World Diabetes Day - Type 1 diabetes rare in Pakistan & diagnosed early: Prof Shera

MN Report

Karachi: The Diabetic Association of Pakistan and WHO Collaborating Centre Karachi organized two sessions – one for doctors and other for public - at a local hotel to mark the World Diabetes Day, observed globally on Nov 14.

In his welcome speech, Prof A. Samad Shera, Secretary General of Diabetic Association of Pakistan and Honorary President of International Diabetes Federation, introduced the theme of the World Diabetes Day “Healthy Living and Diabetes” and campaign slogan for this year “Healthy Eating and Diabetes”.

Prof Shera, who is also founder President of Diabetes in Asia Study Group and Director WHO Collaborating Centre for Diabetes, said diabetes is a chronic, debilitating and costly disease. World Diabetes Day provides the opportunity to improve care for the many millions living with diabetes and to encourage governments to do more to prevent diabetes in the many more at risk. He further said currently there are 387 million people living with diabetes worldwide. By 2035, the number will rise to 592m. Diabetes had resulted 5m deaths in 2015, every 6 seconds a person dies from diabetes and diabetes-related complications. Pakistan has also seen a sharp rise in the diabetes prevalence and hence these facts and figures highlighted the importance of urgent action.

He further said Type 1 diabetes cannot be prevented; a healthy lifestyle is an important part of effective management of the disease. 70 per cent of Type 2 diabetes can be prevented by healthy eating and regular physical activity (30 minutes brisk walk daily before meal). Healthy diet contains leafy vegetables, fresh fruits, whole grains, lean meat, un-sweetened yogurt and nuts etc. Encouraging healthy eating habits in young children is the key to halting the rise of diabetes epidemic.

Discussing Insulin therapy, he said Type 1 diabetes is rare in Pakistan and it is diagnosed early. The only treatment is Insulin injection which should be continued throughout life. Insulin is life-saving drug for Type 1 diabetes.

Professor of Medicine & Consultant Endocrinologist at Aga Khan University, Dr Najmul Islam, spoke on the topic of “Management of Type 2 Diabetes: Treatment Options and Clinical Guidelines.” He said Type 2 Diabetes is the commonest variety of diabetes in our population as well as the rest of the world. The treatment of patients with Type 2 diabetes mellitus includes education, with emphasis on lifestyle changes, including diet, exercise, and weight reduction when appropriate.

In the absence of contraindications, Metformin is usually the initial pharmacologic therapy for most patients with type 2 diabetes, he said, adding further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1C result (and the results of home glucose monitoring).

Target A1C levels in patients with Type 2 diabetes should be tailored to the individual, balancing the improvement in micro-vascular complications with the risk of hypoglycemia.

The choice of further therapy after Metformin should be individualized based upon patient characteristics, preferences, and cost from an armamentarium of anti-diabetic medications at our disposal.

After Metformin in Pakistan, the next two medications which can be added are from Sulphonylurea or DPPIV Inhibitor groups, he opined.

The risk of hypoglycemia, which may lead to impaired cognition and function, is substantially increased in older adults. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in older adults, he added. 

Speaking on the topic of “Diabetic Foot” Prof. Abdul Basit of Baqai Institute of Diabetes and Endocrinology said foot complications are common in people with diabetes. Every 30 seconds a lower limb is lost as a consequence of diabetes mellitus. Twenty-five per cent of people with Type 1 and Type 2 diabetes will develop one or more foot ulcers in their life time, 10pc of them will go to have a major lower limb amputation. However, 50pc of foot ulcers and amputations can be prevented by early identification and education. Principal causative factors are peripheral neuropathy, vascular compromise, ulceration and infection. These factors often associated with trauma or foot deformity lead to an increase risk of lower limb amputation, he pointed out.

Regarding prevention, he said there should be proper foot ware, no bare foot walking, daily washing of cotton socks and examination of shoes before wearing. Foot examination should be a part of every clinic visit.

Dr Shabeen Naz Masood, Consultant Obstetrician and Gynecologist at Aga Khan Hospital for Women, spoke about “Gestational Diabetes Mellitus”. She said gestational diabetes mellitus is characterized by glucose intolerance that begins or is first diagnosed during pregnancy and usually resolves after delivery. One in seven births is affected by gestational diabetes mellitus.

Gestational diabetes mellitus is a substantial and growing health concern in many parts of the world. Pakistani population is especially vulnerable to developing this condition because of genetic, social, and environmental factors. Gestational diabetes has serious, long-term consequences for both baby and mother, including a predisposition to obesity, metabolic syndrome, and diabetes later in life. Early detection and intervention can greatly improve outcomes for women with this condition and their babies.

Prof. Zaman Sheikh, director Diabetes and Endocrinology Department at Sir Syed Hospital talked on the topic of “Lifestyle and Diabetes”. He said lifestyle changes are often advised for people at high risk of diabetes and those who are newly diagnosed with Type 2 diabetes to help manage their diabetes. Diabetes prevention programme reported that changes in diet and physical activity resulted in a large reduction in incidence of Type 2 diabetes than medication alone. Many intervention trials showing the benefits of lifestyle change for health, yet prevention programmes and healthier behaviours have not been widely adopted. Between 1999 and 2010, the prevalence of hyperglycemia increased from 12.9 to 19.9pc. The portion of the population having waist size above the recommended threshold also increased from 45.5 to 56.1pc, indicating a rise in the abdominal obesity. The behaviours that are recommended for the prevention of diabetes include a balanced diet, rich in fruits, vegetables, fibers, un-saturated fats, lean meats and low nutrients foods, engaging in regular moderate to vigorous physical activity, avoiding alcohol and tobacco. Education is an important component for managing and preventing diabetes, he added.

The afternoon session was for the people with diabetes and their family members. It was chaired by the DAP’s Patron Illahi Bukhsh Soomro.  

Speaking on the occasion, Prof. Samad Shera said that alarming increase in prevalence impose heavy burden on society in the form of morbidity, early mortality and high health care costs unless urgent and appropriate measures are taken to meet challenges.

He stressed the need for adopting healthy lifestyle and awareness about disease. His concluding message was “To do nothing is not an option”. Act to change your lifestyle today; it will help to change the world tomorrow. “Eat less - Walk more”. Encourage healthy dietary habits.

Lauding the DAP’s mission, Mr Soomro emphasized the need for prevention and management of diabetes to avoid complications.

Later, a panel of experts, including Prof. Samad Shera, Prof. Jaffer Naqvi, Prof. Saleh Memon, Prof. Abdul Basit, Prof. Zaman Sheikh and Prof. Najmul Islam answered the questions posed by the audience.