Controlling common risk factors is cost effective approach to manage NCDs-Prof. Adel El Syed

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 Ramadan & Health Conference by JSMU & SSIDE

Controlling common risk factors is cost effective
approach to manage NCDs - Prof. Adel El Syed

Globally it is urbanization and aging which has increased the
prevalence 
of NCDs with more exposure to the risk factors

KARACHI: Prof. Adel A El Syed from Egypt was the first invited speaker at the first scientific session during Second International conference on Ramadan & Health organized by Jinnah Sindh Medical University in collaboration with SSIDE from September 8-10, 2017. The topic of his presentation was NCDS and Ramadan Fasting. This session was chaired by Prof. Tariq Rafi VC JSMU along with Prof.Nazeer Khan.

Prof. Adel pointed out that previously it was the infectious diseases which used to kill people but the availability of vaccines and antibiotics controlled this but at the same time now Non-Communicable Diseases has made lot of progress and are killing more people than communicable diseases. NCDs are diseases which includes diabetes mellitus, coronary artery disease, cancer and chronic lung diseases. Now NCD Alliances are working in some countries. In the EMRO Region in 2012 death due to NCDs accounted for 65%. Globally it is urbanization and aging which has increased the prevalence of NCDs with more exposure to the risk factors. Some of the important risk factors which he mentioned included Tobacco, Unhealthy diet, Physical inactivity and harmful use of alcohol. Controlling common risk factors is the cost effective approach to manage NCDS.


Continuing Prof. Adel El Syed said that formation of NCD Alliances in some countries was the civil society’s reaction. We need to overcome poor diet, reduce consumption of salt, fat, increase use of vegetables and fruits, increase physical activity, stop tobacco use in any form. Now lot of research was being conducted on Fasting & Health and Pakistan has made tremendous contributions to literature in this field related to Diabetes and Ramadan. Lot of studies are now available which show that fasting does not increase Acute Coronary Syndrome. Patients with stable cardiac disease can safely fast by following dietary guidelines. It has also been reported that there is 30-40% increase in HDL with fasting. Our duty is to establish evidence based guidelines with sufficient data, he added.

Prof. Mafauzy Mohammad from Malaysia was the next speaker and his presentation was on Whether Insulin treated patients with Diabetes could fast? He pointed out that previously it was said that all those diabetic patients who are on insulin therapy should not fast. Patients may suffer from hypoglycemia or hyperglycemia with prolonged fasting after heavy dinner. Dehydration and thrombus formation risk are also increased.  Some studies suggested that  well controlled diabetes Type-I patients, Type2 Diabetes Mellitus patients and those using mixed insulin should not fast but even then about two third of the patients were fasting. EPIDIAR study showed that patients with diabetes did fast for fifteen to sixteen days during Ramadan. They maintained their insulin dose but had some adjustments. CREED study showed that more than 94% of patients suffering from diabetes did fast for more than fifteen days. It did prove safety of insulin treatment. Studies have also showed that Lisspro Mix25 is better and safe in Ramadan. It is a better therapeutic option for these patients. A study done in India showed that children between the age of 11-15 years who are taking Insulin twice a day can also fast safely but with proper education, follow up and dose adjustment. Adolescents can also fast if they reduce their basal insulin.

He concluded his presentation by stating that patients on insulin treatment can fast except those with repeated hypoglycemia, unaware of hypoglycemia, acute illness, living alone, old age and ill health. Furthermore those with a recent history of DKA, sustained poor glycaemia control and patient with renal insufficiency should also not fast.


Dr. Samad Shera was the third speaker in this session who also talked about Ramadan and Insulin. He pointed out that for patients with diabetes, Pre-Ramadan assessment was essential. Fasting patients must know the facts about glucose at Sehar and Iftar. If the blood sugar is below 45, the patient pay die. When the blood glucose is less than sixty, the patient must break the fast. If it is below or less than 70 after few hours of fast, even then the fast should be broken. He laid emphasis on healthy and balanced diet, Delay Sehar as much as possible. Increase liquid intake during non-fasting hours, At Iftar, simple carbohydrates are more appropriate and one should walk before Sehar.

He also pointed out that short acting non-premixed insulin’s are recommended rather than long acting for those patients who can fast safely and those with caution. Low blood sugar is a bad sign and Insulin’s can be taken during fasting. The same syringe can be used forty times in male and fifty times in females. Analogues are rich men’s insulin as they are very costly.

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