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October 2018, Volume 68, Issue 10

Student's Corner

The need of dietary guidelines for people with diabetes in Pakistan - Letter to the Editor

Suhaira Bilquees  ( Dow Medical College, Dow University of Health Sciences, Karachi )
Roha Saeed Memon  ( Dow Medical College, Dow University of Health Sciences, Karachi )
Muhammad Arbaz Arshad Khan  ( Dow Medical College, Dow University of Health Sciences, Karachi )

Madam, diabetes is one of the major health concerns in a developing country like Pakistan. Around 6.3 million (7.9%) people in Pakistan are reported to have diabetes and this number is expected to rise up to 11.4 million (8.9%) by 2030.1 Chronic hyperglycaemia, a pathological feature of diabetes is associated with severe cardiac and renal complications which can lead to a high mortality rate if kept unchecked. Only in the year 2000, the number of deaths caused by diabetes was estimated to be 2.9 million.1 This places immense importance on the need for effective methods of monitoring and maintaining the blood glucose level. Although proper management of diabetes includes medications and constant monitoring of the blood glucose level, self-management plays a very important role.2 One of the self-management techniques is the use and adherence to the dietary guidelines which have proven to be very effective in managing diabetes. According to a study conducted in Canada, people who followed these guidelines religiously experienced a marked reduction of their HbA1c levels. 3 In another study, a significant reduction in weight, body mass index, and fat mass together with increased HDL cholesterol was reported.4 Diabetes receives a very insignificant share in the funds allocated for the health system by the Government of Pakistan with no specific emphasis on diabetic dietary guidelines. The only diabetic dietary guideline that exists in Pakistan is by the Pakistan Nutrition and Dietetic Society.5 This guideline fails to mention the exact amount of each type of food required to be consumed daily and instead concentrates on the total calorie count and the proportion of the different food groups such as fats, sweets, meat, etc, generally. The calorie count of the individual food categories cannot be calculated from the total calorie count with these guidelines which results in non-adherence to them. Furthermore, dietary management is not considered to be a major part of the treatment plan for diabetes which further hinders the management of blood glucose level. Adherence to dietary guidelines helps manage blood glucose levels and promotes healthy dietary behaviors among people with diabetes such as having more regular meals with decreased portions of individual foods. Dietary guidelines should be constructed by considering the availability and accessibility of the type of food and the dietary patterns of Pakistani people which vary considerably when compared with those of the Western countries. For these reasons, it is not advisable for the people of Pakistan to make use of the Western guidelines. Thus arises a need for a separate diabetic dietary guideline for Pakistan. Practitioners should be instructed to inform the patients about these dietary guidelines and their importance since compliance to them has proven to play a major role in the management of the disorder.4

Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Sources: None to declare.

References

1. Siddiqui FJ, Avan BI, Mahmud S, Nanan DJ, Jabbar A, Assam PN. Uncontrolled diabetes mellitus: Prevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan. Diabetes Res Clin Pract 2015; 107: 148-56.
2. American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care 2014; 37 Suppl 1: S14-80.
3. Raj GD, Hashemi Z, Soria Contreras DC, Babwik S, Maxwell D, Bell RC, et al. Adherence to Diabetes Dietary Guidelines Assessed Using a Validated Questionnaire Predicts Glucose Control in Adults With Type 2 Diabetes. Can J Diabetes 2018; 42: 78-87.
4. Soria-Contreras DC, Bell RC, McCargar LJ, Chan CB. Feasibility and efficacy of menu planning combined with individual counseling to improve health outcomes and dietary adherence in people with type 2 diabetes: a pilot study. Can J Diabetes 2014; 38: 320-5.
5. Diet Handout for Diabetes. Pakistan Nutrition and Dietetic Society. [Online] [Cited 2018 May 14]. Available from: URL: http://www.pnds.org/diet-handout-for-diabetes/.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: