‘Regular health evaluations are vital to diagnosing metabolic and endocrine disorders’

Dr. Syed Abbas Raza has been the Consultant Endocrinologist at the Shaukat Khanum Memorial Cancer Hospital and Research Centre and National Hospital in Lahore, since 2004. He received his medical degree from Allama Iqbal Medical College, Lahore, and served as the Chief Medical Resident at Atlantic City Medical Center, NJ, USA, for a year before completing a two-year fellowship in Diabetes, Endocrinology, and Metabolism at the University of Wisconsin-Madison, WI, USA. Dr.

Raza is American Board Certified in Internal Medicine and Endocrinology, Diabetes, and Metabolism. He has presented extensively on diabetes and endocrinology throughout his career and has received numerous awards including the prestigious “Lifetime Achievement Award” by the Pakistan Endocrine Society in recognition of his contributions to the field of diabetes and endocrinology.

Recently, Dr. Syed Abbas Raza has been elected as the president of International Society of Endocrinology (ISE) and will serve in this prestigious position from August 2022 to October 2024. ISE is a global community of endocrine organizations worldwide which represents a broad network of health care professionals integrating all areas of endocrinology and metabolism.

Dr. Syed Abbas Raza is a Member of the Board of Governors and Past-President of the Pakistan Endocrine Society (PES). He has also served as the Past-President and Founder Vice President of the South Asian Federation of Endocrine Societies (SAFES).

Currently, Dr. Syed Abbas Raza is also serving as a Board Member of Dilawar Hussain Foundation and Friends of Mayo Hospital, working for patients suffering from chronic diseases.

Following are the edited excerpts of a recent conversation BR Research had with Dr. Abbas Raza:

BR Research: Tell us about your journey in medicine and interest inendocrinology as your field of expertise?

Dr. Syed Abbas Raza: I am currently working as a consultant Diabetologist /Endocrinologist at Shaukat Khanum Cancer Hospital & Research Center and National Hospital in Lahore, Pakistan. My journey in the field of medicine started in Lahore and continued in Lahore. The reason for selecting Endocrinology was based on the need of the people of Pakistan. When I returned from the USA, hardly anyone specialized in endocrinology, and standardized treatment was unavailable. I can thank God that I was part of the change we see today in managing diabetes at a grassroots level.

BRR: Why is diabetes known as the mother of all diseases?

SAR: Diabetes and metabolic disorder are prime risk factors for cardiovascular disease (CVD). Vascular disorders include Eye Diseases (retinopathy), Kidney disorders (nephropathy), Causes of Gangrene (peripheral vascular disease (PVD), stroke, and Heart Attack (coronary artery disease).

Diabetes can potentially affect all organs from the top of the head to the bottom of your feet and is called the “Mother of all diseases.”

Unfortunately, Diabetes has been called “Sugar,” which remains the focus of doctors and patients. Now we know that patient is the center of care and appropriate measures have to be taken to prevent complications rather than just focusing on blood glucose. These measures include managing complications noted above.

BRR: It is reported by the International Federation of Diabetes (IDF) that Pakistan has seen an alarming rise of 70 percent in the prevalence of Diabetes since 2019. Can you tell us about the cause of this dramatic rise and why have we failed to counter it as a country?

SAR: According to “The Journal of Pakistan Medical Association (JPMA),” the estimated prevalence of type 2 diabetes mellitus in Sindh province is 16.2 percent in males and 11.70 percent in females; in Punjab province, it is 12.14 percent in males and 9.83 percent in females. In Baluchistan province, 13.3 percent among males, 8.9 percent in females; while in Khyber Pakhtunkhwa (KPK), it is 9.2 percent in males and 11.60 percent in females. The prevalence of type 2 diabetes mellitus in urban areas is 14.81 percent and 10.34 percent in rural areas of Pakistan.

From these statistics, we can tell that diabetes has spread all over Pakistan. There are only limited specialists in diabetes management. Hence, it is of utmost importance to standardize the treatment of diabetes so that everyone gets the same quality of care.

This sudden increase is probably due to more awareness regarding the early detection of diabetes. At a given time, almost half of the people who have diabetes don’t know that they have it (undiagnosed). Recent epidemiological surveys have helped us understand the exact burden of disease in Pakistan.

BRR: As the President-elect of the International Society of Endocrinology (ISE), you are the first Asian to head this crucial global society. As President, what are the top three points on your schedule?

SAR: It is an honor and privilege for me to be elected by the world’s largest (Member Endocrine Societies from across Glob) to serve as President. I am humbled that I am the first Asian to hold this position, but I realize that there is a lot of responsibility attached to this position. I have worked in this organization for the last four years and have tried to leave an impact, and I think these efforts have resulted in receiving this additional responsibility.

As President of this global organization, my role is to build bridges and bring standardized care to all individuals suffering from endocrine disorders. The International Society of Endocrinology is the worldwide community of endocrine organizations worldwide. It represents a broad network of health care professionals integrating all areas of endocrinology and metabolism.

My job as President is to not only represent Pakistan but also to facilitate collaboration and integration across endocrine organizations and regions. This organization provides virtual and live platforms to disseminate knowledge and research and bridge the gaps in education.

BRR: Pakistan stands number three in terms of diabetes prevalence across the globe. This presents a significant public health challenge for a resource-constrained country like ours. What would be your advice to the government to help address the challenge?

SAR: We all understand the complication of diabetes. Chronic diseases like diabetes cannot be dealt without the help of the government sector. But it is also essential to know that government alone cannot be successful either. So it’s crucial to join hands and work together against such a monumental task.

Organizations like the Pakistan Endocrine Society can play a significant role in lending a helping hand to government infrastructure. I have done a few awareness projects with the help of the media, and they have been received very well.

We have to break the silos and work together to prevent and treat diabetes and endocrine disorders to create an impact for the future.

As a Founding member and Board of Directors of “Friends of Mayo Hospital,” we have tried giving back to underserved communities. This NGO has generated More than 350 million for the up-gradation of Mayo Hospital and infrastructure development. FOMH is working to improve the Patient Care and Infrastructure of Mayo Hospital, Lahore, Pakistan, one of the oldest and most prestigious institutes of ASIA.

I also serve on the board of Directors of DHF (Dilawar Hussain Foundation), which is dedicated to the improvement of Diabetes care in Pakistan. We have 2 Charity Diabetes Clinics in Lahore, and one opened a new one in Kasur. This foundation serves thousands of patients who have Diabetes and is provided medication and laboratory tests free of cost. The facilities are in the process of up-gradation and plan to deliver state-of-the-art consultation facilities and online services.

“Run for Healthy Life” is a public awareness campaign under the umbrella of SAFES (South Asian Federation of Endocrine Societies) countries, including Pakistan, Nepal and Sri Lanka. The International Society of Endocrinology recognized this campaign at the global level. This campaign helps create awareness of a healthy lifestyle in the young generation.

BRR: Do Pakistani patients have access to the latest therapies available internationally, and what can the Drug Regulatory Authority of Pakistan do to ensure access to best-in-class medicines for millions of patients who suffer from the disease?

SAR: When I started my practice in Pakistan, it was challenging to get medication available from the western world, but things have changed. I am glad to share that the most advanced treatment options are available in Pakistan except for a few.

The medication quality of branded - generic companies is at par with international standards, which gives us a better opportunity to treat and prevent the complication of diabetes.

Cost remains a limiting factor for underserved areas, but I must admit that the medication price in Pakistan is much more affordable than the rest of the world.

BRR: Pakistan also has an alarming number of amputations annually due to complications of diabetes, such as the diabetic foot. What is the scale of the problem, and what can be done to prevent patients from reaching the point where an amputation becomes necessary?

SAR: Leg amputation remains to be the nightmare of anyone who has diabetes. Fortunately, this problem can be prevented and treated with better care and treatment.

In a specialized center for the care of diabetes, the incidence of diabetic foot/amputation is very small. But we see people needing amputation due to a lack of information regarding early signs of diabetic foot. International Federation of Diabetes / Pakistan Endocrine society has done a lot of work on this complication, and physicians have been trained to evaluate and treat it accordingly to recent guidelines.

BRR: How would you suggest that people themselves play a role in bringing down the number of patients who have diabetes?

SAR: Diabetes is also called a lifestyle disease. Although there is an apparent genetic predisposition toward this disease, the lifestyle causes the main problem. As a scientist very nicely put the risk of diabetes into words, and I quote,” Our genes load the gun but more importantly, our lifestyle pulls the trigger.”

So, we can prevent diabetes and even cure it in the initial phase. I usually tell people who have a solid family history of Diabetes (Like both parents suffering from it) that they already have it (Even when blood glucose is average). Still, it is waiting to appear based on their lifestyle and preventative measures.

BRR: Are hormonal imbalances like over or underactive thyroid or PCOS also imminent threats in Pakistan?

SAR: Polycystic Ovarian Disease is my area of interest as an endocrinologist. The University of Wisconsin, where I was a Fellow, was a significant site for research on PCOD. I had the opportunity to work with scientists during that time. I have seen girls suffer from this relatively common problem as they remain undiagnosed. In a situation like Hirsutism, obesity and fertility remain undiagnosed joint presentation. This is a common problem, and as common as one-third of the girls could face this issue. Not all need medication, but early intervention can help prevent complications.

Thyroid remains an under-reported disease as this is a silent disease and is missed easily during medical checkups. I strongly recommend universal age-appropriate screening for thyroid disease in the general population as Thyroid disorder can easily be treated and can relieve people from complications associated with it.

BRR: Is it true that women are more susceptible to hormonal and metabolic diseases than men?

SAR: Endocrine disorders are interesting as they may predispose one gender to another. Like Thyroid disorders are more common in females, while Diabetes is more common in men vs. women. But it is essential to suspect and screen for these disorders in both. It is essential to have universal screening as part of health checkups for both genders for early diagnosis and intervention.

Unfortunately, we spend more money on sick-checkup by physicians than going to physicians for general health evaluations. We should encourage health checkups even before any disease affects us for better care of our population.