Daily Times

World Diabetes Day is a day to create awareness on diabetes. The Diabetic Association of Pakistan and WHO Collaborating Centre Karachi organised it on Sunday. A scientific session for the doctors was held in the forenoon.

The session began with a welcome address by Prof A Samad Shera Secretary General, Diabetic Association of Pakistan (DAP), Honorary President, International Diabetes Federation (IDF), Founding President Diabetes in Asia Study Group (DASG) and Director, WHO Collaborating Centre for Diabetes.

He introduced the theme of the World Diabetes Day “The Family and Diabetes”. Campaign slogan this year is “Protect your Family” He said diabetes has assumed an epidemic proportion. He quoted W H O’s estimate that currently over 425 million people are suffering from diabetes and expected to rise 522 million by 2030. One in two people living with diabetes is unaware of the disease. Type 2 diabetes is most common form of disease and well documented that type 2 diabetes runs in families so screening for diabetes as part of routine medical care may be appropriate if the patient has one or more risk factors. Early detection, timely intervention will reduce the incidence of diabetes. Education is the utmost importance in the prevention of diabetes and diabetic care.

Discussing “Insulin therapy” he said type 1 diabetes is rare in Pakistan and it is diagnosed early. People with type 1 diabetes have to inject insulin to sustain life. He stressed on tight control of diabetes to reduce the risk of complications such as blindness, kidney failure and heart disease.

Professor Zaman Shaikh, Director of Sir Syed Institute of Diabetes and Endocrinology, talked on “Lifestyle Modification in Prevention of Diabetes”. He said diabetes prevention is as basic as eating more healthfully, becoming more physically active and losing extra fat. It’s never too late to start. Making a few simple changes in your lifestyle now may help avoid the serious health complications of diabetes down the road. There are many benefits to regular physical activity. Exercise can help to lose weight, lower blood sugar, boost sensitivity to insulin, which helps keep blood sugar within a normal range. If one is overweight, diabetes prevention may hinge on weight loss. Every kg we lose can improve our health, and it is surprising by how much.

Participants in American DPP Trial, who lost around 7 percent of initial body weight and exercised regularly reduced the risk of developing diabetes by 58 percent. Low-carb diets, the glycaemic index diet or other fad diets may help one to lose weight at first. But their effectiveness at preventing diabetes isn’t known, nor are their long-term effects. And by excluding or strictly limiting a particular food group, one may be giving up essential nutrients. Instead, make variety and portion control part of your healthy-eating plan. International Diabetes Federation (IDF) recommends blood glucose screening if you’re age 45 or older and overweight or you’re younger than age 45 and overweight, with one or more additional risk factors for type 2 diabetes, such as a sedentary lifestyle or a family history of diabetes. Childhood obesity must not be taken lightly as it may be a predisposing factor for many diseases in time to come. Slim parents are role models for their children for prevention of obesity.

Professor Muhammad Yakoob Ahmedani, Professor of Medicine and Consultant Endocrinologist at Baqai Institute of Diabetology and Endocrinology, spoke on the topic of “Role of Hypoglycaemic Agents in the Management of Type 2 Diabetes”. He said type 2 Diabetes mellitus is caused by insulin resistance and characterized by progressive pancreatic beta-cell dysfunction. Management of T2DM includes Lifestyle modification, Treatment of Hyperglycaemia, Treatment of hypertension, Dyslipidaemia, Antiplatelet therapy and Prevention of complications. The management of patients with type 2 diabetes is oral hypoglycaemic agents. In the absence of contraindications, metformin is usually the initial pharmacologic therapy for most patients in the type 2 diabetes. He enumerated other groups of oral hypoglycaemic agents. He further said over time, most patients with type 2 diabetes will need insulin to control glucose. The focus of this lecture will be on efficacy, durability of action, hypoglycaemia, weight, GI side effects, use in renal failure and heart failure, effects on cardiovascular outcome and approximate cost per month on each drug of used.

Professor Shabeen Naz Masood, Professor of Obstetrics and Gynaecology at ISRA University Karachi talked on the topic of “Screening and Management of Diabetes in Pregnancy”. She defined Gestational Diabetes Mellitus as glucose intolerance that begins or is first diagnosed during pregnancy and usually resolves after delivery.

One in seven births is affected by gestational diabetes mellitus. Gestational diabetes mellitus is a substantial and growing health concern in many parts of the world. Pakistani population is especially vulnerable to developing this condition because of genetic, social, and environmental factors. Gestational diabetes has serious, long-term consequences for both baby and mother, including a predisposition to obesity, metabolic syndrome and diabetes later in life. Early detection and intervention can greatly improve outcomes for women with this condition and their babies.

She said that ideally every pregnant lady should be screened for diabetes but if it is not possible then the high risk group must be screened. These are women with significant glycosuria, gross obesity, family history of diabetes, past history of still births, neonatal deaths, repeated abortions, macrosomia, polyhydramnios, birth with congenital anomalies, She said screening should be done on 1st antenatal visit, if screen is negative the ideal time for 2nd screening is between 24-28 weeks of pregnancy.

She described target levels of blood sugar in Gestational Diabetes Mellitus as Fasting blood sugar up to 90mg/dl and 2 hours after breakfast up to 120mg/dl. Treatment includes diet control, physical activity. Insulin is the preferred treatment if not controlled with diet and physical activity. Pregnancy makes the body need more insulin to control levels of glucose in the body. Extra insulin may be needed for type 1 diabetes during pregnancy. She advised to check blood sugar frequently to maintain near – normal blood glucose levels. Good control of blood glucose before and during pregnancy reduces the risk of complications.

Professor Abdul Basit, Professor of Medicine and Director at Baqai Institute of Diabetology and Endocrinology, spoke on the topic of “Primary Prevention of Diabetes in Pakistan”. He said Pakistan is confronting a rapidly growing epidemic of diabetes. The country currently has 27.4 million people with diabetes.

The overall prevalence of impaired glucose tolerance has been found to be 14.4%. International Diabetes Federation apprehends that with the current trends, Pakistan will rank fourth in the world, according to number of diabetics, by the year 2030. This state of affairs is extremely alarming and stipulates an urgent need of pragmatic prevention. Diabetes-related chronic complications are also highly prevalent.

Considering the resource constraints and the low socio economic status prevailing in Pakistan, the treatment costs are extremely high, for example, Rs 2,700 is required to treat a diabetic foot ulcer. The study has shown that lifestyle intervention reduces the incidence of diabetes to 40% in impaired glucose individuals. To conclude, good health is a pre-requisite of good functional capacity and can be positively influenced by general awareness programs, healthy nutrition and regular physical activity which not only provides primary prevention to the rapidly growing diabetic epidemic but also to serious and debilitating complications of diabetes.

To enhance public awareness on diabetes for people with diabetes and their families an open session was organised in the afternoon. Prof Shera said diabetes emerged as a major health concern in Pakistan. Incidence of diabetes is rising worldwide. It is all due to unhealthy lifestyle and unawareness of disease.

He said type 1 diabetes cannot be prevented but type 2 diabetes can be preventable by adopting good lifestyle that is “Eat less-Walk more”. There is need to increase awareness at all levels of society. Chief guest Lt Gen (R) Moin Uddin Haider, HI (M) Former Governor Sindh/Former Federal Minister of Interior applauded Diabetic Association of Pakistan’s efforts towards the improvement of diabetes care in Pakistan. He emphasised on the prevention and best management of diabetes to avoid complications.

A panel of experts comprising Prof Samad Shera, Prof Abdul Basit and Prof Shabeen Naz Masood replied the questions raised by the audience. Prof Samad Shera thanked the chief guest and participants of making the programme a success. Later on chief guest inaugurated the pharmaceutical exhibition organised by the pharmaceutical companies.