Diabetes is a chronic, debilitating and costly disease-Dr. Samad Shera



Diabetes is a chronic, debilitating and
costly  disease- Dr. Samad Shera

50% of foot ulcers and amputations can be prevented
by early identification and education. Prof. Abdul Basit

 Patient’s education is an important component of
Diabetes Management and prevention, Prof. Zaman Sheikh

KARACHI: Diabetes is a chronic, debilitating and costly disease and currently there are 387 million people living with diabetes worldwide. By 2035, the number will rise to 592 million. Diabetes had resulted in five million deaths in 2015 and every six seconds a person dies from diabetes and diabetes related complications. This was stated by Dr. A. Samad Shera, Secretary General Diabetic Association of Pakistan and Director WHO Collaborating Centre for Diabetes while speaking at World Diabetes Day  function organized by DAP at a local hotel here on November 15, 2015.

Continuing Dr. Samad Shera said that Pakistan has also seen a sharp rise in the diabetes prevalence. These facts and figures reiterate the importance of urgent action. 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. Type 1 diabetes Dr.Samad Shera  stated cannot be prevented. A Healthy Lifestyle is an important part of effective management of the disease. Almost 70 % 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.

Prof. Zaman Sheikh Director Diabetes and Endocrinology Department of Sir Syed Hospital talked about Lifestyle and Diabetes”. Lifestyle changes, he said, 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 has reported that changes in diet and physical activity resulted in a large reduction in incidence of type 2 diabetes than medication alone. 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 behaviors 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, Prof. Zaman Sheikh, added.

Prof. Najmul Islam from Aga Khan University discussed the Management of Type 2 Diabetes,   treatment options and clinical guidelines. Type 2 Diabetes, he pointed out, 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 contraindications, 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 HBA1C result. 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 individualized, 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 elderly adults. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in old age patients, he added.

Dr. Shabeen Naz Masood talking about Gestational Diabetes Mellitus stated that (GDS) is characterized 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, she concluded.  

Prof. Abdul Basit Director Baqai Institute of Diabetes and Endocrinology talking about Diabetic Foot said that  foot complications are common in people with diabetes. Every 30 seconds a lower limb is lost as a consequence of diabetes mellitus. About 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. About 50% of foot ulcers and amputations can be prevented by early identification and education. Principal causative factors for foot ulcers are peripheral neuropathy, vascular compromise, ulceration and infection. These factors are often associated with trauma or foot deformity which lead to an increase risk of lower limb amputation.  As regards prevention 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, he further added.

Mr. Illahi Bakhsh Soomro, Patron of the Diabetic Association of Pakistan chaired the public awareness session. A panel of experts which included Dr. A. Samad Shera, Prof. Jaffer Naqvi, Prof. Saleh Memon, Prof. Abdul Basit, Prof. Zaman Sheikh and Prof. Najmul Islam answered the questions asked by the audience.

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