Understanding endocrinology

Ensuring the optimal care of people with diabetes who fast during Ramadan is crucial. Dr Paul Aoun, Endocrinologist, American Hospital Dubai, tackles misconceptions and explains the role of his department

What are the current treatment trends in the field of endocrinology and how many of them are accessible here at American Hospital Dubai?

 Medicine continues to evolve, and the field of endocrinology is no exception. The American Hospital Dubai (AHD) is at the forefront of acquiring cutting-edge developments in endocrinology. For example, we started incorporating the latest technological advances (newer insulin pumps and CGM) approved so far in the UAE in the management of patients with diabetes. These devices help us better monitor blood glucose throughout the day and night, especially for those requiring insulin. The AHD Endocrinology Department is also one of the first in the region to use molecular/genetic markers to aid in the management of thyroid nodules. We are looking forward to incorporating more technologies currently in the pipeline, awaiting approval. On a different note, in June 2016 AHD became the first hospital in the region to join the Mayo Clinic Care Network. Mayo Clinic has been recognised as the best hospital in the US by US News and World Report. The inclusion reflects on a genuine trust in the quality of care that our team has been providing and gives AHD access to a wide range of current medical recommendations and trends in the US and worldwide. With these benefits available to every AHD physician — including endocrinologists — patients can get answers to complex medical questions at no additional cost to them — and without them needing to travel anywhere.

What do patients suffering from endocrine-related conditions need to keep in mind while fasting during Ramadan?

 Many medical conditions require special attention during Ramadan but diabetes is one that necessitates even more delicate handling. This is because certain diabetes medications — mostly the sulfonylurea drugs (such as Gliclazide, Glimepiride, Repaglinide and Nateglinide) and all type of insulins — predispose someone to developing low blood sugar, also known as hypoglycaemia. In addition, the newer class of medications known as SGLT-2 inhibitors — Empagliflozin, Dapagliflozin, Canagliflozin — cause the patient to excrete sugars, and subsequently water, through the urine and could cause dehydration. The risk of hypoglycaemia and dehydration is

 even higher during extended fasting hours. It is imperative that any patient who is on one of these medications discuss with their physician about how best to adjust the doses to prevent hypoglycaemia and/or dehydration. Other diabetes medications may need to also be adjusted to prevent hyperglycaemic excursions, or high blood sugar, as a result of the generous caloric intake at iftar and suhour.