Prioritisation Strategies Of Diabetes In Pakistan

Abstract

According to global ranking, Pakistan is on 7th number. 6.6% adults in Pakistan have diabetes and it is believed that in 2030 around 14 million people will have diabetes. People with foot ulcers, no knowledge of diabetes and specifically young children diabetes are of major concern in the plan of action presented by international diabetes federation. Various shareholders and collaborators were working together at both stages globally to enhance the bad conditions of diabetes in Pakistan.

Introduction

Diabetes is a non transmissible illness that ranks number four in the world. Diabetes is more prevalent in Asian countries. On the report of various researchers and surveyors, people living in urban and rural areas contribute to 22% and 17.1% of the total population respectively. Total ratio varies in different provinces of Pakistan. In Punjab, about 16.6% and 19.3% males and females respectively have diabetes mellitus. Whereas in Sindh 16.2% and 11.7% of males and females respectively have diabetes. In Balochistan, on whole, both males and females, about 10.8% of the population have diabetes mellitus.

There are several mechanism that cause the development of diabetes. Which involves self destructions of beta cells of pancreas. This can completely alter insulin functioning. In some cases it can also lead to insulin insufficiency. Short supply of insulin can cause abnormal functioning of macronutrients. Insulin deficiency and malfunctioning of insulin can also effect normal tissue reactions. In some cases it can also effect normal hormone functioning. If a person has both insulin deficiency and insulin malfunctioning then it is a severe abnormality and it is characterised as the main cause of low blood sugar levels.

There are 3 basic types of diabetes. Type 1 which is insulin dependent; type 2 which is non-insulin dependent and gestational diabetes which occurs during pregnancy. For diagnosis of diabetes, there are several tests that can be performed. It includes oral glucose tolerance test, glycated hemoglobin test and fasting blood sugar levels are tested.

Indications for diabetes include excessive urine, excessive thirst, weight reduction and excessive hunger is also noticed in some of the cases. It can also cause damage to the eye-sight. If blood glucose levels are persistently high then it can cause chronic and severe harm to different organs of body including heart, eyes. Blood vessels and kidneys. Can also cause damage to their normal functioning.

Review of literature

Pakistan was named as the first of the countries that are still developing yet has a complete prioritisation strategy for almost all the non transmissible diseases. Various stakeholders and collaborators played their vital roles in the elimination of non transmissible diseases. Various non governmental agencies also played vital and effective role in the prevention of diabetes mellitus. National leaders alone can not completely stop the spread of diseases. Due to insufficient efforts on governmental and ministerial level, people’s engrossment in tobacco and poor agribusiness has caused unsatisfactory results in the implementation of various health laws.

Pakistan has thrice the fewer amount of medical assistants in comparison to the health professionals globally. Before 1996, there was no proper health and medical facilities for diabetes in Pakistan. Even no organisation was working for the prevention of this disease. “Baqai Institute of Diabetology and Endocrinology” was the first institute that came into being in Pakistan for the prevention and elimination of diabetes. It had proper medical assistance and initial treatments for about 7,000,000 people. This institute was believed to be evolved and enlarged.

In 1999, a one year degree in the management of diabetes was introduced in universities of Pakistan. As a result of which more than 300 doctors were trained for initial management and control of diabetes. More importance was given to diabetes and certain measure were even taken in non-government section to prevent diabetes.

Later in 2010, surgeons and physicians acknowledged diabetes as an important subject from the point of specialisation. So the “College of physicians and surgeons of Pakistan” also gave this subject importance and significance for specialisation. At political level, national leaders also recognised the importance of prevention of diabetes. So they developed a “National institute of Diabetes and Endocrinology” which gave higher degrees in the subject related to the treatment and prevention of diabetes.

In November 2009, Allama Iqbal College established a separate foundations for diabetes in Lahore. Which was named as ‘Jinnah Allama Iqbal Institute of Diabetes and Endocrinology”. This institution also worked for the prevention and primary care of diabetes. It was affiliated with college of physicians and surgeons of Pakistan.

In various cities of Pakistan, there are devoted therapeutic departments that are now operational for the prevention of diabetes. Certain endocrinology departments are in Peshawar’s hospital. There is also a proper department for the treatment and prevention of diabetes in Islamabad. These institutes not only provide medical care but also deliver knowledge and understanding about diabetes. These institutes usually arrange campaigns and schedule various seminars related to the prevention and treatment of diabetes.

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Health institutes and professionals made an alliance with the university of Oslo. It was a significant collaboration. It introduced a high-level degree called as ‘Norad’s programme for master studies”. The main objective of this degree was to enhance and improve the educational activities. This program targeted the countries that are still developing and also selected general and individual groups of the societies. This program also introduced higher degrees such as MPhil and PhD. The main purpose this organisation was to investigate medical treatments and services for the problems related to diabetes and other non transmissible diseases.

In Pakistan, Baqai Institute of Diabetology and Endocrinology is the initiator to develop a group of healthcare professionals for the primary care and prevention of diabetes. This institute also provided the one year degree for the primary care of diabetes for the first time in Pakistan. It has been 15 years and about 15 groups of students have been graduated with the diploma in diabetes education. Ms.Anne Belton and Ms. Marc McGill aided this diploma. They both are superior co-workers of immunodeficiency foundation. They worked hard on the knowledge that was given to healthcare professionals. Significant knowledge and awareness was given to the healthcare professionals on how to handle patients with foot ulcers.

Another program of study was designed which was of two months. It was established to take care of patients with foot ulcers and also the to give awareness to people about how we they can prevent its development. This course was ‘diabetic foot care assistants”. Various international organisations supported and aided all the programs about foot ulcers. International working group on diabetic foot and international diabetes foundation has a consultation department for foot ulcers in diabetic patients. These organisations have completely helped in the spreading of awareness about the disease.

Healthcare professionals are of significant importance in the primary care of diabetes. Special medical education is required for the control of foot ulcers. Diabetic foot care assistants are properly educated and they perform under the management of well trained professionals. National Association for Diabetes Educators of Pakistan was developed in 2010. The main objective of this organisation is to encourage and accelerate the awareness and knowledge of primary prevention and treatment of diabetes. It also involves primary care and treatment of pre-diabetics and diabetics. This organisation also organised various seminars and campaigns that spread the awareness of diabetes. It also monitored several activities in Pakistan. Several seminars and educational workshops were set to spread awareness about the disease.

Baqai Institute of Diabetology and Endocrinology started a program in 2010. The name of this program was “Insulin my life”. This plan worked on the treatment of type 1 of diabetes mellitus. This plan was primarily funded by world’s diabetic foundation. The major purpose of insulin my life program was to provide primary care and prevention specifically to children and people with type 1 diabetes mellitus. It also provided them with all the medicines and insulin supplements.

In 2012, a complete board and organisation for care of diabetes was established in Pakistan. It is “advisory board for the care of diabetes”. This organisation has top doctors for the care of diabetes in Pakistan. This institute has around 10 medical institutions all over in Pakistan. Another agreement was made with the drug industry called as “memorandum of understanding”. This deal provided those 10 medical institutions with medical resources.

Prioritisation Strategies

Main motive of international diabetes federation is to encourage primary healthcare, treatment and elimination of diabetes globally. Healthcare professionals were trained so that while performing operations on the foot ulcers of diabetic patients they will focus on the quality. Total amount on the complete operation of foot ulcer was made very low.

Certain instruments were also developed that were available at low prices. All these measures and actions decreased the proportion to 13.6% from 27.5% within 12 years span.

In 2006, another Organisation was developed with the name of “Pakistan Working Group on the Diabetic Foot”. It was developed in the authority of Dr. Karel Bakker. He is also the president of Pakistan working group on the diabetic foot. There are about 115 healthcare institutions that are treating the foot ulcers in diabetic patients. These medical institutions reduced the proportion to 6.6% from 11.3%.

Knowledge and awareness about diabetes is the infrastructure for the treatment and prevention of diabetes. Baqai Institute of Diabetology and Endocrinology has provided knowledge and degrees to over 100 instructors. 16 years back this institute introduced diabetes recognition seminars and campaigns. Unto 50,000 people came to these awareness programs.

Conclusion

Diabetes is a disease that is spreading all over the globe abruptly. Serious plans of action and measures are to be taken to stop and control this disease. Many strategies have been made to prevent this disease in Pakistan. Still people need education and awareness about this diabetes. Government leaders and stakeholders need to work together to provide essential measures and facilities to completely eliminate this disease.