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26-10-2021 | Type 2 diabetes | Conference report | Article

Conference report: SAFES summit 2021

October 2, 2021: Kathmandu, Nepal

Author: Sanjay Kalra


The South Asian Federation of Endocrine Societies (SAFES) biennial summit is the most prestigious endocrine conference in Southern Asia. Conducted in a virtual format from Kathmandu, Nepal, this year, the 5th SAFES summit showcased top-notch expertise from the subcontinent. A strong emphasis on diabetes and related metabolic conditions was evident during the conference. This underscores the importance of the syndrome, which affects almost one in 10 adults in this part of the world.

Ibrar Ahmed (Lady Reading Hospital, Peshawar, Pakistan) discussed the interaction between type 2 diabetes and COVID-19. He explored the bidirectional link between the two epidemics, and called for greater attention to diabetes management and glucose optimization during current times. Persons with uncontrolled diabetes are at greater risk of developing COVID-19 and its complications, and are at greater risk of poor outcomes. Multiple pathogenetic mechanisms, including corticosteroid therapy, contribute to this unfortunate situation. We can use the COVID-19 pandemic as a wake-up call for societies, to explain the importance of “glucovigilance” and good glucose control. Good glucose management helps improve outcomes with COVID-19, and Ahmed shared pragmatic glucose-lowering regimens for use in these patients.

Shahjada Selim (Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh) highlighted the need for South Asian physicians to address another “twin” syndrome – diabesity. Obesity seems to be fueling the diabetes epidemic across the globe, and South Asia is no exception. Until recently, we were handicapped by the fact that traditional diabetes therapies led to weight gain (increase in kg) along with lowering of glycated hemoglobin (HbA1c). This phenomenon is termed the KgA1c paradox. Weight loss helps optimize outcomes in diabetes care, and Selim shared pragmatic treatment strategies to manage diabetes in obese patients while breaking the KgA1c paradox. These include metformin, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Prasad Katulanda (Center for Diabetes Endocrinology and Cardio Metabolism, Colombo, Sri Lanka) delivered a state-of-the-art lecture on the genetics of diabetes in South Asia. He delved into contemporary research that has tried to unravel the unique etiopathogenesis of diabetes and explain its high prevalence in the region.

Mohammad Wali Naseri outlines best practice for use of modern sulfonylureas in people with type 2 diabetes, as presented at the 2021 South Asian Federation for Endocrine Societies summit (5:53).

The SAFES summit also addressed various therapeutic options for the management of diabetes. M Saifuiddin (Dhaka Medical College, Bangladesh) discussed the pros and cons of the keto diet in a balanced manner, and cautioned against its routine use. Mohammad Wali Naseri (Kabul University of Medical Science, Afghanistan) revisited modern sulfonylureas, batting for their use in a safe and smart manner. Robin Maskey (BP Koirala Institute of Health Sciences, Dharan, Nepal) and Dina Shrestha (Norvic International Hospital and Medical College, Kathmandu, Nepal) explained the nuances of using GLP-1RAs and insulins, respectively, in people with diabetes. While Maskey presented the advantages and limitations of both drugs, Shrestha deep dived into the use of basal insulin in special situations.

Discussions at SAFES extended to metabolic complications associated with diabetes. Polycystic ovary syndrome in midlife and beyond was covered by Sarita Bajaj (MLN Medical College, Allahabad, India), while a new definition of sarcopenia was unveiled by Noel Somasundaram (National Hospital of Sri Lanka, Colombo) and Sanjay Kalra (Bharti Hospital, Karnal, India). Obstetric endocrinology, including diabetes in pregnancy was the focus of the talk from Aisha Sheikh (The Aga Khan University Hospital, Karachi, Pakistan), while Charles Antonypillai (Nawaloka Hospital, Colombo, Sri Lanka) simplified the management of adrenal incidentalomas. Ganapathi Bantwal (St John’s Medical College Hospital, Bangalore, India) took a case-based approach to understand hypothyroidism, and Cheri Deal (CHU Sainte-Justine, Montréal, Québec, Canada) delivered a keynote address on management of the poorly growing child.

The detailed discussions on these topics are a reflection of the relevance of diabetes to South Asia. It is important to have a sustained focus on continuing diabetes education for all healthcare professionals.

About the author

Sanjay Kalra

Sanjay Kalra, MBBS MD DM (AIIMS New Delhi), is an endocrinologist based at Bharti Hospital, Karnal, India.

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