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This book is the latest volume in the World Clinics Diabetology series, focusing on complications associated with diabetes. Divided into 13 sections, the first chapters discuss complications in different organs and body systems, including the musculoskeletal system, liver, skin, lungs, ear, nose and throat, and more. The following sections cover stroke and diabetes, screening for diabetic retinopathy, errors in insulin treatment, routine investigations for complications, and diabetic kidney injury. The comprehensive text is enhanced by more than 160 images and illustrations, and each article is followed by a comment from the editors highlighting the key points of the topic. Key points Latest volume in World Clinics Diabetology series Covers complications associated with diabetes in various organs and body systems Each article concludes with a comment from the editors highlighting key points Highly illustrated with clinical photographs and figures

Diabetes is a disease that occurs when the pancreas does not produce enough insulin to control the amount of glucose in the blood. This book is a comprehensive guide to the latest advances in the diagnosis and treatment of diabetes. Divided into six sections, the manual begins with an overview of diagnosis and classification, followed by discussion on epidemiology and aetiopathogenesis. Section four covers comorbidities and complications of diabetes including hyper- and hypoglycaemia, heart failure, foot ulcers, and diabetic retinopathy. The final sections examine recent advances and technologies. The detailed text is further enhanced by clinical photographs, diagrams and tables to assist learning. Key points Comprehensive guide to latest advances in diagnosis and management of diabetes Discusses diagnosis and classification, epidemiology and aetiopathogenesis Covers many different comorbidities and complications Highly illustrated with clinical photographs, diagrams and tables

Diabetes Clinical Case Series – 2 is the second volume in a three-volume series on diabetes. The book provides a selection of cases reflecting the types of diabetes, related conditions and potential complications in different segments of the population. Divided into 20 chapters, the book features a range of topics, including stress-related diabetes, gestational diabetes, diabetes with renal problems, Cushing’s Syndrome and diabetes, Charcot Foot and Ankle, diabetic retinopathy, Werner Syndrome, and much more. Each chapter begins with a real-life case scenario, followed by guidance on its management, combining evidence-based medicine with the authors’ clinical experience, to provide an authoritative guide for endocrinologists. Key Points Second of three volumes in Diabetes Clinical Case Series 20 chapters featuring real cases and guidance on management diabetes in different segments of the population Authoritative guide combining evidence-based medicine and clinical experience Diabetes Clinical Case Series – 1 (9789352500321) published in 2016

Background: Children with type 1 diabetes (T1D) need to take insulin injections several times a day on a lifelong basis, for survival and to maintain good health. Unfortunately, due to financial, social and other reasons, many fail to achieve good control and thereby develop complications and unfortunately some die a premature death.The main aim of the T1DI initiative, which is supported by the Hinduja Foundation, Mumbai, India is to improve the lives of children with type 1 diabetes.Aims ::uf076tTo establish a type 1 diabetes (T1D) registry including data from the Madras Diabetes Research Foundation (MDRF), Chennai, King Edward Memorial Hospital and Research Centre (KEM), Pune and the P.D. Hinduja Hospital & Medical Research Centre (PD HINDUJA), Mumbai.uf076tTo follow up these patients over the next 5 to 10 years to improve their diabetes control and thereby their general health, including quality of life.uf076tTo study the prevalence of complications of T1D eg; retinopathy (eye), nephropathy (kidney), neuropathy (nerve) and macrovascular disease.uf076tTo contact the u201clost to follow upu201d patients through telephone calls, emails and if possible, house visits and thereby determine their current health status.uf076tTo estimate the mortality rates and causes of death among patients with T1D in those who have died.uf076tTo establish peer and family support groups for patients suffering from T1D and their families, to ensure their physical, emotional and psychological well-being. Methods: The initiative is undertaken by 3 centres, MDRF, Chennai, KEM, Pune and PD HINDUJA, Mumbai. A total of at least 500 patients with T1D would be enrolled. We will provide free or subsidized treatment and other support to those who cannot afford treatment or have other social challenges. We hope to promote a better follow up of the T1D patients, and bring back those who have dropped out. Data on glycated haemoglobin, lipids, retinopathy, neuropathy, nephropathy status, ECG and other measures of macrovascular disease will be collected. Mortality rates and causes of death will be analysed. Control of diabetes will be improved in all.Expected outcomes: This initiative will provide the much needed financial, social and medical support for many children with T1D. It will also provide data on the health care status, prevalence of diabetes complications, survival and mortality rates and causes of death in children with T1D across 3 major diabetes centres in India. Most importantly, we hope to improve their health status and quality of life.AcknowledgementThe study is funded by Hinduja Foundation, Mumbai.

Background: Type 1 Diabetes (T1D) is one of the most common endocrine and metabolic conditions in childhood. T1D is becoming more common in India and learning to manage T1D involves a lifelong learning process. Sharing experiences is a powerful way of learning how to manage diabetes. Meeting other people with T1D can help reduce the isolation and be a source of support when needed. At Dr. Mohanu2019s Diabetes Specialities Centre, Chennai, India, a support group for children with T1D and their family members called u201cFriends Foreveru201d was started in the year 2002 with the aim of providing social and medical support to these children with T1D.Objectives: To assess the initial response of a WhatsApp group formed among the Friends Forever T1D peers. Methods: The Friends Forever support group meet regularly every month. Among them, 100 T1D created a WhatsApp group called u201cWe are No.1u201d. The group admins included a nutritionist, a diabetes educator and a psychologist. Results: u201cWe are No.1u201d group helped children with T1D to bond better with each other. This improved their psychological, social and emotional wellbeing. This group helped them to support each other thereby improved their quality of life. Interacting with each other brought about a more positive attitude towards life. The older T1D children supported the younger ones and thereby they became u2018motivatorsu2019 in the group. Tips for effectively managing the day to day life challenges like insulin techniques, adjustment of dosage according to their food intake, adjustments during travel, exams, while attending parties, exercise and sports activity were topics discussed in the group. Latest updates on diet, healthy recipes, advanced insulin delivery systems and newer self monitoring devices, were also posted in the group. Conclusion: A WhatsApp support group helped children with T1D to improve their self confidence and quality of life.

BackgroundDespite the introduction of novel treatment strategies, diabetic microvascular complications remain a major cause of morbidity and mortality in individuals with diabetes. Though many traditional risk factors have been identified in individuals with older onset diabetes, the relationship between different diabetic microvascular complications in youth onset diabetes has not been clearly described.AimThe aim of the present study was to determine whether the presence of one microvascular complication (diabetic retinopathy, diabetic nephropathy, or diabetic neuropathy) would predict the risk for the development of another microvascular complication among individuals with youth onset, type 1 and type 2 diabetesMethodThe study was conducted among a sub population of individuals with youth onset type 1 and type 2 diabetes, enrolled under the Indian Council of Medical Research - Registry of people with diabetes in India with young age at the onset (ICMR - YDR) from the Chennai and New Delhi centres. We obtained prospective data of 799 type 1 and 371 youth onset type 2 diabetes individuals from the registry database (baseline data of these individuals were collected between 1stJanuary 2001 and 31st December 2012 and their follow up data collected till 31st December 2014 were used for analysis). For assessing diabetic retinopathy, a dilated fundus examination with direct ophthalmoscope, by an experienced ophthalmologist, was done. Diabetic nephropathy was diagnosed, if 24 hour urine protein excretion was greater than 500mg or urine albumin excretion was greater than 300mg. Diabetic neuropathy status was assessed by clinical examination and the monofilament test. Demographic and clinical characteristics of the study population were assessed using standardized baseline and follow up proformae. The anthropometric and biochemical tests were measured using standard methods. Separate multivariable cox regression models were used to evaluate the relationship between the microvascular complications in type 1 and type 2 diabetes, after adjusting for age, gender, duration of diabetes, hypertension, obesity and glycemic control. Any microvascular complication was defined as the presence of nephropathy and neuropathy in the case of retinopathy and likewise for the other two complications.ResultsIn type 1 diabetes, the presence of any microvascular complication at baseline was an independent predictor of incident diabetic retinopathy [adjusted hazard ratio (95% C.I) - 2.5 (1.1, 6.3)] and nephropathy [adjusted hazard ratio (95% C.I) -4.1 (1.5, 11.9)]. In youth onset type 2 diabetes, those who had a history of any microvascular complication at baseline, were at 3.8 times higher risk of developing diabetic neuropathy at follow up [adjusted hazard ratio (95% C.I) - 3.8 (1.8, 8.2)] and 3.3 times higher risk of developing nephropathy [adjusted hazard ratio (95% C.I) - 3.3 (1.2, 9.1)]. These were independent of other covariates such as duration of diabetes and hypertension.DiscussionOur data suggests that the presence of a pre-existing microvascular complication is associated with the development of another in individuals with both youth onset type 1 and type 2 diabetes. Additional research on the timing and progression rate of the diabetes related complications, relative to one another, is required to further refine the risks posed to each individual. The findings of current study, emphasize the need for screening for other microvascular complications when an individual with youth onset diabetes has been diagnosed with one complication. Such individuals should also be managed aggressively to prevent or delay the onset of other complications.