Patient education plays an important role in diabetes management- Dr. Samad Shera


Diabetes Education Conference by NADEP

Patient education plays an important role
in diabetes management - Dr. Samad Shera
 A new era of diabetes care has started in Pakistan - Prof. Abdul Basit
Primary objective of NADEP is to educate and raise awareness
of Diabetes amongst Healthcare Professionals
and Community - Dr. Musarrat Riaz

By Mubarak Ali

KARACHI: Knowledge without use is of no use. We should learn to implement what we have learnt. Make use of the services and efforts of Prof. Abdul Basit and his team for the prevention and management of diabetes in Pakistan. This was stated by Dr. A. Samad Shera, General Secretary Diabetic Association of Pakistan who was the chief guest in the inaugural session in First Diabetes Education Conference in Pakistan held at Karachi from February 21-22, 2015. It was jointly organized by National Association of Diabetes Educators of Pakistan (NADEP) in collaboration with Baqai Institute of Diabetology & Endocrinology (Baqai Medical University) which is a pioneer institute in the field of Diabetes Education and is one of the only eight IDF recognized centers of diabetes education worldwide. It was very largely attended by Doctors nurses, dietitians, diabetes educators and Pharmacists.

Sitting on the dais during the First Diabetes Education Conference in Pakistan
held at Karachi from February 21-22, 2015 from (L to R) are Dr. Musarrat Riaz
(President NADEP), Dr.  A. Samad Shera (Chief Guest), Prof. Abdul Basit
(Director BIDE) and Dr. Muhammad Saif Ul Haque.

Prof. Abdul Basit, an eminent Diabetologist and Director of Baqai Institute of Diabetology and Endocrinology (BIDE) affiliated with Baqai Medical University addressing the participants said that a new era of diabetes care has started in Pakistan . We are sending two nurses for training to UK and their travel expense will be born by BIDE while Foundation of European Nurses in Diabetes (FEND) will provide training and other facilities. After one year training these nurses will come back and train our nurses and we will have a comprehensive nurses training program in Pakistan. Diabetes Registry is very important and we are working on it. Insulin My Life is yet another programme run and managed by BIDE. Continuing Prof. Basit said that we have established thirty four centers in Sindh province and over two thousand children in the province were now getting free insulin. We have now established Insulin Bank to ensure sustained insulin supply to poor deserving children suffering from Type-I diabetes. Screening programme has also started for OBS & Gynea and will have Diabetes Gestational Plan in three years. Diabetes Leadership Forum with the help of M/s NOVO has been  presented to the Government and he hoped it will get approval. We have trained diabetes educators and we are one of the eight IDF recognized diabetes education centers in the world. BIDE introduced diabetic foot care programe and have succeeded in reduction of 50% Foot amputation. Management of diabetes, Prof. Basit said requires a multidisciplinary team. We in Pakistan need to give emphasis on primary prevention of diabetes, address issues of childhood obesity and ensure increased collaboration with more and more institutions, organizations. We must aim at HBA1C control, early use of Insulin, blood pressure control, control of lipids which was extremely important as regards diabetes care in future, Prof. Basit concluded.

Dr. Musarrat Riaz, President NADEP in her welcome address said that NADEP is a national body not only of doctors but of nurses, dietitians, diabetes educators, Pharmacists and other allied health care professionals and their families. Our primary objective is to educate and raise awareness of diabetes amongst our health care professionals and in the community. NADEP was established in the year 2010 with the objective to promote standardization, development and delivery of structured diabetes educational Programs, to set up national and international collaboration for diabetes educational activities in Pakistan and to organize meeting, workshops and conferences in diabetes education and related disciplines. Prof. Rubina Hakeem, a renowned academician, was the first president under whose guidance we started our journey. In the beginning we arranged public awareness programs, organized walks, introduced different types of workshops for health care professionals and developed educational materials which are available free of cost to patients and health care professionals, she added.

Continuing Dr. Musarrat said that we have participated in various projects collaborating with BIDE and World Diabetic Federation like Insulin my life regarding type 1 diabetes and Ramadan study group.Similarly we help in formulating guidelines regarding diabetes & Ramadan. Now we are collaborating in another very important but neglected area that is gestational diabetes projectfocusing on increasing the awareness regarding gestational diabetes among health care professionals as well as in the community. NADEP has initiated a project by the name of “Stop Diabetes in Pakistan” focusing on primary prevention of diabetes at community level. Although designed for the whole community we are specially targeting school children and young adults through his project, she further added. Another important achievement is the development of local guidelines regarding various aspects of diabetes and its management. The first set of guidelines regarding self-monitoring of blood glucose levels by the name of BRIGHT guidelineshas already been published which was endorsed by Advisory Board for the Care of Diabetes (ABCD). This board consists of leading diabetologists from all over Pakistan and currently we are in the process of developing further guidelines regarding Type- 2 diabetes which will shortly be available, Dr Musarrat added.

Dr. Musarrat Riaz further stated that Pakistan being a developing country, we are facing many challenges. On one hand we are still struggling to control communicable diseases like tuberculosis, hepatitis and polio despite being on the priority list of Government and on the other hand non communicable diseases such as Diabetes, hypertension, cardiovascular diseases and obesity are increasing at an alarming rate. Currently Pakistan has an estimated seven million people with diabetes and another seven million are on the verge of developing diabetes if no preventive measures are taken. We are also aware that Pakistan with its limited resources, underdeveloped healthcare system and financial constraints is unable to provide the desired level of care to majority of people with diabetes. Therefore the only cost effective way is through educating the masses regarding primary prevention and all our efforts should be focused on preventing rather than only treating the disease.

The theme of the symposium “Diabetes Education for All” Dr. Musarrat said hasvery nicely summarizes the ideology and philosophy of our organization. When we say Diabetes Education for all we do not mean only health care professionals but also patients with diabetes, their families and the community as a whole, she concluded.

Ms. Anne-Marie Felton, President FEND from London who delivered her talk online, discussed the main features of the Policy Puzzle 4th Edition. It is  estimated that  prevalence of diabetes in Europe is 8.5% (adult population) ranging from 2.4% in Moldova to nearly 15% in Turkey. Nationally reported prevalence’s are both below and above IDF Atlas figures. It is difficult to compare national data due to varying methodology. National Diabetes Registry she stated is important tool to follow the evolution of the diabetes. There is increase in absolute number of registers from 23 to 30 but large majority, 83%, is reported to be incomplete. The Policy Puzzle’s country profiles contain a snapshot of diabetes policies, national diabetes plans, the approach to prevention and the future development. For care provision, it focused on education, renal and eye care, gestational diabetes care and role of Diabetes specialist nursing.

Key findings of Policy Puzzle, Ms. Anne-Marie said, present in all countries, using a mixture of international and national guidelines. However, there is widespread lack of implementation and monitoring. For Diabetes and Pregnancy data collection on prevalence and outcomes is not well reported. Diabetes screening in pregnancy is widely reported and majority of countries screen all pregnant women. Eye screening services availability is also well reported (70% of countries), with 75% recommending annual screening but there is issue with coverage of screening and equal access to treatment, she added. It is encouraging to see that nurses play a crucial role in patient education for self-management. Over 60% of countries are currently implementing a national plan covering diabetes. The issue of primary prevention is well recognized, with 95% of the countries covering the main risk factors of diabetes. In many countries, prevention policies for diabetes are part of an overall prevention policy and strategy, she added.

The Way forward Anne-Marie stated depends on Diabetes Register. We should maintain and increase the effort to routinely collect data on diabetes. Improve data collection and address barriers to screening of Pregnancy and Diabetes,Implement and monitor national diabetes plans. Address gaps regarding inclusiveness, implementation, monitoring and evaluation of prevention plans. Guidelines must be there tomonitor, implementation and build a culture of responsibility and accountability, leading to improved diabetes care. Improvement is needed in availability and accessibility to screening and interventions of eye care, access to screening and make advanced treatment options available for renal care besides.  We should recognize the professional status of Diabetes Specialist Nursing and provide accredited academic training and establish political advocacy groups she concluded.

Prof. Angus Forbes, from Foundation of European Nurses in Diabetes (FEND) –Chair in Diabetes Nursing Care and Research Education from UK also speaking online at the occasion lauded the efforts of Prof. Abdul Basit and his team for excellent work in the management of diabetes being carried out in Pakistan . Access to therapy, he stated, is very important for management of diabetes. We should create opportunities for diabetes nurses to share and develop better ways of delivering diabetes care, generate and transfer of knowledge that will enhance the wellbeing of people with diabetes.

Mr. Rana Azfar Zafar, General Manager Novo Nordisk Pharma talking about the role of Pharma industry in diabetes education said that importance of education is very important, we have good doctors, better drugs but have not able to get desired result. Novo has largest diabetes educator network and role of Pharma industry is very important because government alone cannot tackle this rapidly growing problem. He assured his full support for this noble cause. Dr. Adnan Lateef from Abbott laboratories informed the audience that Abbott has initiated Bright Programme with BIDE and about seven hundred people have been trained.

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