There is an emerging global epidemic of diabetes due to overweight, obesity and physical inactivity

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 World Diabetes Day function at JPMC

There is an emerging global epidemic
of diabetes due to overweight, obesity
and physical inactivity

Diabetes management requires a multidisciplinary
team approach - Prof. Tasnim Ahsan

KARACHI: Diabetes management requires a multidisciplinary approach which includes Endocrinologist, Pharmacist, Diabetes Educator, Podiatrist, Dietitian, Ophthalmologist, Exercise Counselor, Internist, Nurse Practitioner and Mental Health Professional. Diabetes educator has main role for the management of diabetes. We do not have many trained Podiatrist to treat and manage diabetic foot. These views were expressed by Prof. Tasnim Ahsan Professor of Medicine and Director Jinnah Postgraduate Medical Centre Karachi while speaking at World Diabetes Day Programme held on 28thof November, 2012 in Najmuddin Auditorium, JPMC, Karachi. It was organized by the Faculty of Medical Unit II. Patients as well as trainee doctors and nurses attended the meeting.

Prof. Tasnim Ahsan, Professor of Medicine and Director Jinnah
Postgraduate Medical Centre Karachi replying to the questions
at World Diabetes Day Programme held JPMC, Karachi.

Prof. Tasnim Ahsan further said that more than 366 million people worldwide have diabetes in year 2011. By 2030 this is expected to increase to 552 million. There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity. More than 50% of Patients with diabetes need additional lowering of cardiovascular risk factors. According to American Diabetics Association the goal of HbA1C should be <7.0% preprandial glucose 70-130mg/dL 3.9-7.2mmol/l postprandial glucose <180mg/dL and blood pressure < 130/80mmHg. 
Optimal treatment of Diabetes Prof. Tasnim Ahsan said requires more than plasma glucose management. Detect and manage DM-specific complications and modify risk factors for DM associated diseases which consist of education about nutrition, exercise, care of diabetes during illness and medications to lower the plasma glucose. Dietary treatment should be aimed at ensuring weight control, providing nutritional requirements, allowing good glycaemic control with blood glucose levels as close to normal as possible, correcting any associated blood lipid abnormalities. Physical activity promotes weight reduction and improves insulin sensitivity, thus lowering blood glucose levels. A programme of regular physical activity and exercise tailored to the individual’s health status and fitnessbesides education about the potential risk of hypoglycaemia and how to avoid it is very important she added. .
Prof. Tasnim Ahsan also referred to the recently published joint position statement of ADA and EASD, regarding the Management of Diabetes Mellitus. She gave an overview of the oral hypoglycemic drugs and the different types of insulin. She explained how a diabetic patient’s treatment should be initiated and tailored to the individual’s need. Talking about management of hyperglycemia she stated that more stringent approach is required for patients who are highly motivated, adherent, have excellent self care capabilities, patients who are newly diagnosed and have long life expectancy.
Talking about implementation strategies of management of Hyperglycemia in T2DM, Metforminshe stated is the first choice if there are no contraindications. If HbA1c >9% use 2 non-insulin agents or insulin itself. If Blood Glucose is >300-350, A1c >10-12%, insulin therapy, should start with combination therapy followed by triple combination therapy and transitions to & titrations of insulin.
Prof. Tasnim Ahsan further said the we do need to use diabetes treatment algorithms in the first place to reduce the impact of the disease, to alter the natural history of the disease, reduce the costs of the disease to translate known scientific insights into treatment, interventions to benefit patients and to reach and maintain treatment goals in the most efficient, practical and feasible way. Glycemic targets & BG-lowering therapies must be individualized. Diet, exercise, & education are the foundation of any T2DM therapy program. Unless contraindicated, metformin is optimal 1st-line drug. After metformin, data are limited. Combination therapy with 1-2 other oral / injectable agents is reasonable. Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain BG control. All treatment decisions should be made in consultation with the patient and focus on preferences, needs & values she concluded.
Dr. Subheen Ghafoor presented the Overview of Diabetes and highlighted facts and figures regarding the prevalence of diabetes globally as well as in Pakistan. This was followed by a lecture on a “Healthy Lifestyle” by Dr. Urooj Lal Rehman. She emphasized how unhealthy our lifestyle is and also gave tips on improving lifestyle by exercising and making healthy food choices. The topic of “Hypoglycemia” was discussed first by Dr. Zeenat Banu, who emphasized on the acute and long term effects of hypoglycemia.Dr. Samar Abbas Jaffri explained the Hypoglycemia in Urdu and discussed its symptoms and how it can be managed at home.
The highlight of the programme was a skit prepared and presented by the House Officers and postgraduate trainees of Medical Unit II. Drs. Anosh Inkesar, Paras Jamil, Imran Hilal and Aneeta Parmani worked as a team to show a typical doctor-patient interaction of a middle-aged obese diabetic suffering from shortness of breath. It was very entertaining, and yet very informative. A brisk walk within the JPMC campus was also part of this activity followed by an interesting interaction with diabetic patients which gave the patients an opportunity to give their perspective on their disease and the difficulties they are facing in managing their disease.