For diagnosis Punch skin biopsy is a gold standard while
Neuro Pad is a quick test but not yet officially approved
SGLT2 inhibitors are useful in diabetic neuropathy while spinal
cord stimulation can also give some relief – Prof. Uzma Khan
BIDE Conference on Diabetes and Diabetic Foot
KARACHI: Baqai Institute of Diabetes and Endocrinology (BIDE) in collaboration with Baqai University organized the Diabetes and Diabetic Foot conference 2025 from August 15th to 17th 2025. It attracted a large number of participants from all over the country besides a few guest speakers from overseas. The Theme of the conference was “Stepping Forward: Global Strategies on Diabetic Foot.
Prof. Javed Akram along with Prof. Jameel Ahmed and others chairing a session on the second day of the Diabetes and Diabetic Foot conference organized by BIDE in collaboration with Baqai Medical University in Karachi from August 15th to 17th 2025.
The first scientific session on August 16th was devoted to Diabetic Neuropathy. It was moderated by Dr. Saiful Haque and jointly chaired by Prof. Najmul Islam, Prof. Jamil Ahmad, Prof. Kamaruddin along with others. Prof. Zulfiqar G. Abbas form Tanzania was the first speaker who spoke about Catching DPN early. He suggested taking targeted history as over 50% of DPN patients have no symptoms. The patient should be asked to take off the shoes for examination. Pain he further stated was the greatest gift of God Almighty to mankind. He then discussed in detail the clinical assessment of DPN, advances in diagnosis and screening tools. Neurophysiologist is the best person to diagnose diabetic peripheral neuropathy. He then referred to small and large nerve fiber tests. Punch skin biopsy, he stated, is also a gold standard. Neuro Pad is a quick test but not yet officially approved. Diabetic neuropathy, he opined, can be easily diagnosed in the community. We need simple, accurate and reliable test. Early diagnosis can stop progression of the disease and severe complications.
Prof. Uzma Khan from United States discussed latest advances in diabetic neuropathy and most common cause of complications. Non pharmacological treatment and supplements, she stated, are not important. Speaking about the risk factors, she said, metabolic syndrome can be a risk factor with diabetes mellitus. Smoking and lack of physical activity are other risk factors. We usually do not talk about autonomic neuropathy and classification of diabetic neuropathy. She also talked about biomarkers and diagnostic advances as well as microbiota therapy. B12 supplements. she said. is useful. SGLT2 inhibitors are also useful in diabetic neuropathy while spinal cord stimulation can also give some relief in diabetic neuropathy. Gene therapy is also useful and at present many studies are being conducted. It improves nerve regeneration. Stem cell therapy was also in the pipeline. It is important how we can address pathogenesis of diabetic neuropathy. All these treatment modalities will be included in the future guidelines. She concluded her presentation by stating that diabetic neuropathy is under estimated and undertreated and has significant morbidity and mortality.
Some of the speakers and organizers of the Diabetes & Diabetic Foot conference photographed during the meeting held at Karachi last month.
Prof. Roberto Anichini from Italy was the next speaker who talked about Charcot Foot- a diagnostic challenge for physicians. Tracing the history, he said that it was French neurologist Jean Charcot who first described this condition. In this condition a specific type of bone and joint destruction is noted. It is not recognized by other physicians. Time, he stated, was Tissue. X-Ray and MRI are useful to detect it early. He then discussed principles of treatment in acute phase of this disease. Off loading devices should be introduced as early as possible. Custom made footwear are extremely useful. With appropriate management development of deformity can be prolonged. He also talked about recurrence of non-healing wounds and ischemic wounds.
Dr. Tashfeen Ahmad from Aga Khan University Hospital discussed surgical challenges in management of Charcot Foot. He pointed out that with diabetic foot ulcer the five years mortality was about 31%. With Charcot Foot the mortality is 29%, with major amputation it is 53% whereas mortality from breast cancer was just 90% while from all cancer’s mortality figures are about 31%. Foot ulcers tend to recur and almost 82% recur after two years. Radiographs are usually negative but bone scan may be positive in all cases.
Surgery is recommended for Charcot foot and it has just 2.8 to 5% complications after surgery. After deformity off loading devices do not work hence patients should be referred for surgery. He also discussed beaming of the columns of Charcot foot. He reiterated that orthopedic surgery has a place in the management of Charcot foot as with surgery the risk is just 12.5% as compared to 75% risk without surgery.
The panelists in their concluding remakes emphasized the importance of early diagnosis of these conditions and resorting to surgery at the right time.
Dr. Tashfeen Ahmed, Dr. Uzma Khan, Dr. G. Abbas, Prof. Roberto from Italy along with others photographed during the diabetes and Diabetic Foot conference organized by BIDE recently.
In the Satellite Symposium Prof. Ali Asghar from Liaquat National Hospital was the guest speaker who discussed cardio renal and metabolic significance of SGLT2 inhibitors in the management of Type-2 diabetes. Majority of the diabetic patients, he said, suffer from cardiovascular diseases and have increased risk of other complications. Diabetes patients suffer from so many other diseases like heart failure and renal diseases. Hence, he suggested starting SGLT2 Inhibitors combined with Metformin before the onset of diabetes. SGLT2 inhibitors, he opined has in fac brought together cardiologists, diabetologists, Neurologists, Nephrologists and various other specialists.
Peripheral Artery Disease
The next session was devoted to Peripheral Artery Disease. Dr. Asim Bin Zafar was the first speaker who pointed out that PAD was not an uncommon condition in Pakistan. It is missed and under estimated. Its prevalence is reported to be 20-30% globally while it is 50% in diabetic related foot ulcers. It results in delayed healing of wounds, develop gangrene which results in amputation. Speaking about its risk factors he mentioned diabetes, chronic kidney disease, smoking and aging population. Neuropathy masks pain. It has atypical presentation and ABI is not routinely performed in Medical OPDs. Reasons for poor glycemic control are poor health literacy, economic burden, overcrowding in OPDs. Most often feet are not examined. He then gave details of PAD Registry at BIDE which has registered 2348 patients so far. There was total ninety-four amputations which included ninety-two minor and two major amputations. In all one thousand two hundred eighty-three limbs were salvaged. Six hundred ulcers healed while two hundred fifteen patients were still under treatment.
Group photograph of some of the participants and speakers during the concluding session of Diabetes and Diabetic Foot conference organized by BIDE in collaboration with Baqai Medical University in Karachi from
August 15th to 17th 2025.
Prof. Muhammad Ali radiologist from Ziauddin Medical University discussed imaging in PAD and referred to Doppler, ABI and other investigations. PAD patients, he said, are classified based on symptoms. Acute limb Ischemia can be diagnosed with Doppler, ultrasound. We do CT Angio before doing revascularization. He suggested individualized tailored treatment plan for every patient. In the step wise plan, he gave details of road map for revascularization. He was of the view that one must explore the patient’s attitude before deciding for revascularization. Below knee revascularization is most challenging.
Prof. Ziaur Rehman also discussed revascularization in diabetic foot. In fact, this was a debate on Endo vascularization vs Surgical treatment in which the other speaker was Dr. Naveed Ullah Khan from NICVD. Dr. Naveed Ullah opined that one has to be careful while managing these patients because of procedure risk, cost involved, availability of the blood vessels. Open surgical vascularization is gold standard. He then shared the details of surgical strategy adopted at NICVD. Most of the patients. he said. are referred from BIDE. So far, we have managed two hundred fifty patients. It included 70% male and the rest females. About the comorbid. he said. 69% had hypertension, 38% coronary artery disease and 18.4% had renal impairment. Anatomical considerations are looked at, below knee revascularization is very difficult. We had 79.6% patients who had the procedure below knee. This is a high-risk surgery. In some patient’s surgery is not feasible as they are not suitable for bypass. Most of the lesions are diffused and calcified. We had a success rate of 93.5%. Most of the patients were poor and ignorant. The picture of diabetic foot seen in books is far better than the actual patients that we see in Pakistan, he added.
A view of the workshops in progress during the Diabetes and Diabetic Foot conference organized by BIDE in collaboration with Baqai Medical University in Karachi from August 15th to 17th 2025.
Dr. Fahad Tariq referred to BEST and BASIL-II studies. GDP of the country and its population, priorities and policies of the government also matter in the management of these conditions.
