Dedicated doctors and motivated patients are important for diabetes management-Prof. Ali Jawa

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 IDEA Conference proceedings

Dedicated doctors and motivated patients are important
for diabetes management-Prof. Ali Jawa

Cardiomyopathy is treated just like heart failure patients- Kamran Baber

CABG gives good results in diabetics & Dyslipidemias
should be addressed aggressively by Statins

LAHORE: Dedicated doctors and motivated patients are extremely important for the management of diabetes. This was stated by Prof. Ali Jawa a noted endocrinologist while speaking on Healthy Lifestyle approach to Cardiovascular Risk Reduction at the International Diabetes Excellence Academy meeting held along with the just concluded SAFES conference organized here from Nov. 23-26, 2017.

Talking about the issues which hamper compliance and barriers Prof. Ali Jawa said that healthy options may be more expensive, proteins may be more expensive than carbohydrates, patient live in joint family system where the food is cooked for the whole family and people with diabetes may not be getting the healthy diet which they need. FAD diets, he further stated lead to rapid weight loss but it means rigid menu, specific menu combinations and there is no need for exercise but remember most FAD diets are not sustainable in the long run, he remarked. His conclusions were that one must know the meal, meal planning need to be individualized. FAD diets can adversely affect glycemic control. Carbohydrates taken in appropriate quantity does help the patient. Responding to a question Prof. Ali Jawa said that Metformin does reduce weight. The treating physicians should prepare Diet charts and Guidelines for the diabetic patients and they should be provided to all patients suffering from diabetes.

The overall learning objectives of this two day meeting by IDEA were to recognize new ways of diagnosing diabetes, recognizing new therapies appropriate to personalized therapy besides discussion on management of immediate and long term complications of diabetes.

Prof. A.H. Amar from Pakistan spoke on diagnosing and managing diabetes beyond guidelines while Dr. Dina Shrestha from Nepal talked about What, When and How to start oral medical treatment Vision 2017. In her presentation she reviewed the international and regional guidelines. Dr. Rayaz Malik discussed surgical interventions in diabetes, Bariatric Surgery beyond Weight Loss. Dr. Arif Asif from USA who talked about Managing Hypertension and Nephropathy in Diabetes pointed out that if GFR goes down, it is renal failure and one must remember that renal failure has very high mortality. Management of hypertension in DKD and proteinuria’s were also discussed in detail. Diabetic Kidney Disease (DKD), it was stated is on the rise and proteinuria is common. Use of ACE Inhibitors and ARBs is quite useful in these patients. DKD is a major cause of End State Renal Disease and target blood pressure in these patients should be less than 140-90. In the absence of diabetic retinopathy, monitor cGFR every six months and when the GFR is less than 30, refer the patient to nephrologist.

Dr. Kamran Baber’s presentation was on diabetes and cardiovascular diseases. This was based on some case presentation. He discussed in detail the cardiovascular risk stratification in cardiovascular disease, case based approach. Cardiomyopathy patients, he pointed out are treated just like heart failure patients. He also referred to the use, safety and efficacy of antiplatelet and statins. He was of the view that it is good to be objective in heart disease patients. Discussing the management of another patient he said that stress test is the cheapest in diabetics to check heart disease. If ETT is not positive after six minutes, the patient will do better on medical therapy. In case the patient has symptoms, it is better to do Thallium Test, Cardiac Enzymes and MRI. CABG gives good results in diabetics. Dyslipidemias should be addressed aggressively by Statins and non-statins if need be.

Other topics discussed by various speakers during the meeting included Diabetes and Stroke, Early diagnosis, treatment and rehabilitation, Dr. Abbas Raza talked about Rapid Endocrine Update- Coexistence of Endocrine disorders. Managing Hypertension and Nephropathy in Diabetes, It’s Updates in Prevention. There was an interesting debate on Insulin vs. New therapies wherein the speakers included Dr. Hamed Farooqi from UAE and Dr. Noel Somasundaram from Sri Lanka. One of the sessions was devoted to Diabetic triopathy, Dr. Abdul Jabbar spoke about Vitamin D beyond Bones. Dr. Manilka from Sri Lanka spoke on Management before, during and beyond in Gestational Diabetes in the session on Diabetes during pregnancy.

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