivyog Foundation, DelhiCordially invites you to

Program will be followed by Amrutasya Bhojanam- THE LUNCH -

For Registration Contact AMA Office (26588775) or 75729 05046

Registration is free. But for better management please Register

yourself at AMA office on or before 05, December. 12.00 p.m.

AMA OFFICIALS :

thDate : 06 December, 2015 SUNDAYTime : 09.00 a.m. to 12.30 p.m.Venue : R. M. Fozdar Hall, AMA Building,

B/h. Handloom House, Ashram Road, Ahmedabad.

Contact Us

Dr. BRIJAN H. CHOKSI, President98242 65642 [email protected]

Dr. ASHOK D. KANODIA, Hon. Secretary94284 05746 [email protected]

CO-ORDINATORS FOR PROGRAM

MR. JITENDRA AWASTHIDR. HETAL PANDYA

DR. DEENA SUTARIA 7572905046eMail : [email protected]

Ms. SANGITA MUKESH 9924684643ONLINE REGISTRATION www.webnx.in/ama

"Cure Is Possible" - National healing

Seminar

for Doctors : Revolutionary healing

science seminar presented by his

Holiness Avdhoot Baba Shivanandji

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Date : 13-12-2015, Sunday

9.45 am to 10.00 am Registration & Tea-Coffee

Time : 10:00 am to 12:30 pm

Venue : AMA Premises, Opp. H.K. College, Ahmedabad.

SEMINAR ON FINANCIAL AWARENESS

Registration Fee : Rs. 50/-

Please register on or before 11-12-2015, 05:00 PM

Speaker : Mr. Vinay Vaidya, Course Director : Ekkalavya

Academy of Wealth Creation.

Subject : Become an entrepreneur and create wealth

Speaker : Mrs. Komal Kanzaria, Reg. Head Guj. MCX

Subject : Awareness Programme on Commodity Market

Speaker : Mr. Ashwinbhai C. Shah, CA

Former Central Council Member ICAI

Subject : Post retirement financial Planning

Programme will be followed by L U N C H

You are requested to register your name at our

AMA office on Tel. No. : 079-26588775.

Co-Ordinators : Dr. Devendra Patel, Dr. Piyush Bhansali

PROGRAMME DETAILS

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AHMEDABAD MEDICAL ASSOCIATIONMEDICO'S LISTENERS' CLUB

(Festival songs of films)

Presentation : Dr. Gurudatt Thakkar

Anchor : Respected Dr. G.G. Oza

Concluding Remarks : Dr. Ashok Patel

Place : A.M.A. Hall

Date : 13-12-2015, Sunday Time : 5.00 p.m. onwards

Courtesy : Eris Life Sciences

Entry : For Registered Members only. (No spot entry)

AMA CULTURAL BOARD

[Kindly note the changes in timing and day of programme]

AMA SENIOR CITIZEN CLUB

Date : 13-12-2015, Sunday

Time : 10.00 am to 12.30 pm

Venue : AMA Premises, Opp. H.K. College, Ahmedabad.

Subject : Retirement Planning

All senior members of the club with their spouse are cordially

Invited to attend this very useful programme.

Please register at AMA office between 2.00 pm to 6.00 pm

This programme is arrange with Ahmedabad Medical Association.

CO-ORDINATORS

Dr. K. R. Sanghavi Dr. Abhay S. Dikshit Dr. Ramesh C. Shah

Dr. Brijan H. ChoksiPresident, AMA

Dr. Ashok D. KanodiaHon. Secretary, AMA

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Important Daysst 1 December World AIDS Dayrd 3 December International Handicapped Day

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AMA FAMILY BENEFIT SCHEME

OFFICE BEARERS & EXECUTIVE COMMITTEE MEMBERS

Dr. Mehul J. Shah

Chairman

Dr. Pragnesh M. Vachharajani

Hon. Secretary

Dr. K. C. Gadhavi

Vice Chairman

Dr. J. P. Darbar

Hon. Treasurer

Dr. Jitendra N. Patel

Hon. Jt. Secretary

Following are the Executive Committee Members

Dr. Monaben Desai

Dr. Rupande Patel

Dr. Alpa Gandhi

Dr. Pratik Shah

Dr. Mehul Shelat

Dr. Jignesh Shah

Dr. Kamlesh Saini

Dr. Dhiren Mehta

Dr. Vijay Bhavsar

Dr. Piyush Bhansali

YOGA SHIBIR

Late Dr. C. C. Raval - Divya Jivan Sangh

For Doctors and their Family Members

Date : 1-12-2015 to 10-12-2015

Time : 7.00 a.m. to 8.00 a.m.

Place : AMA Premises

# Registration fee Rs. 50/- per Person

# This Shibir will be Conducted by

Dr. Puspa P. Multani (Qualified Yoga Teacher)

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NEW LIFE MEMBERS

8662 LC DR. SHAH GEET M.

8663 LC DR. SHAH EKTA GEET

8664 L DR. SACHORA WASIMAHED M.

8665 L DR. THAKER ROHIT ANILBHAI

8666 LC DR. GAADHE RAVINDRA L.

8667 LC DR. GAADHE PARUL R.

8668 L DR. DOSHI BINAL HARESH

8669 L DR. SHAILENDRA KUMAR

8670 L DR. KUBAVAT ASHKA VISHWAS

8671 LC DR. PATEL RUTUL PRAVINBHAI

8672 LC DR. PATEL NIRMIKA RUTUL

8673 L DR. SOLANKI RAJENDRAKUMAR N.

8674 L DR. SHAH HARSH JAYANTKUMAR

8675 L DR. SHAH JAYUNKUMAR M.

8676 L DR. TALUJA AMITKUMAR HARBANSLAL

8677 L DR. SHAH KAIRAV SHIRISHKUMAR

8678 L DR. PATEL PIYUSH VALJIBHAI

8679 L DR. MEHTA RUCHA J.

8680 L DR. PARMAR SANDEEP MADHAVLAL

8681 L DR. KAPADIYA HARESH LAXMANBHAI

8682 L DR. JOSHI DEEP RAGESHBHAI

8683 L DR. SHAH ANKIT ANILBHAI

8684 LC DR. BANSAL MUDIT JITENDRA

8685 LC DR. BANSAL SUSHMA MUDIT

CONGRATULATION

TIRTH S/o. Dr. Pragnesh & Mayuri Vachharajani for winning

Bronze Medal in "Kata & Karate" @ International Shitoryu competition

@ Jaipur.

Dr. Amar Shah has been elected as Member of the National Academy

of Medical Sciences (India) in recognition of significant contribution

for the advancement of Medical Sciences. He has been awarded the

degree of MAMS for the same.

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ANNUAL CONFERENCE OFMANINAGAR MEDICAL ASSOCIATION MMACON – 2015

HighlightsHighlights

Kindly contact ..

Dr. Vipul shah9426533707

Dr. Urvesh Shah9228233441

Dr. Hiren Shah9824045683

Pre-conference session :Date & Time : 26th December, Saturday;

8.30 pm onwardsat Ahmedabad Medical Association Hall,Ashram Road.

Conference :thDate : 27 December, 2015 Sunday

Time : 8.30 am onwardsVenue : J.B. Auditorium,

Ahmedabad Management Association,Nr. Atira.

Coffee table book

We are planning to launch Coffee table book, which includes

> delegates' names/mobile no. & Email .

> super-specialist faculties names & contact no.

> Corporate hospitals contacts

All the doctors /Group of doctors/ hospitals are invited to give their advertisement in this ready recknor coffee table book.

Kindly forward your data on [email protected] with CDR file.

Draw your cheque on the name of “MMACON-2015”

Registration fees - IMA qualified Doctors – Rs. 800/-

*Last date of registration -15/12/2015

*Full page 4 colour - Rs. 4000/- per page.( A-5 size ).

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AHMEDABAD MEDICAL ASSOCIATION

SHARADOTSAVth

SUNDAY, 25 OCTOBER, 2015 at SINDUR PARTY PLOT

PRIZE WINNERS

UPTO 12 YEARS

FROM 13 to 25 YEARS

FROM 26 to 45 YEARS

45 YEARS ONWARDS

BEST TRADITIONAL DRESS

BEST PERFORMANCE COUPLE

MALE

FEMALE

MALE

FEMALE

MALE

FEMALE

MALE

FEMALE

MALE

FEMALE

TEJAL SHAHKEVAL SHAHKATHAN SALVIHELLY GOVANIVEDANGI TRIVEDIYASHVI SHAHDIRGH SHAHVISHWA PATELNAMRA PATELFORUM MEHTAANVI PARIKHDR. NILAMBHAI PATELDR. MAULIK KINARIWALAKRIMA SHAHDR. MITA PATELDR. ARVINDBHAI PANCHALDR. ANILBHAI SONIBINA PARIKHMITA SHAHPRIYANSH SHAHPRITAV SHAHDR. VYOMA SHAHNIMISHA PATELDR. JYOTI DESAIDR. BHARAT MAKWANAMRS. & DR. HARSHAD SHAH

We are thanks to our Judges : Dr. Geetaben Mehta and Ketki Rohit Modi

We are thanks to our sponsors

Punjab National BankUco BankBank of IndiaBank of MaharashtraRelief DevelopersTanishq Jewellery - C. G. RoadEmerald Honda

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AMA FAMILY BENEFIT SCHEME

FEE SCHEDULE :

Member's AGE AF.C. ADM Total

Up to 35

36 to 40

41 to 45

46 to 50

51 to 55

3000

3000

3000

3000

3000

3850

4400

5500

6600

7700

6850

7400

8500

9600

10700

I Eligibility of the members :

Any Life Member of A.M.A. and his/her spouse are eligible to become member of this

scheme,

Provided that :

(1) A member below the age of 55 years

(2) Life members of A.M.A. will be known as Member of the scheme and their Spouse

will be associate member of the scheme (The couple members will be considered

Members of the Scheme). Spouse cannot join alone.

II. Procedure For enrollment :

A. Member who want s to join the scheme has to apply in the prescribed application form

meant for the purpose along with necessary documents & scheduled fees.

B. Associate member who wants to join has to fill separate form, endorsed by his or her

spouse along with necessary documents & scheduled fees.

C. A member need to submit certified copy of (1) standard age proof (A) Driving

Licence, (B) School Leaving Certificate (C) Valid Passport (D) PAN Card (2) Life-

membership certificate of A.M.A. (3) Valid Photo I.D. (4) 2 Passport Size

Photographs along with application form.

In case of associate member: Additionally Marriage Certificate / Valid Passport /

Election Card is mandatory.

D. All eligible members mentioned above shall submit their application along with

admission fees as per age & AFC by D.D. or cheque in name of A.M.A., Family

Benefit Scheme, payable at Ahmedabad (no cash transaction).

E. Nominee : A member will have to give name of 2 nominees along with their

photograph and specimen signature.

III. Fee Schedule :

A. Any eligible member of A.M.A. willing to become member of this scheme can do so

on payment of admission fees as stated below

AFC : Advanced Fraternity Contribution

ADM : Admission Fee

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B. Admission fee is Non-refundable.

C. Advanced Fraternity Contribution (AFC) will remain as security deposit against the death fraternity contribution payable by the member.

IV Benefits to Members :

1. Fraternity Benefits : Rs. 500/ member in event of death of member.

2. Permanent Disability Benefit :

In case of an unfortunate event if a member becomes permanently disabled, can claim Rs. 500/ member as benefit amount, after that he will be retired from the scheme and no longer will avail any benefit.

N.B. : > The disability must not be there at the time of membership and in the next one year after membership.

> In case of claim / dispute the expert panel will decide the admissibility of claim. The decision of executive committee in such case will be final.

> The conditions covered under permanent disability are as per the list mentioned :

1. Loss of both eyes 2. Loss of both either upper limb or lower limb 3. Irrversible Coma 4. Irreversible Hemiplegia 5. Irreversible Paraplegia

3. Voluntary Retirement Benefit :

A. Any member who has completed 21 years in scheme or 70 years of age, which ever is later can withdraw a sum of rupees Rs. 350/member any time after that, then he ceases to be a member of scheme.

B. Any member who has completed 25 years in scheme or 75 years of age whichever is later can withdraw a sum of rupees Rs. 450/member and he ceased to be member of the scheme.

C. Any member who has completed 15 years in scheme or 80 years of age, which ever is later can withdraw a sum of rupees Rs. 150/member any time after that, then he ceases to be a member of scheme.

The Fraternity benefits will be available to members as follows.

Any member who has completed 1 year in scheme will be eligible to make claim in the event of Death or Permanent Disability.

N.B. : In case of Accidental Death no restrictions apply.

V. Claim Procedure :

1. In the event of death of a member the nominee will inform the same to the secretary A.M.A., F.B.S. and will make a claim by submitting prescribed claim forms available with the office with the necessary documents.

2. The claim amount will be paid to first nominee only. In case of death of the first nominee the claim amount will be paid to the second nominee (submission of death certificate of first nominee mandatory)

3. Computation of Fraternity contribution Payment : The fraternity contribution is calculated according the membership strength of the last day of the previous month in which the event has occurred.

Dear Member,

The Family Benefit Scheme is unique, one of its kind scheme launched

by Ahmedabad Medical Association for its Life Members & their spouse.

Scheme started operation from 1st, July 2013. As per the constitution, the

members can claim after completion of one year of membership.

At present, the membership strength of our scheme is 1835

HIGHLIGHTS of the SCHEME

(1) Life member of Ahmedabad Medical Association & their spouse below

55 years can become the member.

(2) Rs. 500/- per member will be disbursed to the nominee of the member

after the death of the member of scheme.

(3) Member of the scheme can Retire Voluntarily from the scheme after

15,21,25 years of the membership of the scheme.

Rs. 150/-, Rs. 350/- & Rs. 450/- respectively per member will be

disbursed to the member.

(4) It's a unique scheme of its kind. Please enroll with your spouse as early

as possible.

(5) For more details contact our office.

Dr. J. P. DarbarHon. Treasurer

Dr. Mehul J. ShahChairman

Dr. Pragnesh M. VachharajaniHon. Secretary

Dr. Brijan H. ChoksiPresident - AMA

Dr. Ashok D. KanodiaHon. Secretary - AMA

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DIABETES MELLITUSDIABETES MELLITUS1 INTRODUCTION

Diabetes mellitus is an important non communicable disease affects all individuals irrespective of age , sex, ethnicity , geographical area or socioeconomic status. It’s prevalence has remarkably increased in recent times and has reached to an epidemic proportion.

The tsunami of diabetes has altered the health budget of an individual in particular and society in general.

It affects the person with acute complications like DKA ( Diabetic Keto Acidosis) and chronic microvascular and macrovascular complication leading to death and disability.

2 DEFINITION AND PATHOPHYSIOLOGY

Diabetes is a metabolic disease characterized by Hyperglycemia (Increased blood sugar levels) which may result from increased insulin resistance or decreased insulin production or release which could result from B cell apoptosis or incretin deficiency.

Besides the eight pathophysiological mechanism described by D Alfrenzo there are four more mechanism leading to “Dirty Dozens”

They are (1) Catecholamines (2) Vitamin D (3) RAS System and (4) Testosterone

There is one more addition to this which is known “Treacherous Thirteen “ is Iron Deficiency.

In short many pathophysiological factors are responsible for hyperglycemia.

However the diabetic epidemic is because of genetic predisposition and life style changes. The genes which were dormant during famine has become expressive because of abundance of calories and available nutrition. Urbanization, maternal nutrition, small birth weight baby, maternal hyperglycemia are few more factors responsible for the same.

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OBITUARY

We send our sympathy & condolence to the bereaved family.

May his/her soul rest in eternal peace.

Dr. Naresh N. Shah

Date of Birth

Date of Death

: 10-5-1933

: 15-8-2015

DISCLAIMER

Opinions in the various articles are those of the authors and do not reflect the views of Ahmedabad Medical Association. The appearance of Advertisement is not a guarantee or endorsement of the product or the claims made for the product by the manufacturer.

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Urbanization has not only lead to change in diet composition and high calorie intake but has also become responsible for inactivity. We can presume that increased calorie intake coupled with inactivity are two important lifestyle changes working on genetic susceptible individuals to produce Type 2 Diabetes Mellitus.

CRITERIA FOR THE DIAGNOSIS OF DIABETES

A1C =6.5%.

(THE TEST SHOULD BE PERFORMED IN A LABORATORY USING A METHOD THAT IS NGSP CERTIFIED AND STANDARDIZED TO THE DCCT ASSAY.)*

OR

FPG =126 MG/DL (7.0 MMOL/L).

FASTING IS DEFINED AS NO CALORIC INTAKE FOR AT LEAST 8 H.*

OR

2-H PG =200 MG/DL (11.1 MMOL/L) DURING AN OGTT.

(THE TEST SHOULD BE PERFORMED AS DESCRIBED BY THE WHO, USING A GLUCOSE LOAD CONTAINING THE EQUIVALENT OF 75 G ANHYDROUS GLUCOSE DISSOLVED IN WATER.)*

OR

IN A PATIENT WITH CLASSIC SYMPTOMS OF HYPERGLYCEMIA OR HYPERGLYCEMIC CRISIS, A RANDOM PLASMA GLUCOSE =200 MG/DL (11.1 MMOL/L). *

(IN THE ABSENCE OF UNEQUIVOCAL HYPERGLYCEMIA, RESULTS SHOULD BE CONFIRMED BY REPEAT TESTING)

PREVALENCE

According to statistics from the International Diabetes Federation (IDF), India has more diabetics than any other nation of the world. Current estimates peg the number of diabetics in the country at about 62 million – an increase of over 10 million from 2011 when estimates suggested that about 50.8 million people in the country were suffering from the disease. If you think the disease has already reached endemic proportions in the country, consider this. By the year 2030, over 100 million people in India are likely to suffer from diabetes, say researchers.

CLASSIFICATION

Diabetes can be classified into the following general categories:

1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency)

2. Type 2 diabetes (due to a progressive insulin secretory defect on the

background of insulin resistance)

3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes)

4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation

Source ADA 2015

Criteria for testing for diabetes or prediabetes in asymptomatic adults

1. Testing should be considered in all adults who are overweight (BMI $25 kg/m2 or $23 kg/m2 in Asian Americans) and have additional risk factors:

2. physical inactivity

3. first-degree relative with diabetes c

4. high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) c

5. Women who delivered a baby weighing .9 lb or were diagnosed with GDM c

6. Hypertension ($140/90 mmHg or on therapy for hypertension) c

7. HDL cholesterol level ,35 mg/dL (0.90 mmol/L) and/or a triglyceride level. 250 mg/dL (2.82 mmol/L)

8. Women with polycystic ovary syndrome c A1C $5.7%, IGT, or IFG on previous testing

9. Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)

10. history of CVD

2. For all patients, particularly those who are overweight or obese, testing should begin at age 45 years.

3. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.

Type 2 diabetes is far most common prevalent variety of diabetes and almost 90 % all diabetes cases are type 2only.

Symptoms

Persons suffering from type 2 diabetes are often asymptomatic and abnormal blood sugar is a chance finding. Many a time’sdiabetes is detected during routine health checkup or during preoperative examination or work up during insurance examination.

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Type 1 patient’s symptoms are florid and characterized by polyuria, polydipsia and weight loss. A sizable no of patients with type 1 present as Diabetic Ketoacidosis.

A slight polyuria or nocturia , leg cramps , change in spectacle power and itching around genitalia , vulvovaginitis in females and balanoprostitis in males are often clinch the diagnosis in type 2 Diabetes.

Clinical Examination

The clinicalexamination is unremarkable in persons suffering from Diabetes Mellitus. Hence diabetes cannot be diagnosed with only clinical examination.

Hyperglycemia and Complications

Acute and chronic hyperglycemia are detrimental in a variety ways. Acute hyperglycemia if not treated in time may lead to acute metabolic complications like Diabetic ketoacidosis and hyperosmolar states and coma.

Acute decrease in blood sugar (Hypoglycemia) can also result in coma, seizures, myocardial infarction, arrhythmia etc. and may result in death also. Besides overzealous treatment, poorcompliance, cognitive dysfunction, onset of CKD and onset of CLD and various other causes can be responsible for hypoglycemia.

Chronic hyperglycemia can result in many complications which are predominantly microvascular but can also contribute to macrovascular complications. Endothelial dysfunction, increased AGE increased ROS and micro ischemia are few pathological factors for its development.

Complications of diabetes mellitus

Acute

Diabetic ketoacidosis, Hyperosmolar coma, Hypoglycemic

Chronic

MacrovascularCoronary Artery Disease and IHD, Carotid Artery Disease and Stroke,

Peripheral Vascular Disease

MicrovascularRetinopathy, Nephropathy, Neuropathy,

Miscellaneous

Infection like emphysematous cholecystitis, Pyelonephritis, mucormycosis and Malignant, Otitis externa etc, Recurrent abortions, Premature cataract, Diabetic foot and Amputation, Erectile Dysfunction

Management of Diabetes

Life style changes, Oral antidiabetic agents, Injectables, Insulin, GLP 1RA, Pramilinitide

The Glycemic Control

Life style modification including decrease calorie intake and decreased CHO consumption coupled with increased calorie expenditure with aerobic and muscle strengthening exercise.

Once lifestyle fails to control hyperglycemia then pharmacotherapy comes in to action. The detail of pharmacotherapy is out of scope in this article, however the AACE guideline has beautifully described the availabledrugs in the following algorithm, which itself is self-explanatory.

Glycemic control is an important part of diabetes management, however it is not the sole management. Besides the lifestyle modification and glycemic control, the blood pressure management and lipid management are also important part of management.

The glycemic goals are advised by different organizations which are mentioned in the above slide.

Modern Management of D M

Early diagnosis, Good Glycemic Control, Glycemic monitoring, Target organ damage and monitoring, C V Risk Modification, Prevention and care of foot (to prevent amputation), Prevention of diabetes and education of general population

Patient centric approach

Although good glycemic control is useful and DCCT and UKPDS are trials are the great supportive evidence for the same.

The recent trials like Accord, Advance and Vadt have on the contrary demonstrated contrary to the above mentioned trials.

Hence the goals should be according the patient’s profile.

Use of Insulin

There are various guidelines for use of insulin in D M Type 2.

The indications of insulin therapy in Diabetes Mellitus Type 2 is beyond this article !

Currently available OAD

In recent times we have seen the emergence of various oral antidiabetic agents and newer insulin analogues.

The profiles of various antidiabetic are as follows.

To win the war against Diabetes we should have

1. Healthy Life Style 2. Early diagnosis 3. Good Glycemic Control 4. Target Organ

Monitoring and early institution of preventive changes 5. C V Risk modification

6. Diabetes Foot Care 7. Education for All in General and for Patients in particular

8. Preventive Strategies for Diabetes

Dr. Navin ShahMD

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