Diabetes mellitus
Classification and external resources
Universal blue circle symbol for diabetes.[1]
ICD-10	E10–E14
ICD-9	250
MedlinePlus	001214
eMedicine	med/546 emerg/134
MeSH	C18.452.394.750

Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.^[2] This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

The three main types of diabetes mellitus (DM) are:

• Type 1 DM results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus (IDDM) or "juvenile" diabetes)
• Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as noninsulin-dependent diabetes mellitus (NIDDM) or "adult-onset" diabetes)
• Gestational diabetes is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both types 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy (retinal damage). Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.

Globally, as of 2010^[update], an estimated 285 million people have type 2 diabetes, making up about 90 percent of all diabetes cases.^[3]

Classification[link]

Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes and "other specific types".^[2] The "other specific types" are a collection of a few dozen individual causes.^[2] The term "diabetes", without qualification, usually refers to diabetes mellitus. The rare disease diabetes insipidus has similar symptoms as diabetes mellitus, but without disturbances in the sugar metabolism (insipidus means "without taste" in Latin).

The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.

Type 1 diabetes[link]

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated autoimmune attack.^[5] There is no known preventive measure against type 1 diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of these diabetes cases were in children.

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.^[6] There are many different reasons for type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).^[6] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.^[7]

Type 2 diabetes[link]

Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.^[2] The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 diabetes is the most common type.

In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At this stage, hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver.

Gestational diabetes[link]

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

A 2008 study completed in the U.S. found the number of American women entering pregnancy with pre-existing diabetes is increasing. In fact, the rate of diabetes in expectant mothers has more than doubled in the past six years.^[8] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential for the children of diabetic mothers to become diabetic in the future.

Other types[link]

Prediabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 DM. Many people destined to develop type 2 DM spend many years in a state of prediabetes which has been termed "America's largest healthcare epidemic."^[9]:10–11

Latent autoimmune diabetes of adults (LADA) is a condition in which type 1 DM develops in adults. Adults with LADA are frequently initially misdiagnosed as having type 2 DM, based on age rather than etiology.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.^[10]

Signs and symptoms[link]

Overview of the most significant symptoms of diabetes

The classical symptoms of untreated diabetes are loss of weight, polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).^[11] Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes.

Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected^{[citation needed]}. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.

Diabetic emergencies[link]

People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone, a rapid, deep breathing known as Kussmaul breathing, nausea, vomiting and abdominal pain, and altered states of consciousness.

A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration.

Complications[link]

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease.^[12] The main "macrovascular" diseases (related to atherosclerosis of larger arteries) are ischemic heart disease (angina and myocardial infarction), stroke and peripheral vascular disease.

Diabetes also causes "microvascular" complications—damage to the small blood vessels.^[13] Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms, reduced vision, and potentially blindness. Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis. Diabetic neuropathy is the impact of diabetes on the nervous system, most commonly causing numbness, tingling and pain in the feet and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation.

Causes[link]

The cause of diabetes depends on the type.

Type 1 diabetes is partly inherited, and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. A genetic element in individual susceptibility to some of these triggers has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 DM seems to require an environmental trigger.

Type 2 diabetes is due primarily to lifestyle factors and genetics.^[14]

The following is a comprehensive list of other causes of diabetes:^[15]

Pathophysiology[link]

This unreferenced section requires citations to ensure verifiability.

Mechanism of insulin release in normal pancreatic beta cells - insulin production is more or less constant within the beta cells. Its release is triggered by food, chiefly food containing absorbable glucose.

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.

Humans are capable of digesting some carbohydrates, in particular those most common in food; starch, and some disaccharides such as sucrose, are converted within a few hours to simpler forms, most notably the monosaccharide glucose, the principal carbohydrate energy source used by the body. The rest are passed on for processing by gut flora largely in the colon. Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage.

Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the β-cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin. Glucose thus forcibly produced from internal liver cell stores (as glycogen) re-enters the bloodstream; muscle cells lack the necessary export mechanism. Normally, liver cells do this when the level of insulin is low (which normally correlates with low levels of blood glucose).

Higher insulin levels increase some anabolic ("building up") processes, such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat-burning metabolic phase).

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not have its usual effect, so it will not be absorbed properly by those body cells that require it, nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.

When the glucose concentration in the blood is raised beyond its renal threshold (about 10 mmol/L, although this may be altered in certain conditions, such as pregnancy), reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst.

Diagnosis[link]

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:^[10]

• Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)
• Plasma glucose ≥ 11.1 mmol/l (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test
• Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
• Glycated hemoglobin (Hb A1C) ≥ 6.5%^[19]

A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.^[20] According to the current definition, two fasting glucose measurements above 126 mg/dl (7.0 mmol/l) is considered diagnostic for diabetes mellitus.

People with fasting glucose levels from 110 to 125 mg/dl (6.1 to 6.9 mmol/l) are considered to have impaired fasting glucose.^[21] Patients with plasma glucose at or above 140 mg/dL (7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease.^[22]

Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.^[23]

Management[link]

Diabetes mellitus is a chronic disease which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications, as well as possibly insulin, in type 2 diabetes).

Patient education, understanding, and participation is vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels.^[24][25] The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.^[26] Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.^[26]

Lifestyle[link]

There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.^[27]

Medications[link]

Oral medications

Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality.^[28] Routine use of aspirin, however, has not been found to improve outcomes in uncomplicated diabetes.^[29]

Insulin

Type 1 diabetes is typically treated with a combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.^[28] Doses of insulin are then increased to effect.^[28]

Support[link]

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists, podiatrists/chiropodists, dietitians, physiotherapists, nursing specialists (e.g., diabetic specialist nurses), nurse practitioners, or certified diabetes educators, may jointly provide multidisciplinary expertise.^{[citation needed]} Home telehealth support can be an effective management technique.^[30]

Epidemiology[link]

Prevalence of diabetes worldwide in 2000 (per 1,000 inhabitants) - world average was 2.8%.

no data   ≤ 7.5   7.5–15   15–22.5   22.5–30   30–37.5   37.5–45

45–52.5   52.5–60   60–67.5   67.5–75   75–82.5   ≥ 82.5

Disability-adjusted life year for diabetes mellitus per 100,000 inhabitants in 2004

No data   <100   100–200   200–300   300–400   400–500   500–600

600–700   700–800   800–900   900–1,000   1,000–1,500   >1,500

Globally, as of 2010^[update], an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases.^[3] Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double.^[31] Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030.^[31] The increase in incidence in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at present, though there is much speculation, some of it most compellingly presented.^[31]

United States[link]

For at least 20 years, diabetes rates in North America have been increasing substantially. In 2010, nearly 26 million people have diabetes in the United States alone, from those 7 million people remain undiagnosed. Another 57 million people are estimated to have prediabetes.^[32][33]

The Centers for Disease Control and Prevention (CDC) has termed the change an epidemic.^[34] The National Diabetes Information Clearinghouse estimates diabetes costs $132 billion in the United States alone every year. About 5%–10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs. Most of this difference is not currently understood. The American Diabetes Association (ADA) cites the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that one in three Americans born after 2000 will develop diabetes in their lifetimes.^[35][36]

According to the ADA, about 18.3% (8.6 million) of Americans age 60 and older have diabetes.^[37] Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) demonstrated, in the population over 65 years old, 18% to 20% have diabetes, with 40% having either diabetes or its precursor form of impaired glucose tolerance.^[38]

Australia[link]

Indigenous populations in first world countries have a higher prevalence and increasing incidence of diabetes than their corresponding nonindigenous populations. In Australia, the age-standardised prevalence of self-reported diabetes in indigenous Australians is almost four times that of nonindigenous Australians.^[39] Preventative community health programs, such as Sugar Man (diabetes education), are showing some success in tackling this problem.

United Kingdom[link]

About 3.8 million people in the United Kingdom have diabetes mellitus, but the charity Diabetes U.K. have made predictions that that could become high as 6.2 million by 2035/2036. Diabetes U.K. have also predicted that the National Health Service could be spending as much as 16.9 billion pounds on diabetes mellitus by 2035, a figure that means that the National Health Service could be spending as much as 17% of its budget on diabetes treatment by 2035.^[40]

History[link]

Diabetes was one of the first diseases described,^[41] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine".^[42] The first described cases are believed to be of type 1 diabetes.^[42] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.^[42] The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Appollonius of Memphis.^[42] The disease was rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.^[42] Type 1 and type 2 diabetes where identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 AD with type 1 associated with youth and type 2 with being overweight.^[42] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination.^[42] While many measure where tried, effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best developed insulin in 1921 and 1922.^[42] This was followed by the development of the long-acting insulin NPH in the 1940s.^[42]

Etymology[link]

The word diabetes ( /ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtɨs/) comes from Latin diabētēs, which in turn comes from Ancient Greek διαβήτης (diabētēs) which literally means "a passer through; a siphon."^[43] Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease.^[44][45] Ultimately, the word comes from Greek διαβαίνειν (diabainein), meaning "to pass through,"^[43] which is composed of δια- (dia-), meaning "through" and βαίνειν (bainein), meaning "to go".^[44] The word "diabetes" is first recorded in English, in the form diabete, in a medical text written around 1425.

The word mellitus (/mɨˈlaɪtəs/ or /ˈmɛlɨtəs/) comes from the classical Latin word mellītus, meaning "mellite"^[46] (i.e. sweetened with honey;^[46] honey-sweet^[47]). The Latin word comes from mell-, which comes from mel, meaning "honey";^[46][47] sweetness;^[47] pleasant thing,^[47] and the suffix -ītus,^[46] whose meaning is the same as that of the English suffix "-ite".^[48] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria).^[45] This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.

Society and culture[link]

The 1990 "St. Vincent Declaration"^[49][50] was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy, but also economically—expenses due to diabetes have been shown to be a major drain on health- and productivity-related resources for healthcare systems and governments.

Several countries established more and less successful national diabetes programmes to improve treatment of the disease.^[51]

Diabetic patients with neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be unemployed as those without the symptoms.^[52]

In other animals[link]

In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are also more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles.^[53] The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognised in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.^[53]

References[link]

External links[link]

Find more about Diabetes mellitus on Wikipedia's sister projects:
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• Diabetes at the Open Directory Project
• American Diabetes Association
• IDF Diabetes Atlas
• National Diabetes Education Program

Amitabh Bachchan
Amitabh Bachchan in 2009
Born	Amitabh Harivansh Bachchan (1942-10-11) 11 October 1942 (age 69) Allahabad, United Provinces, British India
Residence	Prateeksha, Mumbai, Maharashtra, India
Occupation	Actor, producer, singer, television presenter
Years active	1969–present
Spouse	Jaya Bhaduri (1973–present)
Children	Abhishek Bachchan Shweta Nanda
Website
bigb.bigadda.com

Amitabh Bachchan ([əmɪtaːbʱ bəttʃən] ( listen), born Amitabh Harivansh Bachchan on 11 October 1942) is an Indian film actor. He first gained popularity in the early 1970s as the "angry young man" of Hindi cinema, and has since appeared in over 180 Indian films in a career spanning more than four decades.^[1][2] Bachchan is regarded as one of the greatest and most influential actors in the history of Indian cinema.^[3][4][5]

Bachchan has won numerous major awards in his career, including three National Film Awards as Best Actor, and fourteen Filmfare Awards. He is the most-nominated performer in any major acting category at Filmfare, with 37 nominations overall. In addition to acting, Bachchan has worked as a playback singer, film producer and television presenter. He also had a stint in politics in the 1980s. He has received both the Padma Shri and the Padma Bhushan civilian awards from the Indian government.

Early life[link]

Bachban was born in Allahabad, Uttar Pradesh. His father, Harivansh Rai Bachchan, was a Hindi poet, and his mother, Teji Bachchan, was a Sikh from Faisalabad (now in Pakistan).^[6] Bachchan was initially named Inquilaab, inspired from the famous phrase Inquilab Zindabad, during the Indian independence struggle. However, at the suggestion of fellow poet Sumitranandan Pant, Harivansh Rai changed the name to Amitabh which means, "the light that would never go off." Though his surname was Shrivastava, his father had adopted the pen-name Bachchan (meaning child-like in colloquial Hindi), under which he published all his works. It is with this last name that Amitabh debuted in films, and, for all public purposes, it has become the surname of all members of his family. Bachchan's father died in 2003, and his mother in 2007.^[7]

Amitabh is the eldest of Harivansh Rai Bachchan's two sons, the second being Ajitabh. His mother had a keen interest in theatre and had been offered a role in a film, but preferred her domestic duties. She had some degree of influence in Bachchan's choice of career because she always insisted that he should take the centre stage.^[8] He attended Allahabad's Jnana Prabodhini and Boys' High School (BHS), followed by Nainital's Sherwood College, where he majored in the art stream.^{[citation needed]} He later went on to study at Kirori Mal College of the University of Delhi and completed a Bachelor of Science degree.^{[citation needed]} In his twenties, Bachchan gave up a job as freight broker for the shipping firm, Bird and Co., based in Calcutta now known as Kolkata, to pursue a career in acting.^{[citation needed]}

Career[link]

Early work: 1969–1972[link]

Bachchan made his film debut in 1969 as a voice narrator in Mrinal Sen's National Award winning film Bhuvan Shome. Thereafter he got his first acting role as one of the seven protagonists in Saat Hindustani, a film directed by Khwaja Ahmad Abbas and featuring Utpal Dutt, Madhu and Jalal Agha. Though the film was not a financial success, Bachchan won his first National Film Award for Best Newcomer.^[9]

Anand (1971) followed, where he starred alongside Rajesh Khanna. Bachchan's role as a doctor with a cynical view of life garned him his first Filmfare Best Supporting Actor Award. He then played his first negative role as an infatuated lover-turned-murderer in Parwaana (1971). This was followed by several films including Reshma Aur Shera (1971). During this time, he made a guest appearance in the film Guddi which starred his future wife Jaya Bhaduri. He narrated part of the film Bawarchi. In 1972, he made an appearance in the road action comedy Bombay to Goa, directed by S. Ramanathan. Many of his films during this early period did not do well, but that was about to change.^[10]

Rise to stardom: 1973–1983[link]

Director Prakash Mehra cast him in the leading role for the film Zanjeer (1973) as Inspector Vijay Khanna. The film was a sharp contrast to the romantically themed films that had generally preceded it and established Amitabh in a new persona—the "angry young man" of Bollywood cinema.^[2] He earned a Filmfare nomination for Best Actor. Filmfare considers this one of the iconic performances of Bollywood history.^[10] The year 1973 was also when he married Jaya, and around this time they appeared in several films together; not only in Zanjeer but in films such as Abhimaan which followed and was released only a month after their marriage. Later, Bachchan played the role of Vikram in the film Namak Haraam, a social drama directed by Hrishikesh Mukherjee and scripted by Biresh Chatterjee addressing themes of friendship. His supporting role won him his second Filmfare Best Supporting Actor Award.^{[citation needed]}

In 1974, Bachchan made several guest appearances in films such as Kunwara Baap and Dost, before playing a supporting role in Roti Kapda Aur Makaan. The film, directed and written by Manoj Kumar, addressed themes of honesty in the face of oppression and financial and emotional hardship. Bachchan then played the leading role in film Majboor, released on 6 December 1974, which was a remake of the Hollywood film Zigzag. The film was only a moderate success at the box office.^[11] In 1975, he starred in a variety of film genres from the comedy Chupke Chupke, the crime drama Faraar to the romantic drama Mili. 1975 was the year when he appeared in two films which are regarded as important in Hindi cinematic history. He starred in the Yash Chopra directed film Deewaar, opposite Shashi Kapoor, Nirupa Roy, and Neetu Singh, which earned him a Filmfare Nomination for Best Actor. The film became a major hit at the box office in 1975, ranking in at number 4.^[12] Indiatimes Movies ranks Deewaar amongst the Top 25 Must See Bollywood Films.^[13] Released on 15 August 1975 was Sholay (meaning flames), which became the highest grossing film of all time in India, earning INR 2,36,45,00,000 equivalent to US$ 60 million, after adjusting for inflation.^[14] Bachchan played the role of Jaidev. In 1999, BBC India declared it the "Film of the Millennium" and like Deewar, has been cited by Indiatimes movies as amongst the Top 25 Must See Bollywood Films.^[13] In that same year, the judges of the 50th annual Filmfare Awards awarded it with the special distinction award called Filmfare Best Film of 50 Years.

Bachchan starred in comedies such as Chupke Chupke (1975) and Amar Akbar Anthony (1977) and in films such as Kabhie Kabhie (1976). In 1976, he was once again cast by director Yash Chopra in his second film, Kabhi Kabhie, a romantic tale in which Bachchan starred as a young poet named Amit Malhotra who falls deeply in love with a beautiful young girl named Pooja played by actress Rakhee Gulzar. The film saw him again nominated for the Filmfare Best Actor Award. In 1977, he won his first Filmfare Best Actor Award for his performance in Amar Akbar Anthony where he played the third lead opposite Vinod Khanna and Rishi Kapoor as Anthony Gonsalves. In 1978 he starred in all four of the highest grossing films of India in that year.^[15] He once again resumed double roles in films such as Kasme Vaade as Amit and Shankar and Don playing the characters of Don, a leader of an underworld gang and his look alike Vijay. His performance won him his second Filmfare Best Actor Award. He also performed in Trishul and Muqaddar Ka Sikandar which both earned him further Filmfare Best Actor nominations. He was billed a "one-man industry" by the French director François Truffaut.^[16]

In 1979, for the first time, Amitabh was required to use his singing voice for the film Mr. Natwarlal in which he starred alongside Rekha. His performance in the film saw him nominated for both the Filmfare Best Actor Award and the Filmfare Best Male Playback Awards. In 1979, he also received Best Actor nomination for Kaala Patthar (1979) and then went on to be nominated again in 1980 for the Raj Khosla directed film Dostana, in which he starred opposite Shatrughan Sinha and Zeenat Aman. Dostana proved to be the top grossing film of 1980.^[17] In 1981, he starred in Yash Chopra's melodrama film Silsila, where he starred alongside his wife Jaya and rumoured lover Rekha. Other films of this period include Ram Balram (1980), Shaan (1980), Lawaaris (1981), and Shakti (1982) which pitted him against legendary actor Dilip Kumar.^[18]

[edit] 1982 injury while filming Coolie

On 26 July 1982, while filming Coolie in the University Campus in Bangalore, Bachchan suffered a near fatal intestinal injury during the filming of a fight scene with co-actor Puneet Issar.^[19] Bachchan was performing his own stunts in the film and one scene required him to fall onto a table and then on the ground. However as he jumped towards the table, the corner of the table struck his abdomen, resulting in a splenic rupture from which he lost a significant amount of blood. He required an emergency splenectomy and remained critically ill in hospital for many months, at times close to death. The public response included prayers in temples and offers to sacrifice limbs to save him, while later, there were long queues of well-wishing fans outside the hospital where he was recuperating.^[20] Nevertheless, he spent many months recovering and resumed filming later that year after a long period of recuperation. The film was released in 1983, and partly due to the huge publicity of Bachchan's accident, the film was a box office success.^[21]

The director, Manmohan Desai, altered the ending of Coolie after Bachchan's accident. Bachchan's character was originally intended to have been killed off but after the change of script, the character lived in the end. It would have been inappropriate, said Desai, for the man who had just fended off death in real life to be killed on screen. Also, in the released film the footage of the fight scene is frozen at the critical moment, and a caption appears onscreen marking this as the instant of the actor's injury and the ensuing publicity of the accident.^[20]

Later, he was diagnosed with Myasthenia gravis. His illness made him feel weak both mentally and physically and he decided to quit films and venture into politics. At this time he became pessimistic, expressing concern with how a new film would be received and stated before every release, "Yeh film to flop hogi!" ("This film will flop").^[22]

Politics: 1984–87[link]

In 1984, Bachchan took a break from acting and briefly entered politics in support of long-time family friend, Rajiv Gandhi. He contested Allahabad's seat of 8th Lok Sabha against H. N. Bahuguna, former Chief Minister of Uttar Pradesh and won by one of the highest victory margins in general election history (68.2% of the vote).^[23] His political career, however, was short-lived: he resigned after three years, calling politics a cesspool. The resignation followed the implication of Bachchan and his brother in the "Bofors scandal" by a newspaper, which he vowed to take to court. Bachchan was eventually found not guilty of involvement in the ordeal.^[24]

His old friend, Amar Singh, helped him during a financial crisis due to the failure of his company ABCL. Therefore Bachchan started to support Amar Singh's political party, the Samajwadi party. Jaya Bachchan joined the Samajwadi Party and became a Rajya Sabha member.^[25] Bachchan has continued to do favors for the Samajwadi party, including advertisements and political campaigns. These activities have recently gotten him into trouble again in the Indian courts for false claims after a previous incident of submission of legal papers by him, stating that he is a farmer.^[26]

A 15 year press ban against Bachchan was imposed during his peak acting years by Stardust and some of the other film magazines. In his own defense, Bachchan claimed to have banned the press from entering his sets until late 1989.^[27]

Slump and retirement: 1988–1992[link]

In 1988, Bachchan returned to films, playing the title role in Shahenshah, which was a box office success due to the hype of Bachchan's comeback.^[28] After the success of his comeback film however, his star power began to wane as all of his subsequent films failed at the box office. The 1991 hit film, Hum, for which he won his third Filmfare Best Actor Award, looked like it might reverse this trend, but the momentum was short-lived as his string of box office failures continued. Notably, despite the lack of hits, it was during this period that Bachchan won his first National Film Award for Best Actor, for his performance as a Mafia don in the 1990 film Agneepath. These years would be the last he would be seen on screen for some time. After the release of Khuda Gawah in 1992, Bachchan went into semi-retirement for five years. In 1994, one of his delayed films Insaniyat was released but was also a box office failure.^[29]

Producer and acting comeback 1996–99[link]

Bachchan turned producer during his temporary retirement period, setting up Amitabh Bachchan Corporation, Ltd. (A.B.C.L.) in 1996, with the vision of becoming a 10 billion rupees (approx 250 million $US) premier entertainment company by the year 2000. ABCL's strategy was to introduce products and services covering the entire section of the India's entertainment industry. Its operations were mainstream commercial film production and distribution, audio cassettes and video discs, production and marketing of television software, celebrity and event management. Soon after the company was launched in 1996, the first film was produced by the company. Tere Mere Sapne failed to do well at the box office but launched the careers of actors such as Arshad Warsi and South films star Simran. ABCL produced a few other films, none of which did well.

In 1997, Bachchan attempted to make his acting comeback with the film Mrityudata, produced by ABCL. Though Mrityudaata attempted to reprise Bachchan's earlier success as an action hero, the film was a failure both financially and critically. ABCL was the main sponsor of the 1996 Miss World beauty pageant, Bangalore but lost millions. The fiasco and the consequent legal battles surrounding ABCL and various entities after the event, coupled with the fact that ABCL was reported to have overpaid most of its top level managers, eventually led to its financial and operational collapse in 1997. The company went into administration and was later declared a failed company by Indian Industries board. The Bombay high court, in April 1999, restrained Bachchan from selling off his Bombay bungalow 'Prateeksha' and two flats till the pending loan recovery cases of Canara Bank were disposed of. Bachchan had, however, pleaded that he had mortgaged his bungalow to Sahara India Finance for raising funds for his company.^[30]

Bachchan attempted to revive his acting career and had average success with Bade Miyan Chote Miyan (1998),^[29] and received positive reviews for Sooryavansham (1999)^[31] but other films such as Lal Baadshah (1999) and Hindustan Ki Kasam (1999) were box office failures.

Return to prominence: 2000–present[link]

Bachchan at the IIFA Awards in 2006

In 2000, Amitabh Bachchan appeared in Yash Chopra's box-office hit, Mohabbatein, directed by Aditya Chopra. He played a stern, older figure that rivalled the character of Shahrukh Khan. His role won him his third Filmfare Best Supporting Actor Award. Other hits followed, with Bachchan appearing as an older family patriarch in Ek Rishtaa: The Bond of Love (2001), Kabhi Khushi Kabhie Gham... (2001) and Baghban (2003). As an actor, he continued to perform in a range of characters, receiving critical praise for his performances in Aks (2001), Aankhen (2002), Khakee (2004) and Dev (2004). One project that did particularly well for Bachchan was Sanjay Leela Bhansali's Black (2005). The film starred Bachchan as an aging teacher of a deaf-blind girl and followed their relationship. His performance was unanimously praised by critics and audiences and won him his second National Film Award for Best Actor and fourth Filmfare Best Actor Award. Taking advantage of this resurgence, Amitabh began endorsing a variety of products and services, appearing in many television and billboard advertisements. In 2005 and 2006, he starred with his son Abhishek in the hit films Bunty Aur Babli (2005), the Godfather tribute Sarkar (2005), and Kabhi Alvida Na Kehna (2006). All of them were successful at the box office.^[32][33] His later releases in 2006 and early 2007 were Baabul (2006),^[34] Ekalavya and Nishabd (2007), which failed to do well at the box office but his performances in each of them were praised by critics.^[35]

In May 2007, two of his films Cheeni Kum and the multi-starrer Shootout at Lokhandwala were released. Shootout at Lokhandwala did very well at the box office and was declared a hit in India, while Cheeni Kum picked up after a slow start and only had average success.^[36] A remake of his biggest hit, Sholay (1975), entitled Ram Gopal Varma Ki Aag, released in August of that same year and proved to be a major commercial failure in addition to its poor critical reception.^[36] The year also marked Bachchan's first appearance in an English-language film, Rituparno Ghosh's The Last Lear. The film premiered at the 2007 Toronto International Film Festival on 9 September 2007. He received positive reviews from critics who hailed his performance as his best ever since Black.^[37] Bachchan was slated to play a supporting role in his first international film, Shantaram, directed by Mira Nair and starring Hollywood actor Johnny Depp in the lead. The film was due to begin filming in February 2008 but due to the writer's strike, was pushed to September 2008.^[38] The film is currently "shelved" indefinitely.^[39] Vivek Sharma's Bhoothnath, in which he plays the title role as a ghost, was released on 9 May 2008. Sarkar Raj, the sequel of the 2005 film Sarkar, released in June 2008 and received a positive response at the box-office. Paa, which released at the end of 2009 was a highly anticipated project as it saw him playing his own son Abhishek's Progeria-affected 13-year-old son, and it opened to favourable reviews, particularly towards Bachchan's performance. It won him his third National Film Award for Best Actor and fifth Filmfare Best Actor Award. In 2010, he debuted in Malayalam film through Kandahar, directed by Major Ravi and co-starring Mohanlal.^[40] The film was based on the hijacking incident of the Indian Airlines Flight 814.^[41] Bachchan did not receive any remuneration for this film.^[42]

Television career[link]

In the year 2000, Bachchan stepped up to host India's adaptation of the British television game show, Who Wants to Be a Millionaire? entitled, Kaun Banega Crorepati. As it did in most other countries where it was adopted, the program found immediate success. He has hosted all but one of the seasons of the show. Canara Bank withdrew its law suit against Bachchan in November 2000. Bachchan hosted KBC till November 2005, when he fell ill. At that time he was admitted to Lilavati Hospital's ICU once more, to undergo surgery for diverticulitis of the small intestine.^[43] During the period and that following his recovery, most of his projects were put on hold, including KBC.^[44] He has hosted all but one season of the show. Its success set the stage for his return to film popularity. In 2009 Oscar winning movie Slumdog Millionaire in the first question of Who Wants to be a Millionaire? contest "Amitabh Bachchan" was the correct answer to the question "Who was the star of Zanjeer? Feroz Abbas Khan performed as Amitabh Bachchan in a scene in the movie while Anil Kapoor performed as the host of the contest. Bachchan hosted the third season of the reality show Bigg Boss in 2009.^[45]

Voice[link]

Bachchan is known for his deep, baritone voice. He has been a narrator, a playback singer and presenter for numerous programmes.^{[citation needed]} Renowned film director Satyajit Ray was so impressed with Bachchan's voice, that he decided to use his voice as commentary in Shatranj Ke Khilari since he could not find a suitable role for him.^[46] In 2005, Bachchan has lent his voice to the Oscar-winning French documentary March of the Penguins, directed by Luc Jacquet.^[47]

Controversies and criticism[link]

Barabanki land case[link]

In the runup to the Uttar Pradesh state assembly elections, 2007, Bachchan made a film extolling the virtues of the Mulayam Singh government. His Samajwadi Party was routed, and Mayawati came to power.^{[citation needed]}

On 2 June 2007 a Faizabad court ruled that he had legally acquired agricultural land designated specifically for landless Dalit farmers.^[48] It was speculated that he might be investigated on related charges of forgery, as he has allegedly claimed he was a farmer.^[49] On 19 July 2007, after the scandal broke out, Bachchan surrendered the land acquired in Barabanki in Uttar Pradesh and Pune. He wrote to the chief minister of Maharashtra, Vilasrao Deshmukh, to donate the lands that were allegedly acquired illegally in Pune.^[50] However, the Lucknow Court has put a stay on the land donation and said that the status quo on the land be maintained.

On 12 October 2007, Bachchan abandoned his claim in respect of the land at Daulatpur village in Barabanki district.^[51] On 11 December 2007, the Lucknow bench of the Allahabad High Court gave a clean chit to Bachchan in a case pertaining to alleged fraudulent allotment of government land to him in Barabanki district. A single Lucknow bench of Justice said there was no finding that the actor "himself committed any fraud or manipulated any surreptitious entry in the revenue records".^[52][53]

After receiving a positive verdict in Barabanki case, Amitabh Bachchan intimated to Maharashtra government that he did not wish to surrender his land in Maval tehsil of Pune district.^[54]

Raj Thackeray's criticism[link]

Bachchan featured on an advert in shopping mall in India

In January 2008 at political rallies, Raj Thackeray, the chief of Maharashtra Navnirman Sena, targeted Amitabh Bachchan, asserting that the actor was "more inclined" towards his native state than Maharashtra. He expressed his disapproval of Amitabh's inaugurating a girls' school named after his daughter-in-law, actress Aishwarya Rai Bachchan, at Barabanki in Uttar Pradesh, rather than in Maharashtra.^[55] According to media reports, Raj's censure of Amitabh, whom he admires, stemmed out of his disappointment of not being invited to Amitabh's son Abhishek's marriage to Aishwarya, despite invitations to his estranged uncle Bal and cousin Uddhav.^[56][57]

Responding to Raj's accusations, the actor's wife, SP MP Jaya Bachchan, said that the Bachchans were willing to start a school in Mumbai, provided the MNS leader donated the land to build it. She told the media, "I heard that Raj Thackeray owns huge properties in Maharashtra, in Mumbai—Kohinoor Mills. If he is willing to donate land, we can start a school in the name of Aishwarya here."^[58] Raj responded to it saying, "Jaya bachchan claims she does not know me then how come she knows how much property I own?". Amitabh abstained from commenting on the issue. However, he apologized to Raj for controversial remarks from Jaya in some other incidence. "^[59]

Bal Thackeray refuted the allegations, stating, "Amitabh Bachchan is an open-minded person, he has great love for Maharashtra, and this is evident on many occasions. The actor has often said that Maharashtra and specially Mumbai has given him great fame and affection. He has also said that what he is today is because of the love people have given him.^{[citation needed]} The people of Mumbai have always acknowledged him as an artiste.^{[citation needed]} It was utter foolishness to make these parochial allegations against him. Amitabh is a global superstar. People all over the world respect him. This cannot be forgotten by anyone. Amitabh should ignore these silly accusations and concentrate on his acting."^[60]

On 23 March 2008, more than a month and half after Raj's remarks, Amitabh finally spoke out in an interview to a local tabloid saying, "Random charges are random; they do not deserve the kind of attention you wish me to give."^[61] Later, on 28 March at a press conference for the International Indian Film Academy, when asked what his take was on the anti-migrant issue, Amitabh said that it is one's fundamental right to live anywhere in the country and the constitution entitles so.^[62] He also stated that he was not affected by Raj's comments.^[63]

Awards, honours and recognitions[link]

Apart from National Film Awards, Filmfare Awards and other competitive awards which Bachchan won for his performances throughout the years, he has been awarded several honours for his achievements in the Indian film industry.^{[citation needed]} In 1991, he became the first artist to receive the Filmfare Lifetime Achievement Award, which was established in the name of Raj Kapoor. Bachchan was crowned as Superstar of the Millennium in 2000 at the Filmfare Awards. The Government of India awarded him with the Padma Shri in 1984^[64] and the Padma Bhushan in 2001.^[65] France's highest civilian honour, the Knight of the Legion of Honour, was conferred upon him by the French Government in 2007 for his "exceptional career in the world of cinema and beyond".^[66] In 2011, actor Dilip Kumar blogged that Black should have been nominated for an Oscar. Kumar added: "If any Indian actor, in my personal opinion, deserves the world's most coveted award, it is you."^[67]

In 1999, Bachchan was voted the "greatest star of stage or screen" in a BBC Your Millenium online poll. The organisation noted that "Many people in the western world will not have heard of [him] ...[but it] is a reflection of the huge popularity of Indian films."^[68] In 2001, he was honoured with the Actor of the Century award at the Alexandria International Film Festival in Egypt in recognition of his contribution to the world of cinema.^[69] Many other honours for his achievements were conferred upon him at several International Film Festivals, including the Lifetime Achievement Award at the 2010 Asian Film Awards.^[70]

In June 2000, he became the first living Asian to have been immortalised in wax at London's Madame Tussauds Wax Museum.^[71] Another statue was installed in New York ^[72] and Hong Kong in 2009.^[73]

In 2003, he was conferred with the Honorary Citizenship of the French town of Deauville.^[74] He was honoured with an Honorary Doctorate by the University of Jhansi, India, in 2004,^[75] the University of Delhi in 2006,^[76] the De Montfort University in Leicester, UK, in 2006,^[77] the University Brandan Foster by the Leeds Metropolitan University in Yorkshire, UK, in 2007,^[78] and the Queensland University of Technology in Brisbane, Australia, in 2011.^[79]

Severals books have been written about Bachchan. Amitabh Bachchan: the Legend was published in 1999,^[80] To be or not to be: Amitabh Bachchan in 2004,^[81] AB: The Legend: (A Photographer's Tribute) in 2006 ^[82]/, Amitabh Bachchan: Ek Jeevit Kimvadanti in 2006,^[83] Amitabh: The Making of a Superstar in 2006,^[84] Looking for the Big B: Bollywood, Bachchan and Me in 2007 ^[85] and Bachchanalia in 2009.^[86] Bachchan himself also wrote a book in 2002: Soul Curry for you and me – An Empowering Philosophy That Can Enrich Your Life.^[87] In the early 80s, Bachchan authorized the use of his likeness for the comic book character Supremo in a series titled The Adventures of Amitabh Bachchan.^[88]

Personal life[link]

This biographical section of an article needs additional citations for verification. Please help by adding reliable sources. Contentious material about living persons that is unsourced or poorly sourced must be removed immediately, especially if potentially libelous or harmful. (May 2012)

Bachchan is married to actress Jaya Bhaduri. They have two children, Shweta Nanda and Abhishek Bachchan. Abhishek is also an actor and is married to actress Aishwarya Rai.

Filmography[link]

Latest films[link]

Producer[link]

Playback singer[link]

Further reading[link]

• Mazumdar, Ranjani. Bombay Cinema: An Archive of the City. Minneapolis: University of Minnesota Press, 2007.

References[link]