Lack of will and dearth of awareness with regard to prevention of diabetes has not only exposed country to constant surge in the disease incidences but is also contributory to aggravating complications including retinopathy leading to blindness and foot ulcers enhancing risk to amputations besides several other fatal consequences.
Experts addressing a seminar "Put Feet First - Prevent Amputations" organised by Diabetic Association of Pakistan (DAP) and WHO Collaborating Center, here on Sunday to observe World Diabetes Day, suggested need for a holistic approach to address the ailment which also has its socio-economic as well as psychological implications.
DAP President, Professor A. Samad Shera, Professor Abdul Basit (Director), Baqai Institute of Diabetology and Endocrinology) and Professor Moosa Murad (Psychiatry Department, Aga Khan University) were the key speakers at the meeting's scientific session.
Professor Abdul Basit in his presentation mentioning that diabetes was a serious and chronic disease said foot problems and amputations were one of the most costly complications of diabetes.
"Most important factors for developing ulcers are peripheral neuropathy, foot deformities, minor trauma, infection and peripheral vascular disease," he told the participants comprising general physicians and health care professionals.
Under the given conditions, he stressed that early detection and timely interventions were key to address the factors behind the continual increase in diabetes related complications adding that 49 to 85 percent of amputation rate could be avoided by identifying people at risk of diabetic foot complications.
Referring to community based studies conducted by his Institute, he mentioned that neuropathy was found in 36 percent diabetic patients, 5.4 percent of them had peripheral vascular disease, 10.4 percent had foot ulcers, 2.5 percent had to undergo below knee amputations and 1.9 percent above knee amputations.
Amputations, he said was due to delayed referral adding that doctors as well as patients need to be extremely cautious in taking proper care of diabetic foot with provision for regular foot examination, providing education and self care programme, appropriate foot care and good diabetes control.
The senior diabetologist also discussed economic aspect of the ailment with direct bearing on financial capacities of local diabetic population.
It was mentioned that while an average urban Pakistani spends Rs 260 per year under the head of health expenditure which grows by 25 to 35 percent in case of grade two to five foot ulcers, manifested through depth of ulcers, involvement of bones and tendon, generalised gangrene and localised gangrene respectively.
The speaker also mentioned that foot ulcers not only develop due to neuropathy but trauma, wrong type of shoes, smoking and negligence of foot also leads to serious conditions making necessary for people in general and diabetic in particular to ensure good hygiene and check their feet on daily basis, wear comfortable and right type of shoes, avoid smoking and also opt for regular examination of their feet by doctor.
Dr Basit also discussed an importance of managing foot ulcers by pressure off-loading devices that facilitate healing.
He mentioned that an indigenous and cost effective device has been developed for the purpose at his Institute and was being used by many of the patients.
Dr Murad Moosa Khan in his presentation "Psycho-Social Aspects" of Diabetes mentioned that not only the diabetics are prone to develop clinical depression but patients suffering from deep depression and other psychological conditions are extremely vulnerable to be inflicted with diabetes.
The fact, he regretted was largely ignored at the expense of concerned patients.
Elaborating his stance, the psychiatrist said depression leads to a poor glucose control and eventually a higher frequency of diabetes complications.
He mentioned that diabetes, a chronic disease with high prevalence of mood disorder and depression was closely linked to the fact that patients have to take on extra responsibilities in managing their health.
As for kids, the psychiatrist said children with diabetes feel discriminated from their peers. Recognition of the psychological problems were said to be very important as treatment was essential to maintain good metabolic control and provide a good quality life.
Professor Murad Moosa Khan suggested close co-ordination among general physicians, diabetologists and psychiatrists to help address distress of diabetic patients.
Professor A. Samad Shera, Secretary General, Diabetic Association of Pakistan made an elaborate presentation on "New Insulins."
It was mentioned that insulin, a life saving medication, discovered in 1921, for diabetics has experienced massive technological advancements.
With advanced technology, long acting and intermediate acting insulin was developed and later using genetic engineering human insulin was manufactured with the same formula as that of human beings, he said.
He mentioned that developments witnessed in 1979 were further supplemented with the introduction of insulin analogues or designer insulin in 1995.
"These analogues are more convenient to use and largely acceptable by diabetics but not affordable for large majority of diabetics belonging to third world due to cost factor," the senior diabetologist said mentioning that these people thus still prefer conventional insulin which may not be as fast acting nor as efficient to combat hypoglycemic risks and control post prandial blood sugar.
Professor A. Samad Shera mentioned that inhalable and oral insulin are still under trial.
The scientific session was followed by a public session for people with diabetes. It was chaired by former speaker of National Assembly, Illahi Buksh Soomro.
It was an interactive session during which a panel of experts comprising Professor Shera, Professor Fatema Jawad, Professor Nadeem Rizvi, Professor Saleh Memon, Professor Zaman Sheikh, Dr Najmul Islam and Dr Obaid Hashmi answered questions raised by diabetics, their friends and relatives.