Diabetes in pregnant women poses serious problems for Mother and Baby-Tasnim Ahsan


MIDEM holds meeting to celebrate World Diabetes Day

Diabetes in pregnant women poses serious
problems for Mother and Baby - Tasnim Ahsan

There are chances of early miscarriage and they are
ten times more likely to develop heart disease

KARACHI: Diabetes in pregnant women poses serious problems for the mother and the baby. There are chances of early miscarriage and they are also ten times more likely to develop heart disease. One in seven births is affected by diabetes. Screening for diabetes and Gestational Diabetes Mellitus should be integrated. Most cases of Type-2 diabetes can be prevented. This was stated by Prof. Tasnim Ahsan a noted physician and endocrinologist who after retirement from JPMC has now established Medical Institute of Diabetes Endocrinology and Metabolism (MEDIM).  She was speaking at a meeting organized by MIDEM here recently in connection with the World Diabetes Day. The theme for this year was Diabetes in Women.  The meeting was chaired by three distinguished medical personalities i.e. Prof. I.H.Bhatti a well known Neurosurgeon of the country, Prof. Naeem ul Haque,  Consultant Endocrinologist and former President of Pakistan  Society of Endocrinology, and Prof. Hasan Aziz an eminent Neurologist and former Director of JPMC.

Speaking about the global burden of diabetes Prof. Tasnim Ahsan said that at present there are 422 million diabetics in the world and this figure is likely to increase to 700 million by 2045. About 1.5 Million deaths are attributed to diabetes and over 350 Million are at risk of development Type-2 diabetes. Highlighting the importance of screening and early diagnosis she further revealed that one in ten persons are now obese while two third of diabetics are in working age group. About eight million diabetics are over sixty five years of age.

Medicel Institute of Diabetes Endocrinology and Metabolism (MEDIM) organized a meeting to celebrate
the World Diabetes Day at Karachi recently. Picture taken on this occasion shows from (L to R) Prof.
Naeem ul Haque, Prof. I.H.Bhatti, Dr.Seemin Jamali, Prof. Tasnim Ahsan and Prof. Hassan Aziz.

In Pakistan acceding to IDF the prevalence of diabetes is 6.9% and the same percentage has impaired glucose tolerance test. WHO says that the prevalence of diabetes in Pakistan is about 9.8%. However, another survey conducted by Baqai Institute of Diabetes and Endocrinology (BIDE) which is not yet published has reported the prevalence of diabetes to be 26% and 14.4% have IGT. In Pakistan both infectious and non-communicable diseases has the same burden. Speaking about the diagnostic criteria she mentioned Fasting Blood Glucose of 126, or HbA1C of more than 6.5mg/dl. Random blood glucose of more than two hundred is considered as diabetes. HbA1c should be aimed at less than 7mg/dl or 180mg post parandial.  The target blood pressure in diabetics should be less than 140/90, LDL less than 100 and HDL more than 40. Waist in men should be 90cm, in women 80cm while normal BMI should be 23.

She then gave historical background and accomplishments of an NGO Diabetes and Endocrine Foundation which she had established in 1999 which was founded to impart health education and improved quality of medical care, standardized medical teaching and training facilities besides conducting research. It was started in Ward-6 of JPMC where new Ward was built through donations. Two new sub-specialties were also started by establishing Endocrinology and Rheumatology clinics. In 2001 the Ward got a new look with a beautiful building. It now has fifty beds indoor facilities, three ICU beds and even after retirement I still go there twice a week and these facilities are available.

Now we have established Medical Institute of Diabetes, Endocrinology and Metabolism (MIDEM). Four institutes are in the pipeline which will be part of it. We have competent well trained endocrinologist’s team. We wish to promote research through a multidisciplinary team which will generate local data. We intend to train doctors, nurses, diabetes educators. The four partners of MIDEM at present include JPMC, OMI, Concept Fertility Centre and Chughtai Laboratory while some more centers are likely to join later. We will work together which is good for patients, trainees. We have developed six core elements of chronic care model. Patients will be the most important member of the healthcare team. Management will be by monotherapy, dual therapy and triple therapy. She also discussed the combination injectable therapy for the management of diabetes in detail.

Prof. Tasnim Ahsan former Prof. of Medicine and Executive Director of JPMC who is a noted
endocrinologist has established Medicel Institute of Diabetes Endocrinology and Metabolism (MEDIM)
in Karachi. MEDIM organized its first meeting at Karachi recently. Group photograph taken on the
occasion shows Prof. Tasnim Ahsan and Dr. Naeem ul Haque an eminent Endocrinologist and former
President of Pakistan Endocrine Society along with Dr. Samar Abbas Jafri, Dr. Aisha Sheikh, Dr. Saima and Dr. Tamseela
Ahmed who have joined the faculty of Endocrinology at MEDIM.

Prof. Kamran Asdar Ali a social scientist from Mushtaq Ghurmani School of Humanities and Social Sciences, LUMS was the next speaker who talked about the use of Cinema for national integration with special reference to Cinema in Karachi. He depicted some rare pictures of Karachi and then referred to eruption of violence in Karachi, ethnic and Islam based politics. During the last two decades or so the city of Karachi and country has seen lot of changes. In the good old days Pakistani cinema was used for national cohesion. He then referred to a famous Urdu Film “Behan Bhai” wherein the stars were Kamal, Nadeem and Deba. The story revolves around the partition days of Indo-Pakistan sub-continent. It is a song which reunited all the family members who were separated during the partition. In the later years as we all know Karachi was politicized. He then referred to social and economic diversity of Karachi, deprivation of Karachi, emergence of class disparity.  Cinema and Film which used to play a role of national integration is no more seen. Ethnic and sectarian differences are very much visible in Karachi. Time has come that we must learn to live with disagreement, develop tolerance and compassion which is no more visible in Karachi.

Speaking at the occasion Prof. Naeem ul Haque said that Prof. Tasnim Ahsan changed the look of Ward-6, established Endocrinology Clinic where she is still working. She continues to struggle for a change for the better and I wish him success in her new initiative.

Prof. Hasan Aziz remarked that her plan will be successful as she knows how to work and get things done. Speaking in a jovial mood he further stated that when someone becomes intelligent, the government retires you though that is the best time when one can do something really good. He regretted that due to a constitutional amendment, the premier postgraduate medical institute of the country JPMC has been converted into a DHQ Hospital. Despite all handicaps, we at JPMC did not lose heart and the two men at JPMC (Prof. Tasnim Ahsan and Dr. Seemin Jamali) continued the struggle. He hoped that the original JPMC will be revived one day. Knowing Prof. Tasnim Ahsan, I have no doubt that she will take the specialty of endocrinology too high.

Prof. I.H. Bhatti speaking in his typical style remarked that with aging, one develops cognitive decline and intelligence impairment. Aging process is unstoppable. Type-2 diabetes and its longer duration accelerate the processing of aging further. Structure of human body also deteriorates with the every passing day and all this makes a man just like a child who has poor memory, has Lack of concentration, and becomes irritable besides suffering from behavioural changes. Prof. Kamran presented an interesting story about Karachi and now is the time to conclude the proceedings.