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Diabetic Foot Clinics

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Diabetic Foot Clinics In the Name of ALLAH, Ever Beneficent, Infinitely Merciful Current Status of Diabetes Care in Pakistan MMDA International Symposium on Diabetes “ 2017 Updates” (F.R.C.P) Yangon, Myanmar Prof. Abdul Basit Professor of Medicine th 11 June, 2017 Director Baqai Institute of Diabetology & Endocrinology(BIDE) Karachi, Pakistan Prof. Abdul Basit (FRCP) • Chair- elect IDF MENA Region • Director, Baqai Institute of Diabetology and Endocrinology (BIDE) • Joint Secretary , Diabetic Association of Pakistan (DAP) • Founder, National Association of Diabetes Educators of Pakistan (NADEP) • Chairman, Pakistan Working Group on Diabetic Foot (PWGDF) • Founder member , Diabetes in Asia Study Group (DASG) Current Status of Diabetes Care in Pakistan Screening and Prevalence Prioritization Strategies Capacity Building Management updates Future Directions Screening and Prevalence Still the gold standard diagnostic and screening test in Asians is Modified GTT Screening and Prevalence International bodies are now recommending HbA1c as diagnostic criteria but regional/national studies are required before it can be included in national guidelines Reference: American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, International Diabetes Federation. Consensus statement on the worldwide standardization of the HbA1c measurement. Diabetologia 2007; 50: 2042-2043 Nature Reviews Endocrinology 6, 589-593 (October 2010) National Diabetes Survey – Pakistan 2016-17 Parameters being assessed • Fasting blood glucose • Random post 75 gms. Glucose load • HbA1c • Fasting lipid profiles • Blood pressure • Obesity measurements Approved by National Bioethics Committee (NBC) - Pakistan Collaborators DROP 2 Sampling progress Required Done Punjab 5800 4401 (76%) Sindh 2630 1730 (66%) KPK 1695 1513 (89%) Baluchistan 555 528 (95%) Islamabad 120 117 (97 %) Overall 10800 8289 (77%) DROP 2 Current Status of Diabetes Care in Pakistan Screening and Prevalence Prioritization Strategies Capacity Building Management updates Future Directions Prioritization Strategies IDF Consultative Sections Diabetes education 3 top most Diabetic foot priority sections Diabetes and children BIDE in Diabetes EducationPrioritization Strategies University based One year diploma in Diabetes Education 148 Educators trained International recognition Prioritization Strategies WDC, Montreal 2009 Eight centers designated as IDF Centers of Education 2009-2013 WDC, Melbourne in 2013 Renewal till 2015 done 115 diabetic foot clinics Sehwan Mirpur Khas Quetta Lahore Diabetic 14 12 foot clinics 10 Amputation rate 8 6 4 halved 2 Percentage of Patients Percentage 0 2008 2009 2010 A.Basit and A.Nawaz. Preventing diabetes related amputations in a developing country – steps in the right direction. Diabetes Voice 2013;58:36-39 Second Decade of Diabetic Foot Care International Diabetic Foot Guidelines Prioritization Strategies Noordwijkerhout, Netherlands 2007 Noordwijkerhout, Netherlands 2011 The Hague,Netherlands2015 ISDF Advisory Board Member The Hague, Netherlands IWGDF Prioritization Strategies th 8 International Symposium on the Diabetic Foot in 2019 May 22-25, 2019 World Forum - The Hague - Netherlands Invited as a member of the International Scientific Advisory Board Prioritization Strategies ABCD Advisory Board for the Care of Diabetes Prioritization Prof. Abdul Basit Assoc. Prof .Qazi Masroor Chairman ABCD in Pakistan Bahawal Victoria Hospital Strategies Director Baqai Institute of Quaid-e-Azam Medical College Diabetes & Endocrinology Bahawalpur Professor of Medicine – Karachi Assoc. Prof. Bilal Bin Younus Asst. Prof. Abdul Waheed Iqbal SIDER (Sakeena Institute of Tehseel Head Quarter Hospital Dadyal Diabetes & Endocrine Benazeer Bhutto Medical College Research) – Lahore District – Mirpur Azad Kasmir Prof. Jamal Zafar Asst. Prof. Salma Tanweer Pakistan Institute of Medical Nishter Hospital & Medical Sciences – Islamabad College – Multan Prof. Zaman Shaikh Asst. Prof. Sobia Sabir Liaqat University of Medical Lady Reading Hospital – and Health Sciences – Peshawar ABCD Hyderabad Assoc. Prof. Jehangir Khan Assoc. Prof. Irshad Khoso Ayub Medical College – Bolan Medical Complex Abbottabad Hospital – Quetta National Diabetic Foot Advisory Board Meeting every Wednesday 9am Islamabad 7 December 2016 Multan ABCD Prioritization 7 December 2016 Strategies IDF, DF MENA Group, 2015 Prioritization Strategies Insulin my life Centers established 34 Teachers sensitized Type 1 diabetes model clinics Subjects registered DAP- BIDE- WDF Free insulin vials distributed International recognition L I F E FOR A CHILD IML Guest Visit 2016 Awareness Walk - IML Patient Participation Resulting National Life for a child acceptance impact 500 children FREE insulin Pakistan Sudan Bangladesh Azerbaijan Mali Genetic studies HbA1c machines NICH Punjab chapter of IML Diabetes Registry of Pakistan (DROP) DROP-1 DROP-F DROP-2 DROP DROP-R DROP-G Dr. Nazeer Soomro Prof. Jamal Zafar Prof. Yakoob Ahmedani Dr. Asif Brohi Dr. Veru Mal Dr. Pawan Kumar Dr. Bilal Bin Younus Prof. Abdul Basit Dr. Fareed Uddin Dr. Zahoor Shaikh Dr. Riasat Dr. Abdul Waheed Iqbal Dr. Asher Fawwad Dr. Farhan Baloch Dr. Muhammad Irfan Dr. Riaz Ahmed Dr. Salma Tanweer Dr. Zahid Miyan Dr. Fateh Dero Dr. Imtiaz Hasan Dr. Saif Ul Haque Dr. Sobia Sabir Dr. Asim bin Zafar Dr. Irshad Ahmed Dr. Ali Jawa Dr. Sanober Prof. Irshad Khoso Dr. Farhatullah Khan Dr. Kashif Dr. Jehangir Khan Dr. Shahid Prof. Abrar Shaikh Dr. Abdul Rasheed Joyo Dr. Merajuddin Nizami Dr. Qazi Masroor Dr. Shahjahan Mangi Prof. Jamal Raza Dr. Abdullah Memon Dr. Najma Samejo Dr. Ahsan Siddiqui Dr, Umeet Kumar Prof. Zaman Shaikh Dr. Aejaz Solangi Dr. Nazeer Khokar Dr. Ameer Memon Dr. Khurshid Khan Dr. A.H. Amir Dr. Abbas Raza Dr. Osama Ishtiaq Registry form Website Online Registry Portal DROP 1 Current Status of Diabetes Care in Pakistan Screening and Prevalence Prioritization Strategies Capacity Building Management updates Future Directions Diploma in Diabetology for Family Physicians Capacity Building Batches completed Diploma holders 17 417 Online Capacity Building Aga Khan University hospital Baqai Institute of Diabetology & Endocrinology Specialists Jinnah Postgraduate Medical Centre Training Jinnah-Allama Iqbal Institute Of Diabetes & Endocrinology Diabetes Setup at Hyattabad Med Complex Diabetes Unit at PIMS Capacity Building Family Physio physicians Therapists Consulatnt Diabetes Diabetologist and care Endocrinologist People nurses with Diabetes Diabetes Educators Dieticians Phamacist Associate Foot Care Diabetologists Assistants Family Physio Gynaecologist physicians Therapists Ophthalmologist Consulatnt Dermatologist Diabetes Diabetologist care Cardiologist and Endocrinologist People nurses with Pshycologist Surgical Diabetes Diabetes colleagues Educators Dieticians Clinical Nutrionist Nephrologist Phamacist Associate Foot Care Diabetologists You name Assistants it and it ought to be Capacity Building here Capacity Building Public Health Depts Politicians Public forums NADEP etc. Role of Physician multiple Associations stakeholders Media Teaching Faculties Donors Pharmaceutical Philantropy industry Diabetes Leadership Forum Capacity Building Policy Makers Advocacy Board Meeting 1st and 2nd March, 2014, Islamabad What needs to be done? M.Sc NCDs Who Can Apply MBBS, MD, BDS or Objective equivalent qualification Develop professional skills Master’s degree in to analyze the underlying Sciences, Social Sciences determinants of NCDs and Any equivalent degree to formulate and implement recognized by PMDC, PNC preventive strategies. or HEC Current Status of Diabetes Care in Pakistan Screening and PrevalencePrioritization Strategies Capacity Building Management updates Future Directions Management updates Low-cost and effective strategies Basit A, et al,. BRIGHT Guidelines on self monitoring of blood glucose. PJMS 2014; 30:1150-1155 Management updates Self Monitoring of Blood Glucose (SMBG) 39 Management updates 40 Management updates EDITORS Prof. A Samad SheraProf. Abdul Basit Advisory Board for the Care of Diabetes (ABCD) PROMPT Core Team Prof. Bilal Bin Prof. Jamal Prof. Qazi Dr. Sobia Sabir Prof. Zaman Younus Zafar Masroor Shaikh Karachi Peshawar Lahore Islamabad Bahawalpur Dr. Zahid Miyan Dr. Dr. Asima KhanDr. Riasat Ali Khan Musarrat Co ContributorsRiaz Dr. Salam Prof. Irshad Dr. Jehangir Tanveer Khoso Khan Prof. Waheed Iqbal Multan Quetta Abbottabad Dr. Asher Prof. Rubina Dr. A. B. Fawwad Hakeem Zafar TABLE OF CONTENTS 01 Introduction 02 Factsheet Referral Criteria for Non Pharmacological 03 different levels of care 04 Management Pharmacological Acute emergencies 05 Management 06 Macrovascular Microvascular Complications 07 Complications of diabetes 08 09 Diabetic Foot 10 Obesity PROMPT 43 Future Plan MENA Regional Council Meeting 20th August, 2016 Karachi- Pakistan Future Plan The PROMPT document MENA has been approved Regional Council by the MENA RC in Khartoum in Dec 2016 Meeting It will be finalized 20th August, 2016 and submitted Karachi- Pakistan in Alexandria in May 2017 The IDF Middle East and North Africa (MENA) Region covers a wide area in North Africa and West-Asia, extending from Pakistan in the east to Morocco in the west. Committee Members FACILITATOR Prof. A. Samad Shera Prof. Kamel Salameh Prof. Abdul Basit Prof. Hessa Al-Kandari Prof. Inass Shaltout COORDINATOR Dr. Muhammed Hassanein Dr. Asher Fawwad Prof. Mesbah Kamel MENA Guidelines Chapter Diabetes in MENA Region Chapter Chapter Factsheet Referral
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