December 13   2015, Sunday
emedinexus emedinexus

Dr KK AggarwalDr KK Aggarwal SPRINT Trial on goal blood pressure

In patients 50 years or older with systolic blood pressure 130 to 180 mmHg and an additional risk factor for cardiovascular disease (other than diabetes, proteinuric chronic kidney disease, or stroke) keep a goal systolic blood pressure of 125 to 130 mmHg if standard manual (auscultatory) measurements are used, or a systolic pressure of 120 to 125 mmHg if automated oscillometric blood pressure measurements are used, rather than higher values.

Goal blood pressure in most hypertensive patients had been <140/90 mmHg, or <150/90 mmHg in older adults.

Breaking News

First emergency antidote to 5-FU Chemo

The US FDA has approved a first-of-its-kind therapy, an antidote to certain types of chemotherapy. Uridine triacetate is approved for the emergency treatment of adults and children who have received an unintended overdose of 5-fluorouracil (5-FU) or capecitabine (Xeloda), an oral prodrug that is converted to 5–FU in the body. The product is also intended for emergency use in patients who develop certain severe or life–threatening toxicities within 4 days of receiving these chemotherapies… (Medscape)

A new global framework to eliminate rabies

The WHO along with the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and the Global Alliance for the Control of Rabies (GARC) has launched a new framework to eliminate human rabies. The framework calls for 3 key actions: making human vaccines and antibodies affordable, ensuring people who get bitten receive prompt treatment and mass dog vaccinations to tackle the disease at its source… (WHO)
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Specialty Updates
• More research is suggesting a possible relationship between cancer itself and the development of CHD. In a new study of participants with normal ejection fraction (LVEF >55%), myocardial dysfunction, as shown with reduced strain measurements, was similar between patients with cancer who did and did not take cancer drug therapies. The findings were presented at the European Society of Cardiology's EuroEcho-Imaging 2015 meeting.

• New research has found a link between moderate alcohol intake - consuming 2-3 units a day - and reduced risk of death in patients with early-stage dementia or Alzheimer's disease. The findings are published online in BMJ Open.

• Skin lesions are a common adverse event associated with the use of antitumor necrosis factor (TNF) antibodies to treat inflammatory bowel disease (IBD), but most patients can continue using the drug with a dermatologist managing the skin symptoms, suggested a study published online December 8 in the Annals of Internal Medicine.

• Targeting bone in patients with breast cancer appears to have life-preserving, not just bone-preserving, benefits, suggested the results from a study on the monoclonal antibody denosumab, presented at the San Antonio Breast Cancer Symposium (SABCS) 2015.

• Significant muscle and bone atrophy occur in the first three years after facial transplantation, leading to an appearance transformation that resembles accelerated aging, suggested a new report published online in the American Journal of Transplantation.

• A new study, published in the Journal of Sports Sciences, revealed that as little as nine days of intense training can cause significant and progressive decline in sleep quality. They also noticed that the athletes' moods and capacity for exercise both worsened over the period of observation.

• Children with moderate-to-severe ulcerative colitis refractory to standard therapy responded successfully to treatment with golimumab, reported a multicenter open-label study presented at the 2015 Advances in Inflammatory Bowel Diseases meeting.

• A diabetes prevention program administered within an integrated health care system was effective in helping women with a history of gestational diabetes reach weight loss goals and increase physical activity following the birth of their children, reported a new Kaiser Permanente study published online in the journal Diabetes Care.
Why do we put on Tilak on the forehead?

The Tilak is a mark of auspiciousness and invokes a feeling of respect in the wearer and others. It is recognized as a religious mark. Its form and color vary according to one’s caste, religious sect or the form of worship of the person in question. Tilak is applied on the forehead with sandal paste, sacred ash or kumkum, a red turmeric powder. In a wedding, a Kumkum tilak is applied on the forehead of both the bride and groom.

In earlier times, the four castes (based on varna or color) – Brahmana, Kshatriya, Vaishya and Shudra – applied marks differently. The Brahmin applied a white chandan mark signifying purity, as his profession was of a priestly or academic nature. The Kshatriya applied a red kumkum mark signifying valor as he belonged to the warrior race. The Vaishya wore a yellow kesar or turmeric mark signifying prosperity as he was a businessman or trader devoted to creation of wealth. The Shudra applied a black bhasma, kasturi or charcoal mark signifying service as he supported the work of the other three castes.

The devotees of Shiva apply sacred ash (Bhasma) on the forehead as a Tripundra (three parallel horizontal lines); the devotees of Vishnu apply sandal paste (Chandan) in the shape of "U" and the worshippers of Devi or Shakti apply Kumkum. The tilak is applied in the spot between the eyebrows, which is the seat of memory and thought. It is known as the Aajna Chakra in the language of Yoga. The Tilak is applied with the prayer – "May I remember the Lord. May this pious feeling pervade all my activities. May I be righteous in my deeds." Even when we temporarily forget this prayerful attitude, the mark on another reminds us of our resolve. The tilak is thus a blessing of the Lord and a protection against wrong tendencies and forces. The entire body emanates energy in the form of electromagnetic waves – the forehead and the spot between the eyebrows especially so. That is why worry generates heat and causes a headache. The tilak cools the forehead, protects the wearer and prevents energy loss. Sometimes the entire forehead is covered with chandan or bhasma.

Using plastic reusable "stick bindis" is not very beneficial, even though it serves the purpose of decoration.
Tips and tricks of olecranon TBW and plating

Dr Alok Aggarwal

• Olecranon fractures are common fractures.
• Some people call it the beginner’s fractures as it is considered simple.
• TBW principles is not viable in olecranon fractures.
• One should have the whole range of implant and instruments to mold the olecranon LCP to bone.

Tips and Tricks with Pearls and Pitfalls: Fixation of Malleolar Fractures–Ankle

Dr Navin Thakkar, Ahmedabad

• Fixation sequence for restoration of fibular length: Medial exploration /Fixation, post malleolar fixation, assessment of mortise stability, syndesmotic fixation.
• But this is not hard & fast! Achieving fibular length & syndesmotic stability are the most important!!
• If fibula is comminuted, then medial side may be reduced first!
• Ankle fracture injury is bad soft tissue injury with a fracture.
• Soft tissue gives you more trouble, not that much a fracture alone
• Timing is important. Poor timing → poor outcome
• Ask the radiologist for soft tissue window in CT scan; understand soft tissue interposition.

Pitfall: We see only fracture on static x–rays and miss instability.
Pearl: Think – Dynamic Stability– Unseen Plane –Third Plane
Tip: Always check for Instability
The Year in Medicine 2015: News That Made a Difference
ICD–10 Transition

The ICD–10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) created by the World Health Organization (WHO) replaced the last set of codes ICD–9 in October 1 this year. The ICD–10 transition did not turn out to be the disaster that everyone anticipated. Insurance claims now must bear one or more of the new diagnostic codes. And with nearly 70,000 choices, roughly five times the number in ICD–9, physicians worried not only that ICD–10 would add to their workload, but also that coding and claims-processing errors would delay payments from third–party insurers. The vast majority of practices are successfully submitting claims with the new codes and getting reimbursed. (Medscape)
Legal Quote
Sanjeevan Medical Research Centre (Private) Ltd. & Ors. Vs State of NCT of Delhi & Anr Crl.M.C.No. 2358/2010

"It has been emphasized by Court that mere error of judgment or an accident does not involve criminal liability or mere inadvertence or some degree of want of adequate care would not create criminal liability though it may create civil liability."
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Digital IMA
IMA White Paper on Live Surgeries


1. For new techniques or technologies, the surgeon should have a high level of expertise and experience.
2. The visiting surgeon should at any time have the option to decline in case the quality standards of the institution are not met.
3. The visiting surgeon should arrive at least 24 h prior to the procedure and have time to examine the patient.
4. Inexperienced assistance for complex procedures is discouraged.
5. Comment should be by experienced surgeons who are experts in their field.


1. Declining participation at any time in the process should have no consequences for the patient.
2. All decisions must be taken in the best interest of the patient.
3. Patients’ confidentiality is to be maintained at all times.


1. Post evaluation should be standard, following standardized protocols.
2. All involved in live surgery (institution, surgeon at site, visiting surgeon, moderator, all staff members) must be clearly identified.
3. Surgeons’ use of their own instruments and staff should be standard wherever possible.



1. All complications should be reported using a standardized procedure.
2. There is an additional risk if: The surgeon meets the staff in the operating theatre for the first time just before the procedure, favored instruments are not delivered and the hosting centre is not experienced in the procedure
3. Increased traffic in the operating room can increase the infection risk.
4. Risk is increased by: Unfamiliar environment (risk of complications, risk of legal challenges) and Intraoperative delays (audio–visual problems, rigid broadcasting schedules, narration, discussion)
5. Live surgery may carry higher risk because of: Suboptimal operating conditions, Extra stress for the surgeon, Travel, jet lag, and social activities, Difficulty ensuring continuity of care
6. It is essential to raise the question of the risk–to–benefit ratio of performing live surgery in an unfamiliar environment.
There is little doubt that the morbidity is higher, and that it is difficult to ensure the continuity of care.


1. Informed consent must be collected by a third party.
2. Pioneering of the latest techniques should involve approval from institutional review boards.
3. The invited professor is the surgeon responsible, even if they are not listed as the primary surgeon and are not named on the informed consent documents.
4. The invited surgeon has agreed to take the patient into their care, perform the operation, and therefore implicitly to assume responsibility.

Active surgical care of the patient continues after the invited professor returns to their own department, and it is important for the surgeon to remain involved with the patient's care following surgery.

(To be contd.)
IMA Satyagraha
IMA Poll
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Provisional programme for the ensuing meeting of the Central Council

Dear Colleague

The provisional programme for the ensuing meeting of the Central Council to be held from 27th (Sunday) to 28th (Monday) December, 2015 at Hotel Le Meridien, New Delhi is as below.

This year, the Central Council will not only have issues related to IMA but also have interactions with top luminaries of the country connected with issues related to health.

Kindly send your names, suggestions with questions related to the Agenda, in advance to us so that the same can be incorporated in the various discussions during the Central Council Meeting, as this CC Meeting is absolutely packed minute by minute. To conduct Central Council smoothly, we request your cooperation.

Please note that the whole meeting of the Central Council will be live webcast.

Dr A Marthanda Pillai                                                                                                                             Dr KK Aggarwal
National President                                                                                                                              Hony Secretary General

27–12–2015 (Sunday)
08:00 – 08:10 AM
Inviting of leaders to the Dais
Adornment of National President with the Presidential Medallion
08.10 – 08:20 AM
Invocation of the IMA Prayer
Flag Salutation
Homage to departed souls
Approval of Minutes of the 135th Ordinary Meeting of IMA Central Council
08:30 – 09:00 AM
Dr A Marthanda Pillai
Presidential Address
09:00 – 09:30 AM
Shri Ashok Chakradhar, Padma Shri Awardee
Laughter the best medicine
09:30 – 10:00 AM
Sh Rajat Sharma, Editor, India News
How media perceives the doctors
10:00 – 10:30 AM
Dr K K Aggarwal
Address by Honorary Secretary General
10:30 – 11:00 AM
Sidharth Luthra, Former ASG
CPA vs Council vs IPC vs specific laws
11:00 – 11:30 AM
CC Continues
Satyagraha Update
11:30 – 12:00 NOON
Sh D K Jain (invited)
National Consumer Dispute Redressal Commission
12:00 – 12:30 PM
IMA Update
Membership, Miscellaneous
12:30 – 01:00 PM
Justice Vipin Sanghi, Justice G S Sistani, High Court Judges (invited)
Duties of a medical professional
01:00 – 02:00 PM
02:00 – 02:30 PM
IMA Update
RNTCP, Child Sexual abuse, UNESCO
02:30 – 03:00 PM
Sh. Sushil Chandra, Member CBDT
Income tax and medical profession
03:00 – 03:30 PM
IMA Update
IMA Accreditation Council, CME Hours
03:30 – 04:00 PM
Sh. Maninder Singh, ASG
Legal open house
04:00 – 05:00 PM
Shri JP Nadda, Hon’ble Minister of Health
05.00 – 07.00 PM
Sh. Satyendra Kumar Jain, Health Minister, Delhi
Reception at 2 Raj Niwas Road
07.00 PM onwards
Banquet hosted by IMA HQs at Asiad Tower Garden (Asian Complex adjacent to Sri Fort Auditorium, New Delhi)
28–12–2015 (Monday)
08:30 – 09:00 AM
Dr Ved Prakash Mishra, MCI
Medical education
09:00 – 09:30 AM
CGP, AMS, AKN, JIMA, NPPS, NSSS, Health Scheme, Pension Scheme, HBI, International wing
Reports by wings of IMA
09:30 – 10:00 AM
10:00 – 10:30 AM
VP, FSC, BSC, YD wing, students wing, Disaster Management
IMA reports
10:30 – 11:00 AM
Shri B S Bassi, Police Commissioner, Delhi
Violence against doctors
11:00 – 11:30 AM
IMA Lybrate, IMA Kent, IMA USV Initiatives
New Initiatives
11:30 – 12:00 NOON
Shri Nalin Kohli, Media Personality
How to face a TV Debate
12:00 – 12:30 PM
Mental health, MMR, IMR, RTA, BMW disposal, Elderly care, safe sound, diabetic blindness, Mediation Cell
New initiatives
12:30 – 01:00 PM
01:00 – 02:00 PM
02:00 – 02:30 PM
Guest lecture
Pediatric Update
02:30 – 03:00 PM
Dr Harsh Vardhan, Minister of Science and Technology, GOI (invited)
Medical Research
03:00 – 03:30 PM
Mental health, MMR, IMR, RTA, BMW disposal, Elderly care, safe sound, diabetic blindness, Mediation Cell
New initiatives
03:30 – 04:00 PM
Shri Sanjay Jaiswal, Member of Parliament
Rural Health options
04:00 – 04:30 PM
CC Meeting
Other issues
04:30 – 05:00 PM
Shri G N Singh, DCGI
Pharmacovigilance Program
05:00 – 07:00 PM
IMA National Awards Function

Dr Jitendra Singh, Hon&rsble Minister of State of Science & Technology, as Chief Guest

Shri Rajyawardhan Rathore, Minister of State of Information & Broadcasting as Co-Chief Guest (Invited)
07.00 - 08.00 PM
Dr S S Agrawal

Shri Mukul Rohatgi, Attorney General of India

Dr Mahesh Sharma, Minister of State for Culture, Tourism & Civil Aviation
Installation of Team IMA – 2015-2016, followed by 136th Ordinary Meeting of Central Council of IMA

Chief Guest

Co-Chief Guest
08.00 PM onwards

Dr RVS Surendran
President, IMA Tamil Nadu State


At this moment of natural fury, Indian Medical Association stands with you to support and help. Indian Medical Association HQ Disaster Management Cell has appealed to its members for generous donation for the needy people affected by the flood.

Please inform us about the need and requirements to carry out the rehabilitation and Medical help to the affected people. IMA HQs will try to provide help in its best ability.

We also request you to inform us regularly about the activities done by IMA Tamil Nadu with regards current floods in the state.

Dr A Marthanda Pillai                                           Dr KK Aggarwal                                                  Dr Chetan N Patel
President                                                                Hon Sec General                                                         Chairman
IMA HQ                                                                           IMA HQ                                                             IMA HQ DMC
Cancer cases rising among women on the rise

There has been a spike in cancer cases among women over recent years with breast cancer being of particular concern as it is found to be increasing in both urban and rural areas. Rise in cancer cases is due to a larger aging population, unhealthy lifestyle, use of tobacco and tobacco products, etc. Citing an ICMR report on ‘Time Trends in Cancer Incidence Rate: 1982–2010’, Health Minister JP Nadda told Parliament that "the Age Adjusted Incidence rates (AAR) show breast cancer is increasing in both urban and rural registries whereas cervical cancer is decreasing or remains static in both urban and rural registries"… (ET Healthworld)
Second exclusive medical device industrial park at Nagpur

The second exclusive medical device industrial park in the country will come up at Mihan SEZ, Nagpur in Maharashtra. The country’s first medical device park is coming up at Andhra Pradesh, a result of the initiative of Association of Indian Medical Device Industry (AIMED)… (Pharmabiz – Ashwani Maindola)
Rotavirus vaccine to be introduced in the immunization program by March 2016

The rotavirus vaccine will be introduced in the government’s routine immunization program by March next year to protect children from diarrhea. An estimated 50,000 lives per year will be saved as a result of this initiative. The Centre will also launch a 3–year–long anti–measles–rubella (MR) campaign next year to save children in the age group of nine months to 15 years from all kinds of measles… (ET Healthworld)
Midostaurin extends life in difficult–to–treat AML patients

Midostaurin, once thought to be ineffective in acute myeloid leukemia (AML) might make a comeback as an agent targeted at a subset of patients. In the study presented at the American Society of Hematology (ASH) meeting, midostaurin combined with standard chemotherapy led to significant more benefit than chemotherapy alone. The 5–year survival rate for patients taking the drug was 50.9% compared with 43.9% for those on standard chemotherapy alone –– a 23% improvement ––v and a similar benefit was seen for event-free survival … (Medpage Today)
India on track to reduce malnutrition rates, but much more needs to be done

Two reports released on Thursday, one at the global level and the other India–specific, say the country is on track to meet only two (under–5 overweight and exclusive breastfeeding rates) of the eight global targets for reducing malnutrition by 2030. The latest data show that 39% of children under–5 in India are short for their age (stunted). The two States that had the worst stunting rates in 2005–06, Uttar Pradesh and Bihar, have made the least progress over the 2005–2014 period, noted the Global Nutrition Report, the first of its kind to be released. The global rate is 24%. The India Health Report (IHR), 2015, offers a critical analysis of nutrition at the national and State levels. The IHR compared nutrition levels among children in 28 States and Delhi… (The Hindu)
Assistance to APL Category Patients

Under the scheme "Health Minister’s Discretionary Grant (HMDG)" of Ministry of Health and Family Welfare, financial assistance is provided to patients having annual family income up to Rs.1,00,000/– and below, to defray a part of the expenditure on Hospitalization/treatment in Government Hospital as per guidelines of the scheme. The quantum of financial assistance granted is as follows:–

I. Rs.50,000/–, if the estimated cost of treatment is up to Rs.1,00,000/–
II. Rs.75,000/– if the estimated cost of treatment is above Rs.1,00,000/– and up to Rs.1,50,000/–
III. Rs.1, 00,000/– if the estimated cost of treatment is above Rs.1, 50,000/–.

At present, no proposal to raise the ceiling of annual family income for availing assistance under HMDG scheme is under consideration of the Government. (PIB)
Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

Smita N Deshpande
Head, Dept. of Psychiatry, De–addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse– a doctor– as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):

Responses received

Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar
Walnuts good for semen

The daily addition of 75 g of whole–shelled walnuts to a typical Western–style diet appears to have positive effects on the vitality, morphology and motility of sperm in healthy men, according to the findings of a randomized, parallel, 2–group, dietary intervention trial by Wendie A. Robbins, PhD, from the University of California, Los Angeles. The study is published in August 15 in Biology of Reproduction.
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
IMA Live Webcast

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Inspirational Story
Our Time in History

The paradox of our time in history is that we have taller buildings, but shorter tempers; wider freeways, but narrower viewpoints. We spend more, but have less; we buy more, but enjoy it less. We have bigger houses and smaller families; more conveniences, but less time.

We have more degrees, but less sense; more knowledge, but less judgment; more experts, but less solutions; more medicine, but less wellness. We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.

We’ve learned how to make a living, but not a life. We’ve added years to life, not life to years. We've been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor. We’ve conquered outer space, but not inner space.

We’ve cleaned up the air, but polluted the soul. We’ve split the atom, but not our prejudice. We have higher incomes, but lower morals. We’ve become long on quantity, but short on quality.

These are the times of tall men, and short character; steep profits, and shallow relationships. These are the times of world peace, but domestic warfare; more leisure, but less fun; more kinds of food, but less nutrition.

These are days of two incomes, but more divorce; of fancier houses, but broken homes. It is a time when there is much in the show window and nothing in the stockroom.
IRIS commonly occurs after how many weeks of ART initiation?

a. 1–4 weeks
b. 2–12 weeks
c. 12–24 weeks
d. After 6 months

Yesterday’s Mind Teaser: The cardinal clinical features of Guillain–Barré syndrome (GBS) are except

1. Progressive, fairly symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes.
2. Patients usually present a few days to a week after onset of symptoms.
3. The weakness can vary from mild difficulty with walking to nearly complete paralysis of all extremity, facial, respiratory, and bulbar muscles.
4. Weakness never begins in the arms or facial muscles

Answer for Yesterday’s Mind Teaser: Weakness never begins in the arms or facial muscles

Answers received from: Dr Kailash Chandra Sharma, Dr K Raju, Amit Mahajan, Dr Avtar Krishan, Daivadheenam Jella

Answer for 11th December Mind Teaser: A: D: Defecation

Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Dr Avtar Krishan.
Readers column
Great achievement of Team IMA & for Doctors. Dr Amit Kumar Goyal, Kota
The shipwrecked mariner had spent several years on a deserted island. Then one morning he was thrilled to see a ship offshore and a smaller vessel pulling out toward him.

When the boat grounded on the beach, the officer in charge handed the marooned sailor a bundle of newspapers and told him, "The captain said to read through these and let us know if you still want to be rescued."
Press Release
The dangers of the growing diabetic population in India

It’s possible that every individual in India knows a relative, a neighbor or a friend who is a diabetes patient. It’s because more than 62 million people in the country live with the disease and research predicts that the numbers will increase to 100 million by 2030. Diabetes is a leading cause of cardiovascular diseases, and resultant mortality in the country and there exists an urgent need to raise awareness about how diabetes is preventable/ manageable if necessary precautions are taken.

Our body turns foods into sugar or glucose after digestion. Once this process is complete, the pancreas release insulin, a substance that helps the cells absorb the glucose and produce energy. Diabetes occurs due to the body’s inability to produce adequate insulin causing a rise in the blood glucose levels. Patients with high blood sugar will typically experience polyuria (frequent urination), become increasingly thirsty (polydipsia) and hungry (polyphagia). While Type 1 and type 2 diabetes are the most common forms of the disease, there are other forms as well including gestational diabetes, which occurs during pregnancy and abdominal diabetes.

Speaking about this, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA in a joint statement said, "The estimated overall prevalence of diabetes among adults ranges from 5.8 to 12.9 percent (median 8.4 percent). Lifestyle irregularities are the major causes of Type 2 diabetes, which accounts for over 90% of all diabetes cases. It is a fact that the prevalence of diabetes in rural India is one–quarter that in urban India. The reason for this is the high–stress lives that urban Indians live. They exercise and sleep less, eat a primarily unhealthy, high trans–fat, salt and sugar–laden diet and resort to smoking and drinking as ways of dealing with high–stress levels. Lifestyle modifications are crucial in order to eliminate disease risks and associated complications".

To keep a check on diabetic incidence and associated complications one must keep the following in mind:

• Diabetics require ongoing evaluation for diabetes–related complications.
• History and physical exam should be performed two to three times yearly to obtain information on nutrition, physical activity, management of diabetes and cardiovascular risk factors, and diabetes–related complications
• One should check BP and visually inspect the feet at every visit, and in addition, perform a more thorough foot examination and refer patients for a dilated eye exam annually.
• Measure A1C every three months if A1C is not in the goal range and therapy requires adjustment, and every six months in patients with stable glycemic control who are meeting A1C goals.
• Measure fasting lipids and urine albumin–to–creatinine ratio annually.
• Morbidity from diabetes is a consequence of both macrovascular disease (atherosclerosis) and microvascular disease (retinopathy, nephropathy, and neuropathy).
• In type 2 diabetes, disease onset is insidious, and diagnosis is often delayed.
• Diabetic complications may be present at the time of diagnosis of diabetes
• The progression of these complications can be slowed with interventions such as aggressive management of glycemia, blood pressure, and lipids; laser therapy for advanced retinopathy; and administration of an angiotensin–converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) for nephropathy.These interventions appear to be reducing the incidence of several diabetes–related complications, including myocardial infarction (MI), stroke, lower–extremity amputation, and end–stage renal disease.

What can you do to prevent/control diabetes?

• Consult your doctor and plan out a suitable workout regime because it is really important if you want to save your heart
• Check your cholesterol levels and triglycerides regularly
• Maintain a normal blood sugar level
• Inculcate a behavioral change, don’t stop taking precautions once the disease has been controlled
• Eat a healthily and balanced diet

To decrease the medical casualties caused by diabetes, it’s not only important to understand the causes of the disease, but it is equally important to implement the precautionary measures in life.