Investment in diabetes education and diabetes prevention programs is extremely important-Dr. Samad Shera


DAP, NIDE, SIUT, PSE celebrate World Diabetes Day
Investment in diabetes education and
diabetes prevention programs is
extremely important-Dr. Samad Shera

Type 2 diabetes is a progressive disease with no
cure but it can be controlled - Dr. Najmul Islam

Diabesity epidemic in Pakistan is association
of diabetes with obesity - Prof. Zaman Sheikh

By Mubarak Ali

KARACHI: Every person affected by diabetes and pre-diabetes has the right to receive high quality treatment, education and care. Diabetes education is recognized as a key component of diabetes prevention and management. Investment in diabetes education and diabetes prevention is extremely important which will save money and deliver quality of life for people with diabetes and at high risk of diabetes. These views were expressed by Dr. Samad Shera, Secretary General Diabetic Association of Pakistan and Director WHO Collaborating Centre for diabetes in Pakistan while speaking at World Diabetes function organized by Diabetic Association of Pakistan held at a local hotel here on November 11, 2012. Theme of World Diabetes Day was “Diabetes Education and Prevention” and campaign slogan this year was “Protect our Future”.
Continuing Dr. Samad Shera said that diabetes is a chronic, debilitating and costly disease and currently more than 366 million people in the world are diagnosed with some form of diabetes. If immediate action is not taken to fight the diabetes, the number will rise to 552 million by 2030. Pakistan has also seen a sharp rise in the diabetes prevalence. Type 2 diabetes is on the rise in children mainly because of obesity which is due to increase in intake of energy, dense fast food and decreased physical activity. Children are our future and we have to protect them. Type 1 diabetes is rare in Pakistan. It is diagnosed early. At present Type 1 diabetes cannot be prevented. The only treatment is insulin injection which should be continued throughout life. Insulin is life saving drug for Type 1 diabetics.

Sitting on the dais during the World Diabetes Day meting held at NIDE
from (L to R) are Dr. Samad Shera, Prof. Umar Farooq Pro VC DUHS,
Prof. Zaman Sheikh and Prof. Masroor Principal DIMC.

Dr. Samad Shera further stated that it is the mission of DAP and all other bodies that no patient should die due to non availability of insulin. In eighty percent cases insulin is not properly injected. Preferred site of injection is abdominal wall due to easy access. Best way to inject insulin is to pinch the skin, do not use spirit, use appropriate size of needle (6MM-8MM) with 90 degree angle and change site to avoid lipodystrophy. He stressed on good control of diabetes to avoid complications and advised to eat less and walk more to avoid obesity at all cost. Diabetic educators have a very important role and we need trained and educated people for the management of diabetes, Dr. Samad Shera added. 

Dr. Najmul Islam Professor of Medicine & Consultant Endocrinologist at Aga Khan University Hospital talking about the Management of Type 2 Diabetes said that it is the most common type of diabetes across the world. China has the largest population of diabetics of approximately 90 million followed by India and USA. Pakistan has a diabetic population of more than 7 million and this figure is likely to double in the next 2 decades. Type 2 diabetes, he stated is a progressive disease and there is no cure for it but it can be controlled. It can be managed by lifestyle modification, which is very important, followed by various medications. He discussed different treatment option but stressed that if diabetes is not controlled with medications insulin should be started early rather than late. There is no ideal medication available for type 2 diabetes and Metformin is the first drug to be used in type 2 diabetes, he added.


Dr. Samad Shera, speaking at World Diabetes Day function organized by
Diabetic Association of Pakistan held at a local hotel here on November 11, 2012.

Talking about Diabetes and Pregnancy, Dr. Shabeen Naz Masood, Consultant Obstetrician and Gynecologist at Aga Khan Hospital said that over recent decade’s onset of diabetes has shifted down a generation to people of working age and more recently adolescents. As a consequence, more women of reproductive age have diabetes. Many of the risks leading to type-2 diabetes originate in the early stages of life, influenced by maternal under or over nutrition, diabetes in mother and fetal and postnatal environment. Carbohydrate intolerance results in hyperglycemia of variable severity with onset or first recognition during pregnancy gestational diabetes mellitus (GDM) arises and typically dissipates after delivery, she added.
A person with family history of diabetes or GDM in mother Dr. Shabeen said has a high risk to develop diabetes than those with no family history. Babies born with low birth weight who subsequently grow into normal or overweight adults are considered to be at a high risk of diabetes later in life. Rates of progression to Type 2 diabetes can be lowered to 25% if women stay active postpartum and achieve a weight closer to their ideal bodyweight. Women with previous GDM have 66% risk of recurrence of GDM in future pregnancies. Regarding management of diabetes in pregnancy, she said it should be tailored to the glycemic profile and acceptability to the individual woman and may include insulin and or oral hypoglycemia agents. Prior control of blood sugar is emphasized in all diabetic women who plan to have a baby. All pregnant especially with high risk factors like family history of diabetes, obesity birth defects in children, birth weight of babies more than 3.5kg, repeated miscarriages should be screened for diabetes, she further added.

Dr Khurram Shahid ,Dr. Qamar Masood ,Prof Zaman Sheikh, Dr Zaqir Alvi,
Dr Khalid Imam Dr. Iqbal, Mr. Shahzad and others photographed
at Karachi Press Club after a press conference in connection
with World Diabetes Day.

Professor M. Zaman Sheikh, Professor of Medicine and Director of National Institute of Diabetes and Endocrinology, DUHS Karachi, talking about Diabesity said that it is a new epidemic’ in Pakistan, which is actually association of diabetes and obesity. Increase in prevalence of diabetes is closely linked to marked increase in obesity. The health risks associated with obesity are diabetes, heart diseases, high cholesterol, stroke high blood pressure joints pain (osteoarthritis), psychological disorders such as depression and psychological difficulties due to social stigmatization. Diabesity causes tremendous increase in health costs. To decrease the epidemic of diabesity and to prevent it one should participate at least 60 minutes daily in moderate to vigorous physical activity. Water, low fat milk is the only beverages at home and school and avoid Fast Foods. Parents should become role models for their children and start life style changes early because their behavior is noticed closely by their children, Prof. Zaman added.
Public awareness session was also part of this program for the people with diabetes and their family members. Mr. Illahi Bukhsh Soomro chaired the session. Prof A. Samad Shera, Prof. Jaffer Naqvi, Prof. Saleh Memon, Prof. Zaman Sheikh and Prof. Najmul Islam answered the questions from the participants.

Meeting at NIDE

Prof. M. Umer Farooq, Pro Vice Chancellor, DUHS, was the chief guest at the World Diabetic Day organized by National Institute of Diabetes and Endocrinology (NIDE) at DUHS Ojha Campus on November 13, 2012. Speaking at the occasion Prof. M. Umer Farooq said preventive type of education must be given preference. Diabetes if not controlled could affect every part of the body. Control of diabetes is must to avoid its complications. Proper walk, lifestyle modification is very essential for the diabetes control.
Prof. M. Zaman Sheikh, in his welcome address said that NIDE has all the facilities to manage diabetic patients, which includes expert consultation, screening for relative and individual at risk, basic lab facilities, Eye clinic, and deals in all type of endocrine disorders besides Diabetic Educator Nurse. NIDE has started MSc programme in diabetes and endocrinology which is a two year program and it has been recognized by PM&DC. In Pakistan, mean health expenditure on Diabetes is only 24 US Dollar which is very low as compared to other countries, he added.
Talking about the new modalities for the management of diabetes, Prof. Zaman Sheikh stated that new insulin pumps in small size with novel features will be in the market which can be programmed to deliver insulin based on individual’s life style. Prof. Zaman Shaikh stressed on identifying the variable clinical presentations of the disease and the correct biochemical values of diagnosis and discussed the management guidelines as described by the IDF.
Prof. Samad Shera Secretary General Diabetic Association of Pakistan Talking about Insulin Therapy said that Insulin is one of the four major inventions. It is a life saving drug. All patients with type 1 diabetes have to use insulin from day one of their diagnosis till the last day of their life to sustain their life. Insulin is also required in type 2 diabetic patients when oral drugs fail in action due to progressive nature of the disease. There are so many misconceptions about insulin therapy. It is thought as the last stage of treatment, actually it is first stage of the management in diabetic patients.

Meeting at SIUT

World Diabetes Day was also observed at Sindh Institute of Urology and Transplantation (SIUT) on 14th November Prof. Adib Rizvi, Director SIUT in his inaugural address said that Diabetes is a major cause of morbidity and mortality and the commonest cause of renal Failure. Largest population of patients undergoing haemodialysis at SIUT develop renal failure because of Diabetes, he added. He stressed on identification of the disorder and control in the early stages which would prevent the long term complications thereby reducing the economic burden.
Dr. Fatema Jawad, the head of Diabetes section at SIUT spoke on the campaign of the International Diabetes Federation, “Diabetes: Protect our Future”. Diabetes has been recognized by the United Nation as a debilitating disease and a Resolution was passed in December 2006, urging all member nations to develop policies and guidelines for the prevention and treatment of the disorder. The importance of diabetes education is imperative as this helps to reduce the incidence and complications of diabetes. Awareness has to be built among old and young, women and men, rich and poor about the warning signs and risk factors for diabetes. In Pakistan there are about 6.3 million people with diabetes and if preventive measures are not taken the figure may reach a record high of 11.4 million by 2030, she added.
Dr. Munawar Abbas, Elaborated on the classification of diabetes. Type 1 Diabetes was insulin dependent caused by the destruction of the insulin producing cells of pancreas. Type 2 diabetes is more commonly encountered with the core defect being insulin resistance mainly caused by obesity. Diabetes in pregnancy is a threat for the unborn baby if not treated adequately. Diabetes is diagnosed by a blood glucose test and a level of 200mg or above is a sure indicator of Diabetes.
Dr. Imran Ali discussed the chronic complications of diabetes. A diabetic had four times a higher risk for a heart attack. Blindness was another serious complication caused by Diabetic Retinopathy, whereas diabetes was the leading cause of Kidney failure. Lower limb amputation due to gangrene was 15 to 40 times more common in people with diabetes.
Ms. Kehkashan Hossain, addressing the participants said that all diabetics must have healthy diet. Avoidance of pure sugars, high fiber with low fat is the recommendation. Regular meal in small size and 30 minutes exercise were essential for maintaining weight and normal blood fat and glucose. Diabetics should choose more high fiber foods, should eat at regular set times and do not skip breakfast. Every diabetic should receive medical, nutrition therapy based on their requirement, she concluded.
A public awareness session was also organized at the occasion. Dr. Akhtar Jamal, Dr. Abdal, Dr. Niala, Dr. Ali, Dr. Fatema Jawad, Dr. Shoaib, Dr. Rubina and Ms. Kehkshan were the panelists. Diabetes screening camp was also part of this activity where blood glucose testing, blood pressure checking and diet counseling facilities were provided.

Pakistan Endocrine Society (PES)
& PharmEvo Press conference

Dr. Qamar Masood General Secretary of Pakistan Endocrine Society (PES) along with Prof Zaman Sheikh, Dr Zaqir Alvi, Dr Khalid Imam and Dr Khurram Shahid addressed a press conference at Karachi Press Club on 14 November. Diabetes, Dr. Qamar Masood stated has become common disease among people, it is impossible to get rid from this disease but it can be controlled and a patient of diabetes can spend normal life without complications. It was thought that diabetes affects those who have family history but now this scenario had also become common that diabetes hit kids before striking parents. It is necessary for every person to go for check-up at least once in a year so that person can tackle disease from at its initial stage, he added.
He further said that pre-diabetes was a stage before diabetes, in which person could not be called normal or diabetes patient but from this stage he/she could deal and control with disease easily. Talking about causes for increase in diabetes patients, Dr. Masood referred to new era of life style, where people prefer vehicle rather than walk. It is necessary for a diabetes patient to manage blood pressure below from 80-130, HbA1C should be maintained at 7% and cholesterol should not be more than 100. Every person should also go for medical test of eyes, feet, lungs and liver once in a year. he added.
Dr. Khurram Shahid said, Diabetes is most expensive disease, as every year almost 71 billion rupees are being spent on it and it is misconception among people that patient of diabetes cannot enjoy taste of delicious foods item. They could eat every kind of food in limited quantity but without compromising on food quality. Insulin could be given to patient from the beginning of disease without any adverse effects. It is incorrect that anti-diabetics affect lungs and liver. Diabetes cannot be eliminated but could be controlled easily.
Prof Zaman Sheikh said that diabetes could be controlled by medicine and exercise, however, patient could also take insulin as there was no harm in it. It is a disease which can cause blindness, failure of lungs, feet disability, hearts and brain disease. Dr Zakir Alvi and Dr Khalid Imam also spoke on the occasion & appreciated role of PharmEvo for creating awareness & education about different diseases.

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