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World Diabetes Day provides opportunity to improve care for many millions living with diabetes.

KARACHI -- World Diabetes Day is celebrated every year on November 14, at global level. The Diabetic Association of Pakistan and WHO Collaborating Centre Karachi observed it on Sunday at local hotel. The Scientific Session in the morning was meant for the doctors.

The session started with the welcome address by Professor A. Samad Shera, Secretary General Diabetic Association of Pakistan, Honorary President International Diabetes Federation, Founder President Diabetes in Asia Study Group and Director WHO Collaborating Centre for Diabetes. He introduced the theme of the World Diabetes Day 'Women and Diabetes'.

He 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 415 million people living with diabetes worldwide. By 2040, the number will rise to 642 million. There are currently over 199 million women living with diabetes. This total is projected to increase 313 million by 2040. Diabetes is the 9th leading cause of death in women globally, causing 2.1 million deaths per year. Pakistan has also seen a sharp rise in the diabetes prevalence. These facts and figures reiterate the importance of urgent action.

He further said Type 1 diabetes can not be prevented, a Healthy Lifestyle is an important part of effective management of the disease. 70 % of Type 2 diabetes can be prevented by healthy eating and regular physical activity (30 minutes brisk walk daily before meal).

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. He stressed on good control of diabetes to avoid complications.

On this occasion, Director of Sir Syed Institute of Diabetes and Endocrinology, Professor Zaman Shaikh, talked on 'Life Style Management and Diabetes'. He said that childhood obesity should never be taken lightly as it may be a predisposing factor for many diseases in future. He also said that parents should act as a role model for their children in order to prevent obesity.

Talking on the significance of lifestyle changes, he emphasized the need of performing daily physical exercise in the form of daily brisk morning walk for at least 30 minutes, doing sensible dieting, losing excessive body weight and avoiding smoking. He further said that healthy breakfast must be taken to stabilize the metabolism of body. He also said that fruits must be taken in raw form and not as juice. He added, fish is the best source of protein and be taken twice a week. Chicken is also healthy protein but must not be taken as broast. Dry fruits contain mono unsaturated fat and are good for health. He said that anxiety and tension make sugar out of control due to production of stress hormones in the body. Moreover, He said there are three white poisons, white flour, sugar and salt should be avoided.

Professor Muhammad Yakoob Ahmedani, Professor of Medicine and Consultant Endocrinologist at Baqai Institute of Diabetes and Endocrinology, spoke on the topic of 'Role of Hypoglycemic Agents in the Management of Type 2 Diabetes'. 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 people with type 2 diabetes include education, with emphasis on life style changes including diet, exercise and weight reduction when appropriate.

In the absence of contraindications Metformin is usually the initial pharmacologic therapy for most people with type 2 diabetes. Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1c result (and the result of home glucose monitoring).

Target A1c levels in people with type 2 diabetes should be tailored to the individual, balancing the improvement in microvascular 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-diabetes medications at our disposal.

After Metformin in Pakistan the next two medications which can be added are from sulphonylureas or DPP-IV inhibitor groups.

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.

Professor Shabeen Naz Masood, Professor of Obstetrics and Gynecology at ISRA University Karachi talked on the topic of 'Management Of Hyperglycemia in Pregnancy'. She defined Gestational Diabetes Mellitus as 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.

Pregnancy makes the body need more insulin to control levels of glucose in the body. Treatment includes diet control, physical activity. Insulin is the preferred treatment if not controlled with diet and physical activity. Extra insulin may be needed for type 1 diabetes during pregnancy.

She advised to check blood sugar frequently to maintain near - normal blood glucose levels. Good control of blood glucose before and during pregnancy reduces the risk of miscarriage, stillbirth, macrosomia, congenital malformation and neonatal deaths.

Professor Abdul Basit, Professor of Medicine and Consultant Endocrinologist at Baqai Institute of Diabetes and Endocrinology talked on 'National Diabetes Survey of Pakistan 2016-2017'. He said this National Diabetes survey of Pakistan (NDSP) estimate the prevalence of diabetes in Pakistan as high as 26.3% in people aged ? 20 years, about 19.2% people known to be suffering from diabetes while another 7.1% have been newly diagnosed to be suffering from diabetes. Similarly, prevalence of Pre-diabetes as high as 14.4% was observed in Pakistan.

More than half (52.6%) of the population were hypertensive, 27.9% individuals were known hypertensive and 24.7% were newly diagnosed with hypertension (BP ?140/90 mm/hg). Three forth of the participants (76.2%) were overweight (BMI ? 23). Similarly, high prevalence (62.1%) of obese (BMI ? 25) population was found as per Asian cutoffs. According to WHO 62.1% (BMI ? 25) and 47.5% (BMI ? 27) were found as overweight and obesity respectively. The prevalence of dyslipidaemia was 93.2%. The ?gures are alarming and underscore the urgent need for national programs to prevent diabetes, to manage the illness and thus prevent complications.

The afternoon Public Session was for the people with diabetes and their family members. Professor A. Samad Shera introduced the theme of the day. The alarming increased 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 for adopting healthy lifestyle and awareness about disease. He further said type 2 diabetes is a silent killer. Therefore all adults with positive risk factors for diabetes should check their blood sugar regularly to know if they are diabetic or not. His concluding message was 'To do nothing is not an option'; Act Now 'Eat less - Walk more'.

A panel of experts which include Professor A. Samad Shera, Professor Zaman Shaikh, Professor Abdul Basit and Professor Shabeen Naz Masood answered the questions asked by the audience.
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Publication:The Frontier Star (Northwest Frontier Province, Pakistan)
Geographic Code:9PAKI
Date:Nov 13, 2017
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