Infections in Diabetes - ECAB
Infections in Diabetes - ECAB

Author: Samar Banerjee

Publisher: Elsevier Health Sciences

Published: 2012-07-05

Total Pages: 110

ISBN-13: 8131232069

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Patients with diabetes are predisposed to infections. The risk ratio for infectious disease-related hospitalization for diabetic versus nondiabetic persons is more than 2, and almost 2 for death attributable to infection. Infections in diabetes may precipitate metabolic derangements and, conversely, the metabolic derangements of diabetes may facilitate infection. Abnormalities in the microvascular circulation of individuals with diabetes may result in decreased tissue perfusion, which facilitates the acquisition of infection and impairs response to therapy. The incidence of TB among diabetic patients is 2–5 times higher when compared to the general population, which recently has raised the concern that a combination of DM and HIV infection might lead to a further increased incidence of TB in India and in other developing nations. However, it is unclear whether diabetes is an independent risk for common upper and lower respiratory tract infections. Urinary tract is also reported to be the most prevalent site of infection in patients with diabetes. These infections are known to account for a relatively smaller percentage of reported patients probably due to the fact that most patients, including diabetics, with urinary tract infection are treated as outpatients. A number of long-term effects of diabetes mellitus on the genitourinary system predispose diabetic patients to bacterial urinary tract infections. In addition, complications of urinary tract infection (e.g., bacteremia, renal abscesses, and renal papillary necrosis) are more common in patients with than without diabetes. Rhinocerebral mucormycosis and emphysematous pyelonephritis are some of the less commonly reported conditions seen in diabetics though being important pathologies. The primary goal of this book is to provide a high-quality, evidence-based text on the various aspects of the associations of various infections in diabetics with prime focus on TB and diabetes, rare conditions such as rhinocerebral mucormycosis and emphysematous pyelonephritis and also the various acute infections commonly reported in the condition. The book includes in-depth analysis of the diagnostic and management issues considering the same.

Diabetic Kidney Disease - ECAB
Diabetic Kidney Disease - ECAB

Author: K V Dakshinamurty

Publisher: Elsevier Health Sciences

Published: 2013-07-22

Total Pages: 223

ISBN-13: 8131232026

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The prevalence of Diabetes Mellitus is increasing rapidly all over the world and more so in the developing countries. The global burden of diabetes is expected to double between 2000 and 2030, with the greatest increases in prevalence occurring in the Middle East, sub-Saharan Africa and India. Moreover, the development of type 2 diabetes during the childbearing years is also likely to increase, primarily in the developing countries. It has already been established that Diabetes is the most common primary cause leading to end stage renal disease (ESRD) and Diabetic Nephropathy is the leading cause of chronic kidney disease (CKD) in India. The cornerstones of management of Diabetic Kidney Diseases include early diagnosis of diabetic nephropathy, prevention of its progression and treatment of the co-morbid conditions. Substantial under-diagnosis of both diabetes and chronic kidney disease leads to lost opportunities for prevention. An inadequate or inappropriate care of patients with diabetic kidney disease contributes to disease progression eventually up to a stage that requires renal replacement therapy, which is not a feasible option for many on a long-term basis, especially in a developing country like ours. This book covers various aspects of diabetic kidney disease in detail and attempts to familiarize the reader with the existing aspects of the conditions as well as touch upon the new advances in the field. The first chapter outlines the extent to which the condition affects the population globally as well as in our country. The second chapter explores the underlying mechanism by which the disease starts and progresses and the pathological markers of the same. The third chapter delineates the clinical and diagnostic markers of the condition. The fourth and fifth chapters speak of the non-diabetic glomerular and non-glomerular diseases in diabetics. The sixth chapter addresses the most important and desirable goal of preventing the progression and ideally the onset of the disease. The seventh chapter puts together the various treatment modalities available and the subsequent chapter explores the management options for cases requiring renal replacement. In addition to the emphasis to Indian literature at the end of each chapter, the ninth chapter is specially included to highlight the salient aspects of this condition from the Indian perspective. This book will be beneficial not only for the nephrologists, but also for the epidemiologists, medical students, diabetologists and every doctor who deals with diabetes mellitus.

Glycemic Monitoring - ECAB
Glycemic Monitoring - ECAB

Author: Rangasamy V. Jayakumar

Publisher: Elsevier Health Sciences

Published: 2009-03-15

Total Pages: 96

ISBN-13: 8131232115

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Diabetes is a chronic disease that is reaching an epidemic proportion in many parts of the world. Despite the high incidence of diabetes, individuals diagnosed with the disorder are only 50%. The main challenge of medical professionals in diagnosing and treating the diabetic patients is the lack of understanding of the disease, which usually leads to problems with treatment compliance and monitoring. There is strong evidence to show that an effective intensive glycemic control reduces various microvascular and neuropathic complications of diabetes mellitus. The Diabetes Control and Complications Trial (DCCT) showed that the intensive glycemic control prevented diabetic complications in type 1 diabetic patients, and the HbA1c levels reduced by 1.5–2.0%. In the UKPDS study, a modest improvement in HbA1c (a difference of 0.9 %) in the intensively treated group than in the control group brought about a 25% reduction in microvascular complications and a 12% reduction in all diabetes related events. There are several methods with differing utilities and limitations existing for monitoring glycemic status in individuals. Diabetes care in India leaves much to be desired and suggested, and there is a need for efforts to increase awareness of both the patients and the doctors for better treatment and monitoring.

Dietary Considerations in Diabetes - ECAB
Dietary Considerations in Diabetes - ECAB

Author: Anoop Misra

Publisher: Elsevier Health Sciences

Published: 2012-07-05

Total Pages: 111

ISBN-13: 8131232093

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Diet plays an important role in the treatment of diabetes, alone or in combination with insulin or oral hypoglycemic drugs. The diabetic nutrition plan of an individual necessitates to be based upon, excepting the usual parameters, his/her socioeconomic status, ethnicity/religion, and local food habits. It is important that diet plan is individualized and also region based. Since there are a number of artificial sweeteners available now, it is necessary that physicians should take in account scientific data while prescribing any artificial sweetener. This issue in the ECAB Update Series: Diabetology reviews these issues in accordance with the Indian Dietary habits and available evidence to support the clinical decisions.

Oral Hypoglycemic Agents - ECAB
Oral Hypoglycemic Agents - ECAB

Author: Abdul Hamid Zargar

Publisher: Elsevier Health Sciences

Published: 2009-09-25

Total Pages: 111

ISBN-13: 8131232166

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Even though we have many advances in the development of oral hypoglycemic agents, an ideal drug for treating type 2 diabetes is still a distant reality. Today, physicians can choose from a variety of medications targeting numerous facets of disease, but each drug class poses some limitations. The age-old molecules, such as sulfonylureas and biguanides, are still valued because of their well-studied mode of action, safety, tolerability, and predictable pharmacodynamic effects. This book attempts to describe the historical aspects and advances in the arena of oral hypoglycemic agents, extended- and sustained-release formulations of glipizide and metformin (both of which have great promise in the treatment of type 2 diabetes mellitus) as well as evaluates the role of the group in diabetic foot infections.

Insulins in Diabetes - ECAB
Insulins in Diabetes - ECAB

Author: Rangasamy V. Jayakumar

Publisher: Elsevier Health Sciences

Published: 2012-07-05

Total Pages: 122

ISBN-13: 8131232077

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Decision making in instituting insulin therapy is an important aspect of diabetes management. The appropriate insulin regimen for an individual patient should take into account the patient’s lifestyle, age, motivation, general health, self-management skills, and treatment goals. In addition, a discussion of the newer insulins versus older insulin is a much desired topic in the Indian context. Another area of interest is the insulin delivery mechanism in the intensive care units in hospital settings. This CME module is designed to address such questions with supportive typical clinical scenarios, with which all readers will be able to identify. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Lipids in Diabetes - ECAB
Lipids in Diabetes - ECAB

Author: S V Madhu

Publisher: Elsevier Health Sciences

Published: 2013-07-23

Total Pages: 134

ISBN-13: 8131232131

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Type 2 diabetes mellitus is associated with a greater risk of developing atherosclerotic macrovascular diseases like myocardial infarction, stroke, and peripheral vascular disease. There is 2- to 4-fold increased risk of atherosclerotic heart disease and stroke in diabetic patients compared to non-diabetic patients. As the prevalence of type 2 diabetes is increasing rapidly, this diabetes related atherosclerotic disease is predicted to be a major public health problem. Atherosclerosis is a complex process and in diabetic patients, it behaves differently with increased lesion progression and severity. This accelerated atherosclerotic process in diabetics is explained on the basis of several risk factors like hyperglycemia, dyslipidemia, accelerated formation of advanced glycation end products, increased oxidative stress, and genetic factors. It is difficult to establish precisely the elements responsible for this atherosclerosis in diabetics, but by epidemiological, clinical, and by animal studies, it has been possible to get an idea of this problem in diabetics. Of the several risk factors for atherosclerosis in diabetes, dyslipidemia is the leading one, and an insight into the pathophysiologic relation of isolated triglyceridemia in Indian diabetics with the identification of the targets for control of lipids in diabetes (practical vs. ideal) needs to be well understood by the treating physician. This book is designed to address such issues with supportive typical clinical scenarios, with which the readers will be able to identify. Thus, it provides an excellent opportunity to widen one’s perspective in this area.

Unconventional Organ Damage in Diabetes - ECAB
Unconventional Organ Damage in Diabetes - ECAB

Author: Samar Banerjee

Publisher: Elsevier Health Sciences

Published: 2012-09-14

Total Pages: 112

ISBN-13: 813123214X

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Cell health depends on a steady supply of fuel from glucose and free fatty acids. Both these major fuels are regulated by insulin. Cells in the muscle, liver, and fat need insulin to receive glucose, and hence do not become exposed to high blood glucose levels when the blood sugars are high and insulin levels are low. The lack of insulin slows the movement of glucose into these cells, and probably spares them from damage when blood sugars are high. However, other cells such as those in the brain, nervous system, heart, blood vessels and kidneys pick up glucose directly from the blood without using insulin. These cells, except the brain, are more prone to damage from high blood sugars because they become exposed to high internal levels of glucose. This to quite an extent explains why damage tends to occur in specific organs such as in nerve and kidney cells, and in small blood vessels like those in the eyes. This project on the organ damage in diabetes is an attempt to elaborate on the various factors to be considered in managing these patients, the pointers for early diagnosis and prevention of the same.

Diabetic Foot - ECAB
Diabetic Foot - ECAB

Author: Arun Bal

Publisher: Elsevier Health Sciences

Published: 2012-07-05

Total Pages: 146

ISBN-13: 8131232085

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Of all lower extremity amputations, 40–70% are related to diabetes. In most studies, the incidence of lower leg amputation is estimated to be 5–25/100,000 inhabitants/year: among people with diabetes the number is 6–8/1,000. Lower extremity amputations are usually preceded by a foot ulcer in people with diabetes. The most important factors related to the development of these ulcers are peripheral neuropathy, foot deformities, minor foot trauma, and peripheral vascular disease. The spectrum of foot lesions varies in different regions of the world due to differences in socioeconomic conditions, standards of foot care and quality of footwear. This clinical update is designed to address this condition in a comprehensive way to help the reader take important questions while managing the patient with supportive typical clinical scenarios, with which all readers will be able to identify. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Microvascular Complications of Diabetes - ECAB
Microvascular Complications of Diabetes - ECAB

Author: V Seshiah

Publisher: Elsevier Health Sciences

Published: 2009-09-15

Total Pages: 146

ISBN-13: 8131232123

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The pathogenesis of microvascular complications is complex and multifactorial. Yet, hyperglycemia emerges as the most important single cause, which has been proved by the Diabetes Control and Complications Trial (DCCT). Thus, the importance of protecting the body from hyperglycemia cannot be overstated; the direct and indirect effects on the human vascular tree are the major source of morbidity and mortality in both type 1 and type 2 diabetes. Generally, the injurious effects of hyperglycemia are separated into macrovascular complications (coronary artery disease, peripheral arterial disease, and stroke) and microvascular complications (diabetic nephropathy, neuropathy, and retinopathy). It is important for physicians to understand the relationship between diabetes and vascular disease because the prevalence of diabetes continues to increase in our country, and the clinical requirements for primary and secondary prevention of these complications are also expanding.