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Shifting paradigms in diabetes care

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Today is World Diabetes Day

The prevalence of diabetes worldwide has nearly doubled since the 1980s. Globally about 422 million people have diabetes according to the World Health Organization and the majority of them live in low and middle-income countries. Around 1.5 million deaths are directly attributed to diabetes each year. A century after the discovery of insulin, millions of people with diabetes around the world still cannot access the care they need.

In this setting the theme for World Diabetes Day 2021-23 has been declared- ‘Access to Diabetes Care.’ The management of diabetes has today taken a shift involving a more holistic approach, points out Consultant Endocrinologist at the Sri Jayewardenepura General Hospital, Dr. Dimuthu Muthukuda. In an interview with the Sunday Island, she throws light on these shifting paradigms which are aimed at enhancing the quality of life of those with diabetes.

by Randima Attygalle

Q: How relevant is this year’s theme ‘Access to Diabetes care’ in a Sri Lankan context?

A: Since the discovery of insulin in 1921, there had been many strides forward in terms of the varieties of insulin – both oral and injectable. Today there are both national and international guidelines pertaining to diabetes care. Despite these, people with diabetes all over the world are challenged in accessing diabetic care. We are at a satisfactory level in delivering diabetic care within our freely accessible and well-structured health care system. Our limiting factor is the non-availability of the ideal device for insulin delivery which is the insulin pen. What we have in the state health sector for cost reasons is still the syringe and the needle. However, we are constantly improving our services for increased accessibility.

Q: What is the current ‘diabetes picture’ here at home?

A: In terms of the numbers, our situation is quite alarming. Recent studies show that the prevalence of diabetes in suburban areas of the island is about 20%. The situation in the rest of the South East Asian countries is no better. The major triggers of diabetes in our part of the world are obesity and being overweight. Today obesity has reached pandemic proportions and is as dangerous as COVID. Worse, there is a sizeable proportion of school children with diabetes.

The accumulation of fat in the abdomen which is called ‘abdominal or central obesity’ is common among South East Asians. This reflects the tendency for a person to develop diabetes. The other major risk factor is insulin resistance. This condition is closely linked to obesity and diabetes and this inter-connectivity leads to a very vicious cycle.

A few decades ago when we talked of a person with diabetes, it was a middle-aged or an older person that we visualized. This is no longer the case. Today many children, adolescents and young adults are diabetics.

Q: What are the most common types of diabetes?

A: Type 1, Type 2 and Gestational diabetes are the common types. In Type 1, the body does not produce any insulin and there is life-long insulin dependency. Very often children under 10 years develop this type although symptoms could occur in adolescence as well.

Type 2 is the most common, where the body does not use insulin which is produced by the pancreas effectively. This insulin resistance is also attributed to obesity where insulin is prevented from working well at tissue-level. Although Type 2 is called ‘adult-onset diabetes,’ today we see many young people developing it giving enough time to develop other complications. After about 10-15 years of having Type 2 Diabetes, the pancreas can get exhausted and it could stop producing insulin. Therefore initially although a person can manage Type 2 with drugs, later he/she may need insulin as well.

Diabetes during pregnancy is what is known as gestational diabetes. The long term consequences of this type could be serious. If a pregnant woman has gestational diabetes, there is a 50% chance of her children getting it. There is also the risk of children being obese. This is why we say that when we manage diabetes of an expectant mother, we also manage the condition in the next generation.

Q: Who are at high risk of developing diabetes?

A: Being a South Asian per se is a risk factor. Besides that, being overweight or obese, appearance of blackish velvety skin behind the neck, having a family history of diabetes (children whose both of whose parents have diabetes have more than 75% chances of developing the disease) and children of mothers with gestational diabetes and people who are on certain drugs such as steroids are at high risk.

Q: Can you throw light on the new interventions in managing diabetes?

A: Today the global trend is to look at the condition from a positive perspective. The traditional understanding was that the moment a person is diagnosed with diabetes, he/she becomes a ‘diabetic’ or a ‘diabetic patient’. Imagine a person being diagnosed at 15 or 20 with diabetes; are we going to call that person a ‘diabetic’ for the rest of his/her life? What will be his/her social and psychological well being in that case? Today diabetes is considered as a condition which you need to manage. Instead of calling ‘diabetics’ or a ‘diabetes patients’ we call them ‘individuals with diabetes’.

A few decades ago the most feared thought was going on a ‘diabetic diet’. Today we are talking of a healthy diet for everyone in the family; we are talking about giving advice to the whole family because it has to be essentially a family affair. For instance, you are going to cook a healthy meal for the entire family and not only for the member with diabetes.

The pharmacological management landscape of diabetes has also changed. Instead of the gluco centric approach which looked only at glycemic or sugar control, today a holistic approach is in place which is known as ‘cardio-renal’ approach. This looks at reducing cardio-renal complications (kidney and heart related complications). Although morbidity and mortality due to diabetes is largely heart attacks, the root cause is underestimated because the cause of death goes as ‘heart attack’ and most of these heart attacks can be prevented. To strengthen the cardio-renal management of people with diabetes, our health sector is trying its best to make the latest cardio-protective drugs available in government hospitals.

In diabetes management, we not only address sugar levels but the entire spectrum of micro vascular and macro vascular complications. When diabetes is mismanaged both small (micro) and big (macro) vessels can be damaged. While micro vascular damage will involve the retina of the eye, kidneys and nerves, macro vascular damage will lead to stroke, heart attack and peripheral vascular disease. As Endocrinologists, our ultimate goal is to prevent people from getting micro and macro vascular diseases. To realize this, we encourage people with diabetes to monitor their blood glucose levels at home using glucometers. It is imperative that they have good metabolic control and healthy cholesterol levels. Diseases such as ischemic heart disease and non-alcoholic fatty liver should also be kept at bay. Then only can we prevent amputations and even death. Today we look at the bigger picture.

Another new trend is what we call ‘diabetes remission’. New clinical trials have shown that in case of recent onset of diabetes, if a person is able to lose weight coupled with a healthy diet and exercise and also with the use of drugs such as Metformin, a person can go into a remission for a long period of time with a fully normalized blood sugar levels.

Q: What measures are in place to empower people with diabetes, so that they become independent and can improve their quality of life?

A: Sri Lanka College of Endocrinologists (SLCE) carries out many educational programmes including training of trainers and health care personnel. Guidelines are also developed by the SLCE.

Education and awareness is very much a part of Endocrinology Units of state hospitals today. We look at the entire metabolic picture and deliver a comprehensive diabetic care delivery through our clinics.

Q: What is the role of diet and exercise in preventing and managing diabetes?

A: Eating in moderation is the key and rather than what you eat, you need to be mindful of how you eat. Managing portions is crucial here. Our plate should ideally have 1/4th of rice and the rest should be green leaves, fish, etc. People should also be more creative and intelligent in their food choices. Mixing food which contains more sugar with fibre-rich food for example, can be a smart way of eating. It is not realistic to stay away from delicacies during festive seasons, nor depriving a child of sweets; the key is enjoying what you like in moderation. Eating fruits in between meals is encouraged so that they serve the dual purpose of having a snack as well as fulfilling the daily fruit requirement. Processed food and fast food should be minimal.

In terms of exercise, we encourage at least half an hour of physical activity such as brisk walking, cycling, swimming or aerobics, at least five days a week. Exercising itself can help minimize insulin resistance.

Even people with disabilities are encouraged to exercise their muscles while being seated or lying down.

Q: What challenges do you see for people with diabetes during the pandemic and how can they be mitigated?

A: When a person has poorly controlled diabetes, his/her immunity is compromised and chances of catching infections are very high. So it is essential that people manage their diabetes and take their drugs diligently. Mismanaged diabetes can result in COVID pneumonia. Even during the lockdowns, we ensured that drugs reached people and most clinics operated uninterrupted in the best interest of the public.

We see more people becoming sedentary during the pandemic. Both children and adults are spending a considerable time before computer screens with little or no exercise. This could make them susceptible to obesity which is a precursor to diabetes. Hence, children should be encouraged to indulge in some kind of physical activity and even adults should regularly take breaks from their desks and take a short walk around.

Q: Finally, how important do you think it is to adopt a multidisciplinary approach to combat diabetes instead of making it the sole responsibility of the health sector?

A: Although management of diabetes has to be customized, it is very crucial that we have a multi modal approach with the participation of schools, policy makers, employers and media to prevent the numbers from escalating. Today we have the traffic light system for certain foods, however there is still a question of consumer literacy. We also see children being the target of advertisers and there is a need for regulation here. Hence it is imperative that all stakeholders get together in preventing diabetes which could take a toll both on individual productivity as well as the health sector.



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Mövenpick Celebrates 5 years of Gratitude

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General Manager – Mövenpick Hotel Colombo Roshan Perera has over 30+ years in the hospitality industry in Sri Lanka, Roshan has worked with multiple International and local brands – from the likes of Intercontinental Hotels, Taj Hotels and Palaces as well as multiple world class Sri Lankan Hotels.

Prior to joining the Mövenpick family, he served as a Director/CEO Laugfs Leisure Ltd managing the flagship brand of Anantaya Resorts & Spas.

With his continued efforts in professional development and numerous qualifications, Roshan is recognized by the American Hotel & Lodging Institute under the Certified Hotel Administrator programme. Meanwhile

Director of Sales and Marketing – Mövenpick Hotel Padmi Fernando, seasoned Sales and Marketing professional with 18 years of experience managing and leading teams across Sales, Marketing, PR, Reservations and Revenue Management of leading International and Local Hotel Brands.

Before joining Mövenpick, she also had Senior Management roles with Taj Hotels Sri Lanka, Cinnamon Hotels and Resorts and the Trans Asia Hotel.

Padmi is also a recipient of the prestigious Pioneer Woman Leader Award (2019) at the 6th World Women Leadership Congress and Awards organized by CMO Asia. Both the GM and Sales and Marketing manager spoke of thier success and challenges of the hotel.

What is the theme of the 5th Year Anniversary, on gratitude?

A: Padmi Fernando: Having faced many remarkable highs in our 5 years of existence and also some very deep lows caused by varied tumultuous challenges, we felt that our five-year Anniversary theme for Mövenpick Colombo is about, ‘Celebrating 5 years of Gratitude’. Essentially all of us at Mövenpick Colombo take this opportunity to celebrate our customers and partners, whose loyalty supported the Hotel and gave us wings to fly high and rise above tough times. Having had the support of our guests from all corners of the world have helped us remain filled with purpose and a sense of optimism. This celebrations is completely dedicated to our guests to make them feel valued and appreciated.

What are your plans to celebrate the 5th year anniversary?

A:

Padmi Fernando: Well, to showcase our appreciation of our guests and partners, we curated meticulously planned ‘Gratitude Offers’. This includes a 25% discount which will be presented at any restaurant of our guests’ choice, on all a la carte meals. We also give guests a reason to celebrate with our extended 3-hour Happy Hour at Vistas, which will start from 5pm till 8pm daily. Robata Grill and Lounge, the Hotel’s Asian Inspired Restaurant will also gift a free bottle of wine to diners who dine in groups of five, in addition to the 25% discount available on a la carte.

Meanwhile Ayu, will serve a special Weekend Celebration Buffet. This special Buffet will be available and will also feature a mouthwatering kiddies’ buffet selection, making it a scrumptious celebration for the whole family.

We have also designed some incredible staycation deals, with all-inclusive Junior Suite offers with special pampering touches such as breakfast in bed and, high tea for two at Ayu restaurant. This is in addition to a host of other remarkable room deals for a relaxing break to unwind and recharge after a tough 2021.

How are you facing covid and what guidelines are you following at Group level?

A:

Padmi Fernando: The health and safety of our guests and employees have been our absolute priority. We are proud to have won the AccorHotels Group ALLSAFE label verified by Clifton, an international independent party. This represents our new elevated hygiene protocols and standards and provides assurance that these standards have been met in our hotel. We have introduced intensified hygiene and prevention measures to ensure the safety of every single person who is welcomed through our doors. We are doing everything possible to reassure our guests and to anticipate their health and safety needs for a pleasant and satisfying stay.

Q: What did the Movenpick brand introduce to the hospitality industry in Colombo when it launched 5 years ago?

A:

Roshan Perera: Movenpick Colombo was the first new International Hotel to open after 30 years, signifying a new and modern era in hospitality. At Mövenpick we are passionate about ‘making moments’. We recognise that small gestures make a big difference to our guests, our owners and our people. We do ordinary things in an extraordinary way – a philosophy that has defined our brand’s success from the very start. Historically Movenpick is a global Hotel Chain with Swiss roots and a restaurant and hospitality heritage that dates back to the 1940s. Movenpick’s very DNA is its F&B and is what the brand is globally famed for. This culinary prowess allows us to take our valued guests on an intriguing gastronomic journey. Our rooms are stunning and artistically appointed, and I would say that overall, our modern and upscale Movenpick brand invites guests to a one-of-a-kind, stylishly vertical urban experience. This has made us the hotel of choice for guests who travel on both business and leisure.

For the greater part of Movenpick’s existence it has faced challenges that heavily affected the hospitality industry. How have you overcome this?

A:

Roshan Perera: There is no doubt that the Movenpick Team is resilient and harbours a deep sense of unity. Most of our staff have been with us since pre-opening and have showcased their loyalty and commitment through the highs and the lows. The Easter bombings and subsequent global pandemic affected us deeply along with the rest of the industry. However, standing strong and united and facing all the challenges that came our way with agility has allowed us to weather the storms. Our focused strategies combined with the robust backing of the Softlogic Group was also undoubtedly the wind beneath our wings that pushed us forward. We have enthusiastically embraced change and new ways of operating with speed and that has made all the difference.

Movenpick Hotels & Resorts come under the wings of the AccorHotels Group, while Softlogic Group owns the Hotel. How does this affect your products and services?

A:

Roshan Perera: I would say that being part of these two giant entities makes our Hotel a remarkable brand powered by two highly respected forces. AccorHotels is a world-leading travel and lifestyle Group comprising 5000 hotels, resorts and residences accounting for over one million rooms worldwide. Meanwhile Softlogic Holdings PLC, is one of Sri Lanka’s most dynamic and progressive conglomerates, with industry headship in six business verticals, growing rapidly under an astutely visionary and trailblazing Leadership. The conglomerate is responsible for bringing the world’s most loved and luxurious global brands to the shores of Sri Lanka. This impeccable combination has allowed us to provide an unmatched hospitality experience to Sri Lanka.

What is the greatest challenge that the industry is facing?

A:

Roshan Perera: The biggest challenge that we as an industry are currently facing is the retention of employees. In order to reduce diminishing talent, the industry must have a sustainable long term plan that benchmarks against international opportunities to keep Sri Lankan employment competitive. If not the industry will be pushed to source talent from overseas to bridge the gaps.

What are your plans for the future?

A:

Roshan: We are excited about the many plans we have in the pipelines. We are working towards launching two new restaurants by quarter 2 of 2022. There are additional plans to launch more eclectic restaurants and unique offerings to provide patrons of Colombo with brand-new dining experiences. We are eager to see what the future holds and look forward to another vibrant and exhilarating 5 years ahead, helping our wonderful guests to continue making unique and unforgettable Movenpick moments.

With over 30+ years in the hospitality industry in Sri Lanka, Roshan has worked with multiple International and local brands – from the likes of Intercontinental Hotels, Taj Hotels and Palaces as well as multiple world class Sri Lankan Hotels.

Prior to joining the Mövenpick family, he served as a Director/CEO Laugfs Leisure Ltd managing the flagship brand of Anantaya Resorts & Spas.

With his continued efforts in professional development and numerous qualifications, Roshan is recognized by the American Hotel & Lodging Institute under the Certified Hotel Administrator program.

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Singapore’s Kavita Thulasidas is back at Lady Hilton

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Kavita Thulasidas the creative and managing director of Stylemart Singapore, who wowed Colombo with her stunning creations at her unforgettable show Threads of Time, will be back with her breathtaking outfits at the Lady Hilton Tea which will be held on February 11 at the Lab, Hilton Colombo.

Kavita and her Sri Lankan partner Anita Dorai who incidentally is also from Singapore are looking forward to working with the Hilton once again. “Since our fashion extravaganza Threads of Time the fashion event of the year; was cancelled due to Covid. However we now feel that the time is ripe h for another fashion show , said Anita and Kavita. “I also have an outlet at One Galle Face Mall which I opened soon after Threads of Time and as Colombo has taken very well to my designs, I felt the time was indeed right to showcase a new collection here in beautiful Sri Lanka”, said Kavita.

Kavita said her outfits have been made for the Colombo market taking into consideration the aesthetics, price points and upcoming occasions for this time of the year. “I have kept the outfits simple and easy to wear. The outfits in this collection are light fabrics and embroideries are balanced and not too over the top with s deisgn attention given more attention to the cuts and styles ,

These are designs suitable to wear for an elegant evening out, as well as outfits for weddings and festive occasions”.

The outfits will be priced reasonably. Clothes will be on sale both at the Hilton and thereafter at the Store at One Galle Face Mall. The sale will go on for a period of five days , from the 14th February to the 20th February. Kavita also said that she has some designs in production with sizes which could be executed made to measure.

Kavita will be using Sri Lankan models and once again Brian Kerkoven will be her choreographer with all models being from his model agency. A total of 60 outfits will be showcased and Colombo’s fashion elite are indeed in for a treat!

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Giving Sri Lankan street dogs love, respect and a home

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by Zanita Careem

An epitome of courage and wisdom, she is one of the top entrepreneurs in Sri Lanka, founder of Sri Lanka’s most stylish department where she served as Managing Director. Otara Gunawardena is truly inspirational.

She has earned many awards and notched several achievements. She was awarded the best female entrepreneur award at the Seventh US Stevie awards for Women in Business and 2018 Women of the Year Award by Women in Management (WIM).

Embark has become a popular brand. How do you account for it, its beginnings and its progress?

“Back in 2007, pedigreed dogs were popularly in demand but there were countless street dogs who needed care and love. Many of them were abused and unwanted. I wanted to change their circumstance and initiated Embark with the dream of providing a better life for our Sri Lanka’s street dogs and to give them the love, respect and the home they deserve.

“The brand was set up so that the profits would support the work we do with street dogs. It was also meant to help people to live a lifestyle supporting the cause and being ambassadors for the dogs with the clothing they wear. Most of the T- shirts have slogans conveying a positive message about street dogs in a fun way and many items became popular fashion statements.”

Explain the concept behind embark and the advocacy campaign for the welfare of homeless dogs?

“The concept was to make the street dog fashionable to own. And we have succeeded in doing so as more than 6,000 street pups have been re-homed, more than 60,000 vaccinated and sterilized throughout the island. Close to 35,000 plus street dogs have been rescued and treated over the last 15 years. Many people also now do their own rescues and adoptions.

“Embark mainly provides free medical treatment for sick and injured street dogs, the majority without owners. We also help find homes for pups who are abandoned on the streets. Besides the direct rescues we do there is also a foster network who rescues these pups, looks after them temporarily whilst we provide the required medical care – vaccinations, de-worming etc. and bring them to our monthly adoption programs where they find forever homes. We carried out many sterilization programs throughout the country and ensure there is population control within the street dog population in Sri Lanka. We also have a free medical clinic weekly at our head office in Colombo where we provide vaccinations, treatments and sterilizations for street/ adopted dogs.

What is your main focus in initiating this project?

“As explained previously, the main reason behind Embark is to give our Sri Lankan street dogs the love, respect and most of all the home that they deserve.”

Don’t you ever find the work you’re doing depressing and do you find any changes for the better?

“Sadly, the situation is quite dire in Sri Lanka but it has definitely improved from the past. There is now a no kill policy and sometimes there are programs of vaccination and sterilization implemented but unfortunately not done well. There is a lot more awareness and concern with people now against cruelty and also many more helping stray animals than before. However, there is still a lot of cruelty to elephants, an increase in terrible pet shops which are filled with suffering animals, cruel pedigree breeding, inhuman zoos, animals suffering in captivity etc.

“Lack of laws is a big issue too, something that has not changed despite many governments that have come and gone. It can be quite depressing to be aware of the cruelty and see it daily in a country such as ours where the need for compassion is stressed. We just do what we can each day to make a positive difference in the current situation.”

What has been the highlight of setting up Embark?

“Well, there are many, but I can say it has been rewarding to see a paralysed dog walk again, a dog who was severely ill recover and a rescued pup finding their forever home and living the best possible life. These may seem small achievements but they are close to my heart and I am glad I am able to help these amazing beings recover and live a good life. “

What are your programs to improve and protect animals and the environment in Sri Lanka?

“Embark under, Otara Foundation has been working on improving the lives of street dogs throughout the country, conducting rescue and re-homing initiatives whilst managing the canine population and preventing rabies through sterilization and vaccination programs across the country. Most of the rescues and treating of the injured are focused in the Western Province, but we do try our best to reach as best as we can in other areas.

“Embark has been at the forefront influencing policy in relation to animals and playing a vital role in making a significant change in the lives of animals and people alike.

“The Otara Foundation works with its accredited partners to promote large and medium-scale reforestation projects in the country. In addition, because it is the Foundation’s mandate that all life matters and every little effort is a step in the right direction, we support and promote smaller individual initiatives in reforestation and replanting. I personally advocate a better life for animals, speak out on behalf of the animals and participate in awareness.”

Any drawbacks?

“I can only look at the change I have been able to make for animals and the environment and be grateful for what’s been achieved. The drawbacks are knowing how much more we need to do and can be done if there was conscious caring leadership as a lot of bigger change has to be initiated from the top.”

How does it feel being a female entrepreneur?

“It has been a challenging yet enjoyable journey. I am happy to have been able to change the direction of retail and fashion in Sri Lanka and to give a lot more women hope to follow their dreams and be who they want to be.”

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