EMPA has revolutionized management of diabetes as regards cardiovascular problems-Prof.Tariq Waseem

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Diabetes and Hypertension Session during PSIM Conference
EMPA has revolutionized management of
diabetes as regards cardiovascular
problems-Prof.Tariq Waseem
After two years treatment, there is significant reduction
in Heart Failure and Cardiovascular deaths

Lahore: Proceedings of the special session devoted to Diabetes and Hypertension during the Pakistan Society of Internal Medicine conference held here from March 12-15th started on time on March 13th at 8.30 AM. Earlier a large number of Pre-conference workshops were held at various medical institutons on March 12th.This session was sponsored by Atco Laboratories. It was jointly chaired by Prof. Hafiz Ijaz Ahmad, Prof. Taj Jamshed, Prof. Muzaffar Sheikh and Prof. Zafar Iqbal Chaudhry.

Prof. Tariq Waseem was the first speaker who talked about Reducing Major Adverse Cardiovascular Events in Diabetics. He pointed out that it is now well established that all new antidiabetic drugs should be cardio protective. Speaking about the challenges in management of diabetes, he mentioned achieving optimal glycaemic control, no hypoglycaemia, renal protection, lipid neutral, weight neutral or reduction. The drug should be tolerable and there should be no complex regimen. Other challenges include blood pressure control, reduction of Cardiovascualr risk and mortality. Once a day dosage is preferred. SGLT2 Inhibitors, he further stated, offer most of these advantages. He then described in detail their mechanism of action and shared the details of various clinical studies including DECLARE Trial which enrolled seventeen thousand patients in thirty three countires and it lasted five years. There was low risk of heart failure and death in patients who were on SGLT2 Inhibitors. In another Meta analysis, 2, 35,000 patients there was marked reduction in heart failure, hypoglycaemia and death.


Prof. Tariq Waseem

EMPA Prof. Tariq Waseem said has revolutionized the management of diabetes mellitus as regards cardiovascular problems. Risk of hospitalization, heart failure and Cardiovascualr events is significantly reduced with these drugs. While other anti diabetic drugs take two to three years to reduce cardiovascular deaths but with SGLT2 Inhibitors, significant reduction is seen after few months of drug therapy with EMPA. Reduction in HbA1c is dose dependent. There is significant reduction in systolic blood pressure as well as diastolic blood pressure. However, there is slight increase in LDL as well as HDL which neutralizes the increase in LDL. As regards their side effects, it may cause dehydration. Patients selected for this therapy should be between 40-65 years of age. Its use is not limited to HbA1c or to high BMI. He concluded his presentation by stating that for management of diabetes, SGLT2 Inhibitors should be preferred and soon it will replace Metformin as the first line of therapy.


Management of
Hypertension

Prof. Khalid Mahmood Yahya was the next speaker in this session who talked about management of hypertension in diabetics. Hypertension and diabetes, he said, share the risk factors. Patients suffering from these diseases also suffer from insulin resistance, hyperglycemia, hyper insulinemia, and dyslipidaemias. All these risk factors are covered in metabolic syndrome which is common in hypertension and diabetes. Again both those suffering from hypertension and diabetes also suffer from obesity. In fact these are the two terrorists travelling in the same plane and they keep on changing their face. He then discussed the Cardiovascualr risk factors in detail and also referred to congestive heart failure, peripheral vascular disease, hypertension and lipid abnormalities. Improvement in diabetes and hypertension is dependent on the blood pressure. Hypertension, he opined is not only preventable and treatable but can also be cured.

Continuing Prof. Khalid Mahmood Yahya said that every third patient is suffering from diabetes and hypertension. We hardly see patients whose diabetes and hypertension is under control despite the fact that now lot of drugs are available. About 35% of patients are suffering from hypertension and a Blood Pressure reduction of 10/5 is linked to 40% lower risk of stroke and death. It also reduces 30% vascular mortality. Lower the blood pressure, lower the mortality and higher the blood pressure, higher will be the mortality. SBP control, he said, was more important for stroke reduction. Doctors should act as role models. Whereas we do prescribe drugs but most of us do not advise life style changes, regular exercise. Blood pressure should be taken by the doctors themselves while examining a patient rather than asking the nurse or junior doctor. Diabetes and Hypertension both result in higher mortality. Almost 75% complications in diabetics are due to hypertension and most of the deaths in diabetics are due to cardiovascular diseases. JNC-VIII has included almost all the drugs but beta blockers have been pushed downward except Labetalol and Lavedolol. He also referred to the NICE guidelines about managing hypertension. Measuring Blood Pressure, he said was very important and while doing so, White Coat hypertension should be kept in mind. Statins, use of ACEIs and ARBs are contra indicated in pregnancy.


Group photograph shows some of the invited speakers at the PSIM conference i.e. Prof.
Munir Azhar, Prof. Bikaram, Prof.Tariq Waseem, Prof. Bilquis, Prof.Ali Hashmi, Prof.
Tanzeem Haider Raza, Prof. Nasir, Mr. Shaukat Ali Jawaid and others.

Participating in the discussion Mr. Shaukat Ali Jawaid Chief Editor of Pakistan Journal of Medical Sciences remarked that he was a bit concerned about the comments that SGLT2 Inhibitors will soon replace Metformin as the first drug of choice. He pointed out that medical economics plays a very important role and one of the important reasons for non-compliance with drug therapy by the patients was high cost of drugs. SGLT2 Inhibitors though quite safe and effective have their own side effects and above all they were very expensive. Not many patients can afford it. Hence, those who can afford it, they can be prescribed these agents but others who cannot afford it should not be deprived of the benefits of Metformin. In fact treatment should always be individualized keeping in view the facilities available and the cost of treatment, he added.

Prof. Tanzeem Haider Raza in his concluding remarks highlighted the importance of taking detailed history and clinical examination; otherwise you are going to miss many patients. Prof. Javed Akram President of PSIM said that in this conference we have not invited any politician but we have honoured our own colleagues who have accomplished a lot. We should change this culture and force other professional specialty organizations to follow. If you download the conference APP, you will see its live coverage, he remarked.

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