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

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DAP celebrates World Diabetes Day

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

Trained Diabetologist is the Gatekeeper to
decide amputation of Diabetic Foot - Prof. Basit

KARACHI: Diabetes is a chronic, debilitating and costly disease. Currently there are 382 million people living with diabetes worldwide. By the year 2035 five hundred ninety two million will be suffering from this disease. This was stated by Dr. A. Samad Shera, Secretary General Diabetic Association of Pakistan in his welcome address at World Diabetes Day function organized by Diabetic Association of Pakistan and WHO Collaborating Centre Karachi at a local hotel here on November 23, 2014. Theme of the World Diabetes Day was “Healthy Living and Diabetes” and campaign slogan this year was “Protect Our Future”.

Dr. Samad Shera further stated that about 316 million people are currently at high risk of development of Type 2 Diabetes. 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 can not be prevented but most cases of Type 2 diabetes is preventable and serious complications of diabetes can be avoided through change in healthy lifestyle and living environments. Healthy lifestyle comprised of healthy eating and physical fitness. A well-balanced diet-containing a variety of foods in appropriate portions, high in carbohydrates and low in saturated fat and sodium, combined with regular physical activity, is key to healthy outcomes and a very important part of preventing, treating and managing diabetes. Talking about Insulin Therapy Dr. Shera said that 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. Abdul Basit Professor of Medicine at Baqai Institute of Diabetes and Endocrinology giving update about Diabetic Foot said that 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. Amputation decision should be taken at a tertiary care center and not by a GP. Trained Diabetologist is the Gatekeeper to decide amputation of Diabetic Foot. Usually it is team decision. Prof. Basit said that so far BIDE has trained over hundred Diabetic Foot Care Assistants besides work is going on for National Health Network for Diabetic control programme and for Master’s in Podiatry We suggest that the physicians should look at the patient as a whole and not foot only. They must have a holistic approach. Early start of the antibiotics is very important, he added. 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. To prevent foot amputation trained doctors are required besides awareness of this disease and our target should be to prevent deaths and prevent amputation. Pyodine dressings is still cost effective, honey can be used but not all honey, only medicated honey should be used, he added.

Dr. Najmul Islam, Professor of Medicine & Consultant Endocrinologist at Aga Khan University, talking about the Management of Type 2 Diabetes said that lifestyle changes including diet, exercise, and weight reduction and education is very important factor to control diabetes Metformin is usually the number one drug for the management of diabetes which is effective and widely used. Sulphonylurea group, is one of the most widely used drug for management of diabetes all over the World. He also discussed the advantages and disadvantages of 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. Metformin, he stated, is the drug of choice , it is cost effective and have the same advantages of DPPIV drugs. New drugs have benefits if proved, we should use them if patients can afford it.

Dr. Shabeen Naz Masood, Consultant Obstetrician and Gynecologist talked about Diabetes and Pregnancy. She said Gestational Diabetes Mellitus is characterized by glucose intolerance that begins or is first diagnosed during pregnancy and usually resolves after delivery. 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 added.

Mr. Illahi Bukhsh Soomro, Patron of the Diabetic Association of Pakistan chaired the Public awareness Session. A panel of experts replied the questions asked by the participants.