Sanjeev Kelkar - Towards Optimal Management of Diabetes in Surgery

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Routine diabetes management itself has remained suboptimal in India. The mammoth effort put in by those who understood diabetes and willingly taught it over hundreds of continuing medical education programs, conferences, small booklets, and other forms of communication on diabetes has resulted in a large body of physicians in India with far better understanding of diabetes. The role of the various societies dedicated to diabetes as well as the pharmaceutical industry in this sphere must be gratefully acknowledged. Many of these efforts have looked into developing better understanding of the perioperative management of diabetes also as part of the overall teaching content. Even then, the perioperative situation of a patient with diabetes remains a large gray area in modern medicine till date. Despite many refined advancements of techniques in surgery, anesthesia, finer anesthetic drugs, and fairly widespread understanding of diabetes management, something extra was required to be done to make these matters also better.

The optimal management for best results in any complex situation needs an integrated, collaborative, proactive approach among the three specialtiessurgery, anesthesia, and medicine. It is not only a question of their individual understanding of diabetes. In the practical management, issues of significance and of great importance are not the medical knowledge only. These relate to logistics for better coordination of them, understanding the contribution each one makes and limitations of each of these specialties. These issues neither get discussed in any forums and even in textbooks on diabetes nor are they addressed where these three specialists work or are expected to work together. This volume we believe will be of great help to make these matters also better.

In this long journey, we received support from many individuals and institutions. Ex-vice chair of the World Diabetes Foundation, Copenhagen, Dr. Anil Kapur, and former director of the Central India Institute of Medical Sciences, Late Dr. G.M. Taori, were the first. Dr. Ravi Bapat, ex-HOD Surgery KEM Hospital, Mumbai, and ex-vice chancellor of Maharashtra University of Health Sciences, has appreciated this effort many years ago. The Association of Surgeons of India and its various state branches, medical colleges across India, Bhilai Steel Plant, and AMRI Hospital Kolkata were some of the institutes where we held these programs. Later, the University of Newcastle, NSW, Australia, incorporated this program in their educational initiatives in India; particularly helpful were Dr. Jean McPherson and Dr. Judith Scott. The Diabetic Foot Society of India and its founder, President Dr. Arun Bal, and other members also supported this initiative. It gave us an opportunity to interact with the professional spectrum intended to be benefitted by. The feedback we received was valuable for us to continue to improve. We are grateful to them all. Three individuals, Mr. Mohan Naik, Mr. B.S.V. Naidu, and Mr. Aravind Kashyap, have exerted themselves for the success of this journey.

In preparation of this volume, we are thankful to Ms. Guneet Kaur, New Delhi, for the considerable work on transcription which made our work far easier. Mr. V.P.M.R. Prasad from Bengaluru has been of enormous help in reference work needed. It has lent depth to our writing. Dr. Shreerang Godbole, endocrinologist, Pune, and Dr. Ashu Rastogi, Asst. Professor, Department of Endocrinology, PGI, Chandigarh, have carefully gone through a few, rather intricate, chapters and corrected them. The idea that it should be published as a volume was initiated by Dr. Naren Agarwal of Springer Nature, New Delhi. We thank him for accepting the proposal and encouraging the development and publication of this volume. We also thank Ms. Teena Bedi and Mr. Ejaz Ahmad of Springer Nature for their assistance and follow-up. We are grateful to all of them.

August 2019

We developed a teaching program on perioperative management of diabetes in 1995. From 1995 till 2005, we presented this in many forum and conferences, particularly to surgeons, in medical colleges across India which has continued till date albeit more sporadically. The principle these programs followed was to build the right perspective and establish the logic behind the themes related to the core ideas, rather than to cram the lectures with enormous details. One forum which trained nearly 700 medical consultants through a process of problem-based learning in India from 2001 to 2005 was found to be particularly rewarding in emphasizing the logic of this ill-understood area. Our efforts were highly acknowledged by all those who listened to it. The persistent suggestion from all of them was to bring this information in one book.