PES to promote Evidence Based Medicine, ethical practice & enhance patient care - Prof. Khursheed Khan


Pakistan Endocrine Society’s 17th annual conference
PES to promote Evidence Based 
Medicine, ethical practice & enhance 
patient care - Prof. Khursheed Khan
Pakistan needs 30 tertiary care & 300 secondary
care centers to control diabetes - Prof. A. Basit

KARACHI: Pakistan Endocrine Society aims to promote Evidence Based Medicine, Ethical Practice, enhance patient care and knowledge of its members through education besides emphasizing the importance of preventive medicine. This was stated by Prof. Khursheed Khan President of Pakistan Endocrine Society while speaking in the inaugural session of the 17th Annual Pakistan Endocrine Society conference held here from 15-17 November 2019. Sharing the academic activities of PES for the last few months since he took over as President, PES he said, holds regular Regional Club meetings in endocrinology. We have had Diabetes Prevention programme all over the country. We are concentrating on Patient Education material as well.

Continuing Prof. Khursheed Khan said that we also had meeting with our corporate members and provided travel grants to our Fellows, facilitated participation in the postgraduate’s courses in diabetes. We have launched the dynamic website of the society. As regular CME activities we have organized Updates in Endocrinology at Karachi and Lahore, Sahiwal, Wah Cantt, Nowshera, Hyderabad and many other cities where PES members actively participated. We are holding Regional Club meetings and an ambitious Diabetes Prevention Programme is being planned. It is well known that only 30% of the diagnosed diabetes patients achieve their target blood glucose control. We are planning to reach out to the schools and the community for prevention of diabetes mellitus. We are working to increase awareness about the importance of life style modifications. We are establishing alliance with the medical community and with the help of pharma industry, we are trying to realize our objectives, he added.

First Plenary Session

Prof. Abdul Basit from Baqai Institute of Diabetes and Endocrinology (BIDE) was the first speaker in this session which was jointly chaired by Prof. Naeem ul Haque and Prof.Khursheed Khan. Prof. Basit highlighted the salient features of Developing National Diabetes Action Plan and gave historical background of various surveys done in the past regarding prevalence of diabetes. While the first survey in 1998 has showed the prevalence of 11.4% one of the most recent surveys done by BIDE with other stake holders showed that its prevalence was 26.3% while another survey performed by Prof.A.H.Amar and his colleagues showed the prevalence of 16.98%. He also referred to the PROMPT Guidelines prepared by BIDE for primary and secondary prevention, Diploma in Diabetes for Family Physicians started by BIDE in which they have so far trained 430 doctors. Pakistan Endocrine Society, he further stated has so far trained 34 Fellows. BIDE has also established the Pakistan Working Group for Diabetic Foot, helped establish 115 Diabetic Foot Clinics which has helped reduce amputation by almost 50%.

Continuing Prof. Basit said that we need at least ten centers for prevention of foot ulcers. We have trained three hundred diabetes educators besides training three thousand nurses in diabetes care. National Associate of Diabetes Educators of Pakistan (NADEP) was established in 2010, we helped develop and establish Rapid Screening Tool for diabetes. We have also completed a Gestational Diabetes Project wherein 11,430 pregnant women were screened, we are part of the diabetes care programme at the national level. We need thirty tertiary care and three hundred secondary care centers all over the country. We have linked ten centers whereby we discuss important cases through video link, we are using Telemedicine for diagnosing the cases in remote areas. We have developed low cost Footwear which cost from Rs. Two thousand onward, three thousand Type-I patients are getting free insulin, we have trained 184 diabetes educators. In collaboration with EHAD Clinics, diabetes care is being promoted. We are collaborating with Indus Hospital and OMI. We are working on a project to start MSc in Non-communicable diseases in collaboration with multiple stake holders. We have set up Diabetes Registry with the name of DROP, he remarked.

Dr. Amir Sharif from Aga Khan University Hospital was the next speaker in this session who talked about surgical management of obesity. He discussed the concept of Serendipity which means occurrence of an event by chance in a happy way. Obesity, he further stated, has become an epidemic and bariatric surgery was one of the treatment modalities to manage this disease. With time it has now been very well established that we do need bariatric surgery facilities. Like all other countries, obesity is also increasing in Pakistan. Studies have showed that almost 52% of women in Pakistan are either overweight or suffer from obesity.

Tracing the history he recalled that bariatric surgery in fact started in the 10th century. In 1954 we saw short gut syndrome while in 1967 the first gastric bypass operation was performed by dividing the stomach. This was followed by Gastroplasties performed in 1971. Bands were used in 1980 while in 1983 vertical cut pouch gastric bypass was performed. Since 1990s, mini gastric bypass is being practiced which is now the preferred choice. Such procedures are now becoming popular every day. He then talked about Sleeve Gastrectomy stand-alone operation. Surgery for diabetes has improved metabolic syndrome which has been shown in many studies. While bariatric surgery helps reduce weight, metabolic surgery helps improve many metabolic conditions and sometimes the patients suffering from diabetes are also off these medications. He also quoted numerous studies to show that bariatric surgery help improve heart diseases, hypertension, type2 diabetes, dementia, cancer, PCOS, NASH etc., and it is not a new idea. In United States, two hundred thousand patients have had bariatric surgery and till 2013, over five hundred thousand operations have been performed globally as reported in literature. There are clearly laid down indications for bariatric surgery, careful selection of patients is important for good results. In future new surgical options, he opined, will keep on evolving, endoscopic therapies will keep on knocking the door. He also referred to Endo barriers, vagal nerve/gastric electrical stimulation. All patients with BMI of 35 and BMI of 30 with obesity and co-morbid related conditions will benefit from surgery, he added.

There were off site workshops prior to the conference on Generating Evidence in Endocrinology at BIDE facilitated by Dr. Musarrat Riaz and Dr. Masood Jawaid, Endocrine Board Review Course at JPMC by Dr. Sobia Sabir, Pre-conference Weill Cornell Diabetes Course by Dr. Abbas Raza and Ultrasound of Thyroid and Parathyroid at JPMC facilitated by Prof. Uzma Khan. The inaugural as well as plenary session were moderated by Dr. Musarrat Riaz from BIDE/Baqai Medical University.