World Diabetes Day is celebrated every year on November 14, at global level. The Diabetic Association of Pakistan and WHO Collaborating Centre Karachi observed it on November 15, at local hotel. The scientific session in the morning was meant for the doctors.
The session started with the welcome address by Professor A. Samad Shera, Secretary General Diabetic Association of Pakistan, Honorary President International Diabetes Federation, Founder President Diabetes in Asia Study Group and Director WHO Collaborating Centre for Diabetes. He introduced the theme of the World Diabetes Day "Healthy Living and Diabetes" and campaign slogan this year "Healthy Eating and Diabetes". He said diabetes is a chronic, debilitating and costly disease. World Diabetes Day provides the opportunity to improve care for the many millions living with diabetes and to encourage governments to do more to prevent diabetes in the many more at risk. He further said currently there are 387 million people living with diabetes world-wide. By 2035, the number will rise to 592 million. Diabetes had resulted 5 million deaths in 2015, every 6 seconds a person dies from diabetes and diabetes related complications. Pakistan has also seen a sharp rise in the diabetes prevalence. These facts and figures reiterate the importance of urgent action.
He further said Type 1 diabetes can not be prevented; A healthy lifestyle is an important part of effective management of the disease. 70 percent of Type 2 diabetes can be prevented by healthy eating and regular physical activity (30 minutes brisk walk daily before meal). Healthy diet contains leafy vegetables, fresh fruits, whole grains, lean meat, un-sweetened yogurt and nuts etc. Encouraging healthy eating habits in young children is key to halting the rise of diabetes epidemic.
Discussing Insulin Therapy he said Type 1 diabetes is rare in Pakistan and it is diagnosed early. The only treatment is Insulin injection which should be continued throughout life. Insulin is life saving drug for type 1 diabetes. He stressed on good control of diabetes to avoid complications.
Dr Najmul Islam, Professor of Medicine & Consultant Endocrinologist at Aga Khan University, spoke on the topic of Management of Type 2 Diabetes: Treatment Options and Clinical Guidelines. He said Type 2 Diabetes is the commonest variety of diabetes in our population as well as the rest of the world. The treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate.
In the absence of contra indications, Metformin is usually the initial pharmacologic therapy for most patients with type 2 diabetes.
Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1C result (and the results of home glucose monitoring).
Target A1C levels in patients with type 2 diabetes should be tailored to the individual, balancing the improvement in micro vascular complications with the risk of hypoglycemia.
The choice of further therapy after Metformin should be individualised based upon patient characteristics, preferences, and cost from an armamentarium of anti-diabetic medications at our disposal.
After Metformin in Pakistan the next two medications which can be added are from Sulphonylurea or DPPIV Inhibitor groups.
The risk of hypoglycemia, which may lead to impaired cognition and function, is substantially increased in older adults. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in older adults.
Talking on the topic of "Diabetic Foot" Professor Abdul Basit Professor of Medicine Baqai Institute of Diabetes and Endocrinology said foot complications are common in people with diabetes. Every 30 seconds a lower limb is lost as a consequence of diabetes mellitus. 25% of people with Type 1 and Type 2 diabetes will develop one or more foot ulcers in their life time, 10% of them will go to have a major lower limb amputation. 50% of foot ulcers and amputations can be prevented by early identification and education. Principal causative factors are peripheral neuropathy, vascular compromise, ulceration and infection. These factors often associated with trauma or foot deformity lead to an increase risk of lower limb amputation. Regarding prevention he said there should be proper foot ware, no bare foot walking, daily washing of cotton socks and examination of shoes before wearing. Foot examination should be a part of every clinic visit.
Dr Shabeen Naz Masood renowned Consultant Obstetrician and Gynecologist at Aga Khan Hospital for Women talked on the topic of "Gestational Diabetes Mellitus". She said Gestational Diabetes Mellitus is characterised by 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.
Professor Zaman Sheikh Director Diabetes and Endocrinology Department of Sir Syed Hospital talked on the topic of "Lifestyle and Diabetes". He said lifestyle changes are often advised for people at high risk of diabetes and those who are newly diagnosed with type 2 diabetes to help manage their diabetes. Diabetes Prevention Program reported that changes in diet and physical activity resulted in a large reduction in incidence of type 2 diabetes than medication alone. Many intervention trials showing the benefits of lifestyle change for health, yet prevention programs and healthier behaviours are not been widely adopted. Between 1999 and 2010 the prevalence of hyperglycemia increased from 12.9 to 19.9%. The portion of the population having waist size above the recommended threshold also increased from 45.5 to 56.1% indicating a rise in the abdominal obesity. The behaviours that are recommended for the prevention of diabetes include a balancing diet rich in fruits, vegetables, fibers, un-saturated fats, lean meats and low nutrients foods, engaging in regular moderate to vigorous physical activity, avoiding alcohol and tobacco. He stressed on education which is an important component of the diabetes management and prevention.
The afternoon Public Session was for the people with diabetes and their family members. Professor A. Samad Shera introduced the theme of the day. The alarming increased in prevalence impose heavy burden on society in the form of morbidity, early mortality and high health care costs unless urgent and appropriate measures are taken to meet challenges. He stressed for adopting healthy lifestyle and awareness about disease. His concluding message was "To do nothing is not an option". Act to change your lifestyle today; it will help to change the world tomorrow. "Eat less - Walk more". Encourage healthy dietary habits. Illahi Bukhsh Soomro, Patron of the Diabetic Association of Pakistan chaired the session. He appreciated the mission of Diabetic Association of Pakistan and emphasised on the prevention and best management of diabetes to avoid complications.
A panel of experts which include Professor A. Samad Shera, Professor Jaffer Naqvi, Professor Saleh Memon, Professor Abdul Basit, Professor Zaman Sheikh and Professor Najmul Islam answered the questions asked by the audience.-PR
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