Dr. Gujral's Speciality Clinics

http://www.diabetesheartcare.com/admin/RTE_popup_word_pashttp://www.diabetesheartcare.com/admin/RTE_popup_word_paste.aspte.asp

PERIOD JOURNEY OF Diabetes Mellitus

PERIOD	THE Concerns	METHODS	OUTCOME
Pre 1923 ( In the times of Gandhi & Nehru ,Hitler ), & our Grandparents	The Patients who develop diabetes wait for death , because of no treatment available except �Starvation�	Use of various �Bitters� , Herbs , Spiritual healing etc. NO MEDICAL TREATMENT WAS AVAILABLE	Certain mortality, physician tool less,Helpless but curious !!
1923 � 1946 (In times of , Vajpai ,Gandhi & Nehru) & our Parents	SURVIVAL for few years	Crude Pancreatic extracts , unpurified Insulin of animal origin ,used for injecting , without a clue about control , or relief. STILL NO ORAL ANTIDIABETIC s !!	Only short term survival , with hardly any relief from symptoms . Physician Helpless BUT hopeful !!
1947 � 1956 ( the times of Indira,Radhkrishnan,Nehru Shastri , ) & our Parents ,	Relief from Ketoacidocis ,Osmotic symptoms , infections , leading to increased survival.	Pharmaceutical injectible Insulin but Unpurified , high Insulin allergy, First Oral drug � Restinon� became available	Much better control , & survival BUT still Insulin the ONLY OPTION for every diabetic Physician waiting for OHA s arrival eagerly
1957 � 1980 ( The Times of our Parents , & our early days and education years)	Better Quality of Life for Diabetics, prevention of Infections , Diabetic Coma , Retinopathy & possibly Heart Attack & Brain Stroke	Glycemic Control with OHAs in Type 2 DM (called NIDDM ) & more purified Animal insulins & better insulin syringes for IDDM,self monitoring of urine sugar by test tube test,MANY MORE Long & short acting OHAs became available : Glibeclamide , Metformin etc,	Much better QOL with long acting OHAs and Long acting insulins. BUT Cardiovascular & Micro vascular complications not under check,not monitored , and high rate of Disability . Physician equipped but not with Instant Research & Knowledge
1981 � 1995 ( The Times of our own , the Early IT days,)	Prevention of Micro & Macro vascular Complications , Self Monitoring of Blood Glucose.	With DCCT, KumoMoto, & UKPDS , Significance of TIGHT Glycemic control was understood and , Handy Glucose Meters came,HUMAN synthetic Insulins , Insulin Pens , & HbA1c became available.& came ACE Inhibitors Role of Insulin in Type 2 DM was first time understood and publicised,MIROALBUMINURIA was started as periodic evaluation, ACTUALLY the RICHEST 15 years since 1923 !!	More & More Patients empowered to self monitoring, better Doctor Patient Co ordination, Physician much better with Tools for INFO & THERAPY
1996 � 2003 ( Times of present generation , IT Revolution , Fast Developments ,Very Fast Urbanization,Indian MNCs,BPOs .........)	Cardiovascular Safety , Reduction of Morbidity , Mortality from T2DM ,	The WHO Projection of Number of Diabetics in World vs. India , HOPE trial , Primary prevention of Diabetes taken up as Priority by NGOs a over the Globe,RAMIPRIL came, and came �better , safer OHAs�, and the GLITAZONES .The Lifestyler Insulin Analogues Pumps came , Type 2 DM was established as CAD equivalent ( the vascular disease ) , THE EXTRAVAGANT but Hi Tech era that is continuing !	No Primary Prevention appeared anywhere near Due to Rampant Urbanisation of eating and transportation behaviour,though better secondary & Tertiary prevention achieved Physician ? getting Carried away by M Forces & Indiscreet INFO.
2004 �2008 / 9 ( The Overdrive Mode , Difficult waters ) 2009 � FORWARDS... our children, juniors	Questions on CV Safety of the agents touted tobe CV Protectors , SAFE Drugs, OBESITY prevention & Treatment,	FDA under Cloud. Physician confused and disgusted in regard to Glitazones,Rimonabent, & Exenatide, DPP4 inhibitors introduced ,The Intensive Glycemic Lowering in Critical care as well as Chronic care is without the clear guidelines due to conflicting results & Doctored conclusions from so called Landmark Trials. THE DIFFICULT TIMES FOR Diabetologist Tightening of scews on M Forces , More Real Life, evidence base trials, Resetting of Priorities, WE NEED ORAL INSULIN , PORTAL Delivery of Insulin , SAFE Anti Obesity Drugs , Safe & Affordable BARIATRIC SURGERY, STEM CELL Rx. BUT More than that ....... THE BALANCED LIFESTYLE ....... & ATTITUDE .	Time for the physician to think , Plan & Act with own updated knowledge,superimposed with guidelines from apex organizations and extrapolate carefully to our own patient type, Be Ware of M Forces !!!!! HUM HONGE KAAMIAAB !!

MORAL OF THE STORY IS

� ��.. �

Please send in your own honest 10 � 100 words,

All will be acknowledged , shared and a Cautious Intelligent Physician Group might emerge !!

Eagerly waiting for your inputs ��.

Dr.Vinod K Gujral

vkg28@hotmail.com

OUTCOME

Certain mortality, physician tool less,Helpless

but curious !!