Religious leaders can play an important role in prevention of NCDs particularly GDM-Prof. Azad Khan


 Religious leaders can play an important role in
prevention of NCDs particularly GDM-Prof. Azad Khan

Management of obesity includes life style modifications, exercise,
food, medications besides bariatric surgery- Dr.Tariq Rehman

Those with BMI of over forty should be offered bariatric surgery
by which we reduce the capacity to eat-Dr. Javed Raza

LAHORE: Religious leaders can play an important role in prevention of Non-Communicable Diseases particularly Gestational Diabetes and we have seen great enthusiasm among them for this cause. This was stated by Prof. A.K. Azad Khan President of Diabetic Association of Bangladesh while speaking in the State of the Art Session of recently concluded South Asian Federation of Endocrine Societies (SAFES) and Pakistan Endocrine Society conference held here from November 23-26th 2017. This session was chaired by Prof. Javed Akram Vice Chancellor of SZABMU Islamabad.  At present over one hundred ten healthcare institutions including medical and dental colleges, he said were affiliated with the Diabetic Association of Bangladesh.

Organizers of the South Asian Federation of Endocrine Societies (SAFES) honoured some senior
Endocrinologists from the region at its meeting held at Lahore recently. Group photograph taken on
this occasion shows Dr.Dina Shrestha from Nepal, Prof. A.K. Azad from Bangladesh, Dr. Abbass Raza
and Prof. Ali Jawa from Pakistan, Prof. Noel from Sri Lanka and others.

Continuing Prof. Azad Khan said that women with diabetes mellitus need special attention.  Diabetes is the leading cause of death in pregnant women. Currently it is estimated that the prevalence of diabetes in Bangladesh was   8.3% which means there are 7.1 Million diabetics and by 2040 this number will increase to 13.6 Million.  So far we have covered just 50% of the diabetics and during 2015 there were 1, 29,300 deaths related to diabetes. Diabetes has an impact on health and economy. Almost 50% of diabetes, he opined, can be prevented with life style modifications. He then highlighted the guiding principles of Ibrahim Model for prevention which includes using mosque Imams and Khatibs for the prevention of NCDs. We will start this programme from next year. We also intend to use Imams and Khatibs, Nikah Khans in pre-conception care. Almost 40% pregnancies, Prof.Azad Khan remarked is unplanned and this increases morbidity and mortality by 20% wherein malnutrition and anaemia also plays a role. We have established a pre-conception corner at BIRDEM and other affiliated institutions.  We plan to train four hundred Kazi who solemnize Nikah at marriage ceremonies, three hundred healthcare professionals. We will develop fifty pre-conception corners in BIRDEM and affiliated hospitals for improvement of maternal health and ensure good pregnancy outcome.  Training manual is ready. The programme will start all over the country.

Prof. Azad Khan further stated that it is important that pregnancy should be planned Blood glucose and blood pressure should be checked first. Haemoglobin will also be checked. Initially we will provide them the essential basic facilities but later on the project will be self sustainable. There will be total seven visits during the pregnancy. We have received support of Ministry of Law and Justice, Ministry of Education and Women support for this project. Telenor has also joined this movement. The challenges that we face are education of religious leaders, training progamme for them, training healthcare professionals, establish pre-conception corners. He also discussed the sustainability of this programme.

Dr. Tariq Rehman from UK was the next speaker in this session who spoke about Obesity, metabolic surgery, morbidity and mortality, efficacy of current interventions, safety and additional benefits as well as practical implications of new interventions. He pointed out that at times it was said that treatment of obesity was an impossible mission. Health risks of obesity include low quality of life, depression, physical emotional problems, prejudice and discrimination. Increase in BMI leads to increase in diabetes and it is seen more in women than men. At present there are forty million people with obesity in Southeast Asia and it will increase to 82 Million by 2030.  Management of obesity includes life style modifications, exercise, food, medications besides bariatric surgery. Bariatric surgery is effective in weight loss. It consists of banding, switch, Roux-enY. Thirty days mortality is less than 1% with banding. Gastric banding results in 48% reduction in diabetes, Gastroplasty results in 68% reduction, Gastric Bypass reduces diabetes by 84% while BPD leads to 98% reduction in diabetes. He further stated that 25-30% rightly selected patients with diabetes for the last three to five years will recover from diabetes and associated cardiac risk factors with gastric surgery. In these patients insulin dose is also reduced, their HbA1C is reduced, during post operative treatment their drugs dose is reduced. However, it must be ensured that the patients are prepared for lifelong follow up. Surgical procedures offer substantial benefits. He concluded his presentation by stating that bariatric surgery leads to remission in diabetes, sustained weight loss, improvement of quality of life, reduced risk of cardiovascular disease and death. He however, cautioned that selection of most appropriate patients for bariatric surgery alone will give good results.

Pakistan Endocrine Society honoured some of its founder members at the Gala Dinner during the
recently held SAFES conference at Lahore. Group photograph taken on this occasion shows Dr. Faisal
Qureshi, Dr. Abbas Raza, Prof. Ali Jawa, Prof. Saeed Mahar, Prof. Abdul Basit, Prof. Abdul Jabbar,
Prof. Najmul
Islam, Prof. Tasnim Ahsan, Dr. Naeem ul Haque and Prof. A.H Amar.

Dr. Jved Raza from UAE gave surgeon’s perspective and highlighted an almost cure for obesity through bariatric surgery. He pointed out that if after the operation patient is hungry, the surgery is not successful because surgery takes away the hunger. This is a team work which includes dietetician, nurse, internal medicine specialist, surgeon and psychologist. At present there are 60 Million obese people in UAE and 66% are obese and overweight. During gastric bypass test should ensure that there is no leak. He opined that all those with BMI of over forty should be offered bariatric surgery by which we reduce the capacity to eat. After surgery the patient does not feel hungry all day. He then presented the results of a Meta Analysis of bariatric surgery which included 621 studies, 1, 35,246 patients of which 78% had complete remission of diabetes and 70% had reduction in diabetes. Hypertension was also reduced.  In UK, about 5% of his patient had re-do surgery and its complications are just like laparoscopic cholecystectomy but it results in excessive weight loss and reduction in diabetes mellitus. In Abu Dhabi I have done two hundred procedures of which 35% had to undergo re-do surgery. So far I have done over twelve hundred procedures. Bariatric surgery he opined was not the best but a best option. We will reduce complications but it requires a team work and the risk was less than gall bladder surgery, he remarked.

Pakistan Endocrine Society conducted a Diabetes prevalence survey recently which was presented at the
SAFES conference held at Lahore recently. Photograph taken on this occasion shows Prof. Ali Jawa,
Prof. Saeed Mahar,
Dr.Abbas Raza, Dr. Faisal Qureshi, Dr. Aisha Sheikh and
Dr.Osama Ishtiaq who participated in this Survey.

During the discussion Dr.Saeed Maher remarked that after one year of bariatric surgery, some patients come back as they have gained weight. Moreover 30-40% of these patients regain weight after five years. Responding to this Dr. Javed remarked that patient education and life style modifications were important. Prof. A.H. Amar asked why there was so much difference i.e. 5-35% in redo-surgery in patients in UK and Abu Dhabi which needs to be looked into. Dr.Javed remarked that he had 5-10 times more risk of complications in Abu Dhabi patients which he did not expect. Bariatric surgery is a team work. Training programme, training of people, patient should be prepared to change their habits and doctors need to spend some time with the patient.

Summing up the discussion Prof. Javed Akram remarked that if there is no team work and no follow up, the results are not going to be good. Lancet had once written that Obesity was a time bomb which needs to be defused. He also highlighted the importance of psychological preparation of the patient, team work, and right advice to the patient before and after the surgery.

Corporate Symposia by Novo Nordisk

This was followed by a corporate symposium by Novo Nordisk. Prof.Stephen Atkins was the guest speaker who talked about IDegAsp-an upcoming advancement in diabetes therapies. He discussed in detail the worldwide challenge of glycaemic control, severe events leading to severe burden and the need to create a balance between hypo and hyperglycemia. He also talked about target properties of new insulin analogues. IDegAsp, he said, was approved in seventy two countries. It offers flexibility in timing of its administration and there was no need for re-suspension. Dosing of this new formulation, initiation of this therapy and switching over were also discussed. The suggested once weekly titration schedule of this therapy in Type-2 Diabetes Mellitus was also highlighted. It offers less injection and there are fewer chances of complications, Prof. Atkins remarked.