Metformin is usually the initial drug therapy for people with type 2 diabetes-Yakoob Ahmedani


 World Diabetes Day meeting by DAP

Metformin is usually the initial drug
therapy for people with type 2
diabetes-Yakoob Ahmedani

Further therapy should be individualized
based upon patient characteristics

Healthy Lifestyle is an important part of
diabetes management of DM-Samad Shera

About 50% GDM patients develop type 2 diabetes
within 5-10 years-Shabeen Naz Masood

KARACHI: Diabetic Association of Pakistan and WHO Collaborating Centre Karachi organized a meeting on Nov. 18, 2018 to celebrate the World Diabetes Day. The meeting was addressed by a number of eminent diabetologists which included Dr. Samad Shera, Prof. Zaman Sheikh, Prof. Yakoob Ahmedani, Prof. Shabeen Naz Masood and Prof. Asher Fawwad.

Speaking at the occasion Dr. A. Samad Shera, Secretary General DAP introduced the theme of the World Diabetes Day “The Family and Diabetes”. Diabetes, he said, was one of the major challenges of this century. 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 stated that Type 1 diabetes can not be prevented, a Healthy Lifestyle is an important part of effective management of the disease. However, 80% of Type 2 diabetes can be prevented by healthy eating and regular physical activity for which a 30 minutes brisk walk daily before meal is recommended.

Dr. A. Samad Shera, Prof. Zaman Shaikh, Prof. Muhammad Yakoob Ahmedani, Prof. Shabeen Naz Masood
and Dr. Asher Fawwad speaking at the World Diabetes Day meeting 
organized by
Diabetic Association of Pakistan and WHO Collaborating Centre at Karachi on 18th November, 2018.

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 Shaikh from SSIDE talked on “Life Style Management and Diabetes”. He said that childhood obesity should never be taken lightly as it may be a predisposing factor for many diseases in future. Parents, he opined, should act as a role model for their children in order to prevent obesity. He also laid emphasis on healthy diet, losing excessive body weight and avoiding smoking. Healthy breakfast must be taken to stabilize the metabolism of body. Fruits must be taken in raw form and not as juice. Fish is the best source of protein and be taken twice a week. Chicken is also healthy protein but fried chicken should be avoided. Dry fruits contain mono unsaturated fat and are good for health. Anxiety and tension make sugar out of control due to production of stress hormones in the body.

Prof. Muhammad Yakoob Ahmedani from BIDE discussed “Role of Hypoglycemic Agents in the Management of Type 2 Diabetes”. 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 people with type 2 diabetes include education, with emphasis on life style changes including diet, exercise and weight reduction when appropriate. In the absence of contraindications Metformin is usually the initial pharmacologic therapy for most people 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 result of home glucose monitoring).

Target A1c levels in people 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-diabetes medications at our disposal. After Metformin in Pakistan the next two medications which can be added are from Sulphonylureas, DPP-IV inhibitor groups and SGLT 2 inhibitor.

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.

Prof. Shabeen Naz Masood, Professor of Obstetrics and Gynecology at ISRA University Karachi talked on the topic of “Management of Hyperglycemia 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. One in seven births is affected by gestational diabetes. Approximately half of women with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery. 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.

Pregnancy makes the body need more insulin to control levels of glucose in the body. Treatment includes diet control, physical activity. Insulin is the preferred treatment if not controlled with diet and physical activity. 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 miscarriage, stillbirth, macrosomia, congenital malformation and neonatal deaths.

Dr. Asher Fawwad, from Baqai Medical University talked on “National Diabetes Survey of Pakistan 2016-2017” and “National Guidelines for the management of Diabetes”. Diabetes-related complications, he said, are the major cause of premature deaths in the world, with a death occurring in every six seconds due to the consequences of diabetes. The first National Diabetes Survey of Pakistan (1st NDSP) was done by the Diabetic Association of Pakistan (DAP) in collaboration with WHO. The 2nd NDSP is a joint collaboration of Ministry of National Health Services, Regulation and Coordination, PHRC, DAP and Baqai Institute of Diabetology and Endocrinology, Baqai Medical University. The aim of this survey was to ascertain prevalence of diabetes, pre-diabetes and associated risk factors at the national and provincial levels. This 2nd NDSP reported an overall age-adjusted weighted prevalence of diabetes as 26.3%, of which 19.2% had known diabetes and 7.1% were newly diagnosed people with diabetes. Prevalence of diabetes in urban and rural areas was 28.3% and 25.3%, respectively.

Giving details of the National Guidelines for the management of Diabetes he pointed out that these guidelines include special considerations to affordability and availability of medicines and the consensus statements by the Advisory Board for the Care of Diabetes (ABCD). These guidelines also provide a key to establish a referral system from primary to secondary and tertiary care and vice versa. Special emphasis has been laid to develop the concept of multi-disciplinary team for the management of diabetes; hence recommendations on nutrition, physical exercise and diabetes education have been included. These recommendations will be revised every two years. Ramadan and diabetes guidelines have been developed. Diabetic foot guidelines by Pakistan Working Group on Diabetic Foot (PWGDF) and Gestational Diabetes Mellitus (GDM) guidelines are being developed by the GDM advocacy board. The outcomes of these projects are expected to be available by 2018.

The afternoon Public Session was for the people with diabetes and their family members.

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