Aggressive treatment of diabetes, early initiation of Insulin will reduce treatment cost and complications-Prof. A.H. Aamir


 Aggressive treatment of diabetes, early initiation 
of Insulin will reduce treatment cost 
and complications - Prof. A.H. Aamir

By training the Family Physicians, we wish to change
the pattern of General Practice-Shehla Naseem

KARACHI: Prof. A.H. Aamir from Hayatabad Medical Complex Peshawar was the first speaker in the second session at the International Diabetes and Endocrinology conference organized by SSIDE in collaboration with CFMP here on September 1-2nd 2018. The topic of his presentation was “New Generation Insulin Therapies: Challenges in Glycemic Control”. He pointed out that now people with diabetes live longer and it was bad to end up with complications. We need to intensify our efforts to control diabetes. There is fear of hypoglycemia. He advocated aggressive treatment of diabetes and early initiation of insulwin therapy which does not hinder patient’s daily activities.

Prof. Mashoor Alam Shah alongwith Prof. Jamal Zafar chairing one of the sessions during 
the Int. Conference on Diabetes and Endocrinology organized by SSIDE in collaboration 
with College of Family Medicine 
at Karachi recently.

With proper adequate treatment the hypoglycemic episodes will be reduced. New insulin analogues are close to human physiology which we need. He then discussed the concept of co-formulation to simplify the insulin regimen. It will lower the burden of injections. He discussed at length the safety and efficacy of IDegAsp which is a rapid acting insulin in 70/30 formulation. It takes two to three days to reach steady state level. He shared with the audience details of Boost Trial conducted in Japan wherein IDegAsp was compared with IGlar. Both reduced the HbA1c level but Ryzodeg was found superior which also had lower episodes of Hypoglycemia. Its other advantages were less number of injections required as it is used once weekly and other advantage was of pen ready to use. Ryzodeg, he further stated, can be started in all patients who are suffering from Type2 diabetes, one can start it in insulin naïve patients. He concluded his presentation by highlighting the advantages of this new formulation of insulin which requires few injections, has less hypo episodes, it can reduce the treatment cost and burden of insulin therapy.

Prof. Abdul Basit from BIDE who is also chairperson of MENA Region of IDF was the next speaker who talked about MENA Road Map for better diabetic Care. He discussed at length the developments taking place in all these Muslim countries in the EMRO region covering Education, Epidemiology, and Advocacy etc. He also referred to the simple diagnostic test for screening of diabetes, use of mobile technology, mobile screening units etc. So far, Prof. Basit said, we have established 115 Diabetic Foot Clinics to prevent foot ulcers. We offer customized foot wear, have established forty two centers for diabetes education and trained 169 people who have diploma in diabetes education. Survey conducted by BIDE in collaboration with other organizations has showed the prevalence of diabetes to be 26.3%, 14.4% are in pre diabetes stage, 7.1% are newly diagnosed diabetics while 19.2% are known diabetics. We have been providing free insulin to Type-1 patients in Sindh for the last many years and now intend to start two Insulin My Life clinics in Baluchistan shortly. WHO list of emergency medicines now includes Insulin, Metformin, Sulfonylureas, Statins, ACEIs, CCBs, Thiazide and Aspirin. Under a programme over ten thousand people will be able to get essential drugs for three months at a very subsidized cost.

Dr. Shehla Naseem from College of Family Medicine gave details of the training programme started by the CFMP to educate the Family Physicians in various diseases including diabetes. The programme in Diabetes was named as Fighting Diabetes. We run regular CME programme. Two hundred fifty Family Physicians got registered in the first course and so far we have trained and certified 286 doctors. Our fifth batch is now in progress. In the past Family Physicians were never involved in research. Now we have involved them and we are collecting data in primary care areas. We have established IRB and a Research Cell. We wish to change the practice of GPs. We wish that general practice should be patient centered. We have organized courses in pain management, depression. We wish to ensure that diabetics have less complications by offering the facility of proper referral in time, she added.

Responding to various questions during the discussion Prof. Aamir said that any patient who is already on two drugs and still not controlled, will be an ideal patient to be put on Ryzodeg. It can fit any diabetic. Responding to yet another question he clarified that overall the dose deficiency is not much. Dr.Samad Shera remarked that search for an ideal insulin continues and it will continue in the days to come.

In the next session Prof. Najmul Islam from Aga Khan University talked about medical management of pituitary tumours. He discussed in detail signs and symptoms, work up of pituitary tumors, clinically non-functioning pituitary adenomas. Bromocriptine offers minimal response and surgical treatment has also been tried for these adenomas. He then discussed the diagnostic algorithm of Acromegaly, its signs and symptoms, management. He pointed out that until radiation works, medical treatment has to be continued. Safety and efficacy of Octeriotide LAR long acting somatostatin was also discussed. In elderly and high risk patients we can use octeriotide as an effective treatment modality. He then talked about dopamine agonist’s therapy, GH Receptor agonists, medical treatment of prolactinomas and Cushing’s syndrome.

Prof. Ahmad Bilal from Faisalabad gave an Update on Metabolic syndrome. It is also known as Syndrome-X, also discussed insulin resistance syndrome, central obesity which is a growing epidemic and quite dangerous. He was of the view that over 50% of Pakistanis are suffering from obesity. Apple obesity, he said, was very dangerous which leads to not only diabetes but cardiovascular diseases as well. He laid emphasis on regular exercise, avoiding junk food, avoiding fast eating which is related to obesity. He also talked about health implications of metabolic syndrome. It is important to intensify exercise programme. Siting for longer time also kills, hence one must get up and have a little bit walk after few hours. Physical activity should be planned. Brisk walk is the best. Breakfast, he opined, was necessary to burn fat hence never skip breakfast. Try to eat less which is the root cause of obesity and many chronic diseases. Self-care and self-management, it was stated, must start from your family.

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