Section of Diabetes, Endocrinology, and Metabolism

As a medical subspecialty, Diabetes, Endocrinology, and Metabolism (DEM) encompasses a wide array of medical disorders including diabetes mellitus, lipid disorders, obesity, hypertension, and pituitary, thyroid, parathyroid, adrenal, pancreatic, gonadal, and reproductive diseases. Many of these diseases, particularly diabetes mellitus and dyslipidemia, are widely prevalent in Pakistan. The Pakistan Diabetes Survey, published in 1995 in collaboration with the World Health Organisation (WHO), noted a prevalence of diabetes among sixteen per cent of adults with a further nine per cent of adults with impaired glucose tolerance.

A major joint initiative for establishing comprehensive diabetes services at Aga Khan University (AKU) and Aga Khan Health Service, Pakistan (AKHS,P), the Staged Diabetes Management Programme (SDM), was undertaken in March 1999 with partnerships between AKU, AKHS,P, George Washington University, Becton-Dickinson, and Nutri-Fit (Canada). This joint venture aims to provide quality diabetes care and improve clinical outcomes at all levels of care in both institutions. The new section of DEM played a major role in the first two years of the SDM project. A full-time Diabetes & Endocrinology Clinic was officially launched in March 2000, and a comprehensive, multidisciplinary diabetes care programme in the form of a University Diabetes Centre at AKU has been proposed.

The nutrition clinic is designed to provide nutrition care counselling and non-pharmacologic interventions to patients for the management and/or prevention of chronic diseases. The approach is a holistic one involving not only the patient but also other significant persons in his/her life. The attempt is to guide the patient towards an optimum nutritional status and a healthier lifestyle that will benefit not only the patient but also his/her family. Diseases that particularly require nutritional counselling include obesity, diabetes mellitus, dyslipidemias and heart disease, chronic renal failure, liver disease, multiple food allergies and intolerance, and malnutrition in both children and adults. The nutrition clinic offers specialised services in cardiac nutrition care, cancer nutrition care, diabetic nutrition care, enteral nutritional care, paediatric nutritional care, prenatal nutritional care, surgical nutritional care, and weight reduction.

Clinical research of the section of DEM focuses on effects of diabetes mellitus on local populations, and methods of improving delivery of diabetes care. But areas of interest also include disorders of lipids, hypertension and obesity. Currently, Dr Jabbar and Dr Akhter are collaborating with Dr Scott Grundy and Dr Asad Karim at the University of Texas, looking at fatty acid levels and lipid sub-fractions in young South Asian patients with ischemic heart disease.  Dr Akhter is also collaborating with investigators at the University of Nebraska Medical Center in a study examining the effects of hormone replacement therapy on platelet function in postmenopausal women with type 2 diabetes mellitus. These are fully funded research studies and both US institutions have expressed the desire to increase collaborative efforts, and in helping to establish a centre of international standards at AKU. The Section is looking to expand its collaboration with the Department of Community Health Sciences in community-based interventional and health outcome studies.

Section of Diabetes, Endocrinology, and Metabolism, Aga Khan University Hospital, Karachi