TPW Sept-Oct 2022

DIABETES





CONTENTS

News Face to Face 36 Red Alert 97

New Arrivals 5, BAPI News 18, Prosenjit Chakraborty
News 21, FIP News 31
Technology 67

Interview Article Insight 90

Dr. Shahjada Selim 53 Facts on Finger Tips 89

National Professor Dr. A K Azad Khan 33 Dr. Khandaker Sagir Ahmed 70 Glossary of Diabetes Term 89

Prof. Dr. Md. Farid Uddin 41 Mohammad Habibur Rahman 86 Health Tips 83

Prof. Dr. SM Ashrafuzzaman 45 FDA Update 94

Prof. Dr. M A Hasanat 49 Forecast 93

Prof. Dr. Indrajit Prasad 55 History Maker 51 Appointments And Promotions 99
AMR 57
Prof. Dr. Feroz Amin 59 Pharmacovigilance 62 FDA Approval 95
Research Update 84
Prof. Dr. Khwaja Nazim Uddin 65 Concern 39
Diabetes update 47
Prof. Dr. Mir Mosarraf Hossain 69 Drug Safety 61

Prof. Dr. M.A. Mannan 75

Dr. Faria Afsana 77

Dr Nazmul Kabir Qureshi 79

National Prof. Brig. (Rtd.) Abdul Malik board of Advisors Prof. Dr. ABM Abdullah
Founder & President UGC Professor, BSMMU
National Heart Foundation, Dhaka Prof. Dr. TA Chowdhury Personal Physician to Hon’ble Prime Minister
Professor, Dept. of Obstetrics & Gynaecology
National Prof. Dr. A K Azad Khan BIRDEM, Dhaka Prof. Dr. Mohammod Shahidullah
President Prof. Dr. Abdul Ghani Department of Neonatology
Diabetic Association of Bangladesh & Ex-Chairman BSMMU, Dhaka
Chairman Board of Trustees Dept. of Pharmacy, University of Dhaka
Bangladesh University of Health Prof. Dr. Harun-Ur-Rashid Prof. M.A. Salam
Sciences (BUHS), Dhaka Founder & Chief Consultant Founder President & CEO
Kidney Fundation Hospital & Urology & Transplant Foundation of Bangladesh
Advisor, International Affairs Research Institute, Dhaka Dhaka
Prof. Dr. Moshe Szyf
GlaxoSmithKline & James McGill Professor Editor head of marketing
Dept. of Pharmacology & Therapeutics Muhammad Masud Faisal Ahmmed
McGill University Medical School Executive Editor Marketing
Montreal, Quebec Canada S A Nadeem Md. Shohag Hossen
Pharmaceutical Advisor Circulation
Abu Nayeem Saifur Rahman managing editor Md. Sikander
Medical Advisor Sandip Kumar Saha Md. Bashar
Dr. R. M. Samiul Hasan Computer Graphics
Media Advisor Associate Editor Md. Aftabul Islam
Dr. Sajal Ashfaque Humayera Kabir Hana Production
Dr. SMG Saklayen Russel Mati Ar Manush
Dr. Saleh Mahmood Tusher Business Editor Editorial/Business Office
Md. Shahjahan 51, Kalabagan 1st Lane (Ground floor)
Dhaka-1205, Bangladesh
Research Editor E-mail: [email protected]
Prof. Dr. Md. Moklesur Rahman Sarker

Volume 13 n No. 4 n sept-oct 2022 Published by Muhammad Masud. 51, Kalabagan 1st Lane (Ground floor) Dhaka-1205,
Bangladesh, Tel/Fax: +88 02 58155677 n Printing: Image Printing & Packaging
3 Purana Paltan, Dhaka.

IMPORTANT: Every care is taken to ensure the accuracy of the information given in
this journal but no responsibility is accepted for any error and/or omissions. Editor/
publisher is not responsible in any way for views/comments expressed herein.





Acme NEW ARRIVALS

Brand Name: Gavisus Brand Name: Momet-F Brand Name: Moringa
Generic Name: Sodium Alginate Generic Name: Mometasone Generic Name: Moringa oleifera
BP + Sodium Bicarbonate BP + Furoate BP +Formoterol Fu- Strength: 500 mg
Calcium Carbonate BP marate Dihydrate BP Dosage Form: Capsule
Strength: (500 mg+ 267 mg+ 160 Strength: 50 mcg + 5 mcg Indications: Helps to over-
mg)/ 10 ml Dosage Form: HFA Inhaler come nutritional deficiency &
Dosage Form: Suspension Indications: For the treat- anemia, increases energy &
Indications: Gastric reflux, ment of asthma removes tiredness, boosts up
heartburn, flatulence as- immunity, helps to maintain
sociated with gastric reflux, healthy body weight, helps to
heartburn during pregnancy, all maintain normal glucose level,
cases of epigastric & retroster- suitable for diabetes patients,
nal distress where the underly- increases milk production of
ing cause is gastric reflux. lactating mother & reduces
fatigue in new mom.

Brand Name: Janmet XR Brand Name: Moxifix Brand Name: Neobet
Generic Name: Sitagliptin USP Generic Name: Moxifloxacin Generic Name: Neomycin
+ Metformin HCl BP Hydrochloride BP Sulfate USP & Betametha-
Strength: 50mg + 500 mg Strength: 400 mg, 400 mg/250 sone USP
Dosage Form: Tablet ml Strength: 15 g
Indications: Type 2 diabetes Dosage Form: Tablet, IV Infusion Dosage Form: Cream
mellitus Indications: Community Ac- Indications: Atopic Eczema,
quired Pneumonia, Acute Bac- postoperative infections &
terial Exacerbations of Chronic burns.
Bronchitis, Acute Bacterial
Sinusitis, Complicated Bacterial
Skin & Skin Structure Infec-
tion, Uncomplicated Bacterial
Skin & Skin Structure Infection,
Complicated Intra-Abdominal
Infection.



Ad-Din Pharma

Brand Name: Carlos 50
Generic Name: Losartan
Potassium
Strength: 50 mg
Dosage Form: Tablet
Indication: Hypertension &
Renal protection in type-2
diabetic patients with pro-
teinuria.

Brand Name: Mucoxin Brand Name: D-Met 500 Brand Name: Clogrel Plus Brand Name: Xofast
Generic Name: Bromhexine Generic Name: Metformin Generic Name: Clopido- Generic Name: Fexofena-
Hydrochloride Hydrochloride grel Bisulfate + Aspirin dine Hydrochloride
Strength: 4 mg / 5ml Strength: 500 mg Strength: 75 mg + 75 mg Strength: 30 mg/ 5 ml
Dosage Form: Syrup Dosage Form: Tablet Dosage Form: Tablet Dosage Form: Suspension
Indication: Respiratory Indication: Type-2 diabetes Indication: Acute coro- Indication: Seasonal al-
tract disorders associated mellitus. nary syndrome, myocar- lergic rhinitis.
with productive cough. dial infraction & stroke.

Aristopharma

Brand Name: B-Z Brand Name: Temcard-A Brand Name: Budison-FG
Generic Name: Thiamine Generic Name: Telmisartan + Amlodipine Generic Name: Budesonide +
Hydrochloride + Riboflavin Strength: 40 mg + 5 mg & 80 mg + 5 mg Formoterol + Glycopyrrolate
5 phospahte + Pyridoxine Dosage Form: Tablet Dosage Form: Inhaler
Hydrochloride + Nicotin- Indication: Hypertension. Strength: 160 μg + 4.8 μg + 9
amide + Zinc μg/ Puff
Strength: 5 mg + 2 mg + 2 Indication: COPD
mg + 20 mg + 27.44 mg
Dosage Form: Tablet
Indication: Prevention of
vitamin B & zinc deficien-
cies.

Beximco

Brand Name: Mulina® Brand Name: Cardocal®
Generic Name: Lefamulin Generic Name: Cilnidipine
Strength: 600 mg   Strength: 5 mg & 10 mg
Dosage Form: Tablet Dosage Form: Tablet
Indications: Community acquired Indications: To control
bacterial pneumonia (CABP) blood pressure in
hypertension, diabetes
Brand Name: Mulina® with renal impairment
Generic Name: Lefamulin
Strength: 150mg/15ml IV injection
Dosage Form: IV
Indications: Community acquired bacterial pneumonia (CABP)

Brand Name: Mopride® Brand Name: Buratuss® Brand Name: Pulmidone® Brand Name: Fixonase®
Generic Name: Prucalopride Generic Name: Butamirate Generic Name: Pirfenidone Nasal Spray
Strength: 1 mg & 2 mg Citrate Strength: 267 mg & 801 mg Generic Name: Fluticasone
Dosage Form: Tablet Strength: 50mg, 100ml, 15ml Dosage Form: Tablet Furoate
Indications: Chronic Dosage Form: SR Tablet, Indications: Idiopathic Strength:  27.5µg/spray
idiopathic constipation. Syrup, Pediatric drop pulmonary fibrosis Dosage Form: Nasal Spray
Indications: Relieve dry Indications: For the
(non-productive) cough. treatment of symptoms of
allergic rhinitis

Biopharma

Brand Name: Vcand Brand Name: Tolema Brand Name: Rixoban Brand Name: Empavic
Generic Name: Voriconazole Generic Name: Tolfenamic Generic Name: Rivaroxaban Generic Name: Empa-
Strength: 200 mg, 50 mg & Acid Strength: 2.5 mg & 10 mg gliflozin
200 mg/ 5 ml (40 ml) Strength: 200 mg Dosage Form: Tablet Strength: 10 mg & 25 mg
Dosage Form: Tablet Dosage Form: Tablet Indications: Acute Coronary Dosage Form: Tablet
Indications: Dermatophy- Indications: Migraine & Syndrome (ACS), Stroke and Indication: Type-2 Diabetes
tosis, invasive aspergillo- headache. Systemic Embolism, Deep
sis, deep tissue infections vein thrombosis (DVT) &
& Esophageal Candidiasis Pulmonary Embolism (PE).

Brand Name: Listari Brand Name: Enoma Brand Name: Ocaliva Brand Name: Gastisol
Generic Name: Eucalyptol + Generic Name: Enoxaparin Generic Name: Obeticholic Generic Name: Sodium
Methyl salicylate + Thymol Sodium Acid Alginate + Potassium Bicar-
+ Menthol Strength: 40 mg & 60 mg Strength: 5 mg & 10 mg bonate
Strength: 0.092gm + Dosage Form: Pre-Filled Dosage Form: Tablet Strength: 500 mg + 100 mg
0.060gm + 0.064gm + Injection Indications: Primary Biliary Dosage Form: Suspension
0.042gm/100ml Indications: Prophylaxis of Cholangitis (PBC), Non- Indications: Heartburn,
Dosage Form: Solution Venous Thromboembolism, Alcoholic Steato-Hepatitis Acid Indigestion & Acid
Indications: Dental plaque, stroke, unstable angina, (NASH), Portal Hyperten- Reflux.
gingivitis & bad breath. Deep Vein Thrombosis & sion Compensated Cir-
Pulmonary Embolism rhosis, Bile Acid Diarrhoea,
Non-Alcoholic Fatty Liver
Disease (NAFLD).

Brand Name: Bestcef Brand Name: Povix
Generic Name: Cefixime Generic Name: Povidone-
Strength: 21 ml iodine USP
Dosage Form: Powder for Strength: 10% (100 ml)
Paediatric Drops Dosage Form: Solution
Indications: Typhoid Fever, Indications: Surgical dress-
Upper and lower respirato- ing, Infections of the skin
ry tract infections, urinary & mucous membrane,
tract infections, gonococ- infection of wounds, burns
cal urethritis & Cervicitis, & abrasions, bacterial &
acute otitis media fungal skin infections and
vaginal infection.
Eskayef

Brand Name: Defcort Suspension Brand Name: Gastrum
Generic Name: Deflazacort Generic Name: Sodium Al-
Strength: Deflazacort INN Sus- ginate + Sodium Bicarbon-
pension (6 mg/5 mL) ate + Calcium Carbonate
Dosage Form: Suspension Strength: 500 mg + 213 mg
Indications: Posing anti-inflam- + 325 mg
matory and immunosuppressive Dosage Form: Liquid Ant-
effects on: Respiratory problems acid Preparation
(Asthma, Pneumonia, Bronchi- Indication: Heartburn, indi-
tis, COPD); allergic conditions; gestion, acid regurgitation.
rheumatoid arthritis and DMD
(Duchenne Muscular Dystrophy).



Everest

Brand Name: Alenil Brand Name: Q-fit 100 Brand Name: Q-fit 25 Brand Name: Zo-MUPS 20
Generic Name: Cetirizine Generic Name: Quetiapine Generic Name: Quetiapine Generic Name: Esomepra-
Hydrochloride Fumarate Fumarate zole
Strength: 10 mg/mL Strength: 100 mg Strength: 25 mg Dosage Form: Tablet
Dosage Form: IV Injection Dosage Form: Tablet Dosage Form: Tablet Strength: 20 mg
Indications: Allergic Indications: Schizophrenia, Indications: Schizophrenia, Indications: Healing of
Urticaria, hypersensitivity manic episodes associated manic episodes associated erosive esophagitis (EE),
reaction to medications, with bipolar disorder. with bipolar disorder maintenance of heal-
anaphylactic episode, ing of erosive esopha-
blood transfusion related Brand Name: SUCRAMAX Brand Name: SUCRAMAX gitis (EE), treatment of
allergic reaction 100 ml 200 ml symptomatic GERD, risk
Generic Name: Sucralfate Generic Name: Sucralfate reduction of Nonsteroidal
Brand Name: Napolin Strength: 1 gm/5 ml Strength: 1 gm/5 ml Anti-Inflammatory Drugs
Generic Name: Naphazo- Dosage Form: Suspension Dosage Form: Suspension (NSAID)-associated gastric
line + Pheniramine Indications: Duodenal ul- Indications: Duodenal ul- ulcer, Helicobacter pylori
Strength: 0.025% + 0.3%. cers, gastric ulcer, chronic cers, gastric ulcer, chronic eradication to reduce the
Dosage Form: Ophthalmic gastritis and the prophy- gastritis and the prophy- risk of duodenal ulcer
Solution laxis of gastrointestinal laxis of gastrointestinal recurrence, pathological
Indication: For treating red hemorrhage from stress hemorrhage from stress hypersecretory conditions
eye with ocular allergy. ulceration. ulceration. including Zollinger-Ellison
Syndrome.

Brand Name: Nintib Goodman
Generic Name: Nintedanib
Strength: 100 mg & 150 mg Brand Name: Cefivic
Dosage Form: Hard Gel Generic Name: Cefixime USP
Capsule Strength: 200 mg, 400 mg, 100 mg/5 ml & 200 mg/5 ml
Indication: Pulmonary Dosage Form: Capsule & PFS
fibrosis. Indications: Pneumonia, typhoid fever, sinusitis, tonsillitis,
pharyngitis, otitis media, acute exacerbation of chronic
bronchitis, respiratory tract infections, acute bronchitis,
skin & soft tissue infections, gonococcal urethritis.



Brand Name: Clavimax-CV Brand Name: Tajenta Brand Name: Tajenta-M
Generic Name: Cefuroxime Generic Name: Linagliptin Generic Name: Linagliptin
USP + Clavulanic Acid BP INN INN + Metformin HCl BP
Strength: 250 mg + 62.5 mg, Strength: 5 mg Strength: 2.5 mg + 500 mg,
500 mg + 125 mg Dosage Form: Tablet 2.5 mg + 850 mg
Dosage Form: Tablet Indications: Type 2 Diabe- Dosage Form: Tablet
Indications: Pneumonia, ty- tes mellitus. Indications: Type 2 Diabe-
phoid fever, sinusitis, ton- tes mellitus.
sillitis, pharyngitis, otitis
media, lyme disease, acute Brand Name: Fevimol Plus Brand Name: Hamdard
exacerbation of chronic Generic Name: Paracetamol BP + Basak
bronchitis, respiratory tract Caffeine USP Generic Name: Vasakarista
infections, urinary tract in- Strength: 500 mg + 65 mg Composition: Each 5 ml
fections, acute bronchitis, Dosage Form: Tablet contains as extract- Ad-
skin & soft structure infec- Indications: Fever, pain, head- hatoda vasica 0.68 g,
tions, surgical prophylaxis. ache, toothache, migraine, com- Piper longum 0.14 g, Vitis
mon colds & flu, menstrual pain, vinifera 0.14 g, Honey 3.47
Hamdard rheumatic & muscular pain etc. g, Woodfordia fruticosa
1.14 g, Terminalia che-
Brand Name: Neement Brand Name: Ispa Plus Brand Name: Hamdard Balm bula 73.24 mg, Glycyrrhiza
Generic Name: Marham (Sugar Free) Generic Name: Marham glabra 6.78 mg, Saussurea
Neem Generic Name: Isabgul Spicy Ajeeb hypoleuca 6.78 mg, Acorus
Composition: Each gram Composition: Each Sachet Composition: Each gram calamus 6.78 mg, Zingiber
ointment contains – Aza- contains- Plantago ovata ointment contains- Cinna- officinale 6.78 mg, Piper
dirachta indica 88.88 mg, (husk) 3 g, Cassia angustifolia momum camphora 200 mg, nigrum 6.78 mg, Syzygium
Delphinium denudatum 1 g and other excipient Q.S. Menthol 200 mg & Thymol aromaticum 6.78 mg, Elet-
5.55 mg, Pinus longifolia Dosage From: 20 Sachets 100 mg. taria cardamomum 6.78
22.22 mg, Curcuma longa IndicationS: Chronic consti- Dosage From: 20 g Ointment mg, Cinnamomum tamala
44.44 mg, Cedrus deodara pation, Piles, IBS, Hyperlip- Indications: Headache, 6.78 mg, Cinnamomum
44.44 mg, Glycyrrhiza glabra idemia and Bowel regula- Pain, Backache, Sprain, Sci- zeylanicum 6.78 mg, Rhus
44.44 mg, Lawsonia inermis tion for bed ridden patient. atica, Insect bites & Cuts. succedanea 6.78 mg &
44.44 mg, Lamp-black 44.44 Myrica nagi 6.78 mg.
mg, Acacia arabica 88.88 Dosage From: 100 ml
mg, Onosma echioides Syrup
88.88 mg and Sesamum Indications: Dry irritable
indicum oil 0.89 ml. cough, Allergic & Smok-
Dosage From: 20g Ointment er’s cough, Hoarseness
Indications: Skin infection, of voice & Sore throat,
Minor cuts, Infected ulcers Asthma and Respiratory
or wounds, Inflammation & tract infection.
Skin diseases.
Brand Name: Kulzam Composition: Each 5 ml contains- Camphor 1.61 g, Thymol
Generic Name: Aab-e-Hayat 0.81 g, Menthol 0.40 g, Eucalyptus oil 0.52 ml, Pine oil 0.26
ml, Caraway oil 0.26 ml, Anisi oil 0.19 ml and Tincture of
ginger 0.19 ml.

Dosage From: 15 ml Drop

Indications: Respiratory tract & lung infection, Pneumonia,
Catarrh, Cough & Cold, Headache, Cuts, Insect’s bite and dif-
ferent type of pains & Rheumatism.

THE PHARMA WORLD 15

Brand Name: Hamdard Bhringaraj Brand Name: Amlasia
Generic Name: Mahabhringaraj Taila Generic Name: Amalaki
Composition: Each 5 ml oil contains- Rasayan
Sesamum indicum 5.63 g, Eclipta Composition: Each 5 ml
alba 22.54 ml, Rubia cordifolia 0.17 contains as extract- Phyl-
g, Prunus cerasoides 0.17 g, Symp- lanthus emblica Juice) 3.03
locos racemosa 0.17 g, Pterocarpus ml, Piper longum 0.12 g &
santalinus 0.17 g, Red Ochre 0.17 g, Honey 0.36 g.
Sida cordifolia 0.17 g, Curcuma longa Dosage From: 450 ml Syrup
0.17 g, Berberis aristata 0.17 g, Mesua Indication: Hyperacidity,
ferrea 0.17 g, Callicarpa macrophylla Dyspepsia, Flatulence,
0.17 g, Hibiscus mutabilis 0.17 g and Heartburn, Anorexia,
Ichnocarpus frutescens 0.17 g. Anaemia, Heart disease &
Dosage From: 130 ml Hair Oil Jaundice.
Indications: Hair fall, Premature
Orion graying of hair, Dandruff, Headache
and Insomnia.

Pharmasia

Brand Name: Dexlion Brand Name: Probal-D Brand Name: Probal-DX Brand Name: Nexterol
Generic Name: Dexlanso- Generic Name: Calcium Generic Name: Calcium Generic Name: Bempedoic
prazole INN (Coral source) + Vitamin D3 (Coral source) + Vitamin D3 acid
Strength: 30 mg & 60 mg Strength: 500 mg+ 200 IU Strength: 600 mg+ 400 IU Strength: 180 mg
Dosage Form: Capsule Dosage Form: Tablet Dosage Form: Tablet Dosage Form: Tablet
Indication: GERD, Erosive Indications: Prevention Indications: Prevention Indications: Heterozygous
Esophagitis (EE), Maintain- & treatment of calcium & treatment of calcium Familial Hypercholester-
ing and healing of EE and deficiency like osteoporo- deficiency like osteoporo- olemia (HeFH), athero-
relief of heartburn. sis, osteomalacia, rickets, sis, osteomalacia, rickets, sclerotic cardiovascular
hypoparathyroidism, hy- hypoparathyroidism, hy- disease.
pocalcemia and increased pocalcemia and increased
demand during pregnancy, demand during pregnancy,
lactation and elderly. lactation and elderly.

Popular

Brand Name: Luzinta Brand Name: Airup 4
Generic Name: Lutein USP + Zeaxanthin USP Generic Name: Montelu-
Strength: 20 mg + 5 mg kast
Dosage Form: Capsule Strength: 4 mg
Indication: Age related macular degenera- Dosage Form: Chewable
tion (AMD), cataracts, retinitis pigmentosa, Tablet
diabetic retinopathy. Indications: Asthma and
allergic rhinitis.

16 THE PHARMA WORLD

Brand Name: Progut MUPS Brand Name: UbiCare
Generic Name: Esomeprazole Generic Name: Ubidecarenone
Strength: 20 mg & 40 mg Strength: 150 mg & 200 mg
Dosage Form: MUPS Tablet Dosage Form: Capsule
Indication: Hyperacidity Indications: Fertility Sup-
related disorders. port Formula (Male &
Female Infertility).
Square
Sharif

Brand Name: Pednil Brand Name: Itra Brand Name: Solospray Brand Name: Rapiflo 4
Generic Name: Predniso- Generic Name: Itraconazole Generic Name: Sodium Generic Name: Silodosin
lone BP Strength: 200 mg Chloride Strength: 4 mg
Strength: 5, 10mg & 50ml Dosage Form: Tablet Strength: 0.9% Dosage Form: Capsule
(5mg/5ml) Indication: Candidiasis, Dosage Form: Nasal Spray Indication: Benign Pros-
Dosage Form: Oral Tablet & Tinea infections, Aspergil- Indication: Colds and tatic Hyperplasia (BPH).
Oral Solution losis, Cryptococcosis. sinusitis, allergic rhinitis,
Indications: Endocrine post-operative nasal care.
disorders, rheumatic
disorders, dermatologic Brand Name: Flemo Plus
diseases (eczema, psoria- Generic Name: Glucosamine Hydrochloride + Chondroitin
sis, pemphigus). Sulfate + Undenatured Type II Collagen
Strength: 150 mg + 120 mg + 40 mg
Dosage Form: Capsule
Indication: Osteoarthritis, joint pain & inflammation,
rheumatoid arthritis, difficulties in flexibility & mobility,
joint discomfort & stiffness, impaired joint function.

Team Pharma

Brand Name: Coralbest D & Brand Name: Lulif Brand Name: Doxobron
Coralbest DX Generic Name: Lulicon- Generic Name: Doxofylline
Generic Name: Calcium azole Dosage Form: Syrup
Carbonate (Coral source) & Dosage Form: Cream Strength: 100 mg/5 ml
Vitamin D3 Strength: 10 gm (1% Cream) Indications: Indicated for
Strength: 1250mg + 200 IU Indications: Indicated for the treatment of bronchial
& 1500mg+400 IU. the topical treatment of asthma, chronic obstruc-
Dosage Form: Oral Tablet interdigital Tinea pedis, tive pulmonary disease
Indications: Osteoporo- Tinea cruris and Tinea (COPD) & bronchospasm.
sis, osteomalacia, rickets, corporis.
tetany, pregnancy & lacta-
tion, parathyroid disease.

THE PHARMA WORLD 17



White Horse

Brand Name: Temtac Brand Name: Olay Brand Name: Sizolex Brand Name: Quetolex
Generic Name: Generic Name: Olanzapine Generic Name: Risperidone Generic Name: Quetiapine
Famotidine USP BP Fumarate USP
Dosage Form: Tablet Strength: 5 mg & 10 mg Strength: 2 mg & 4 mg Strength: 25 mg & 100 mg
Strength: 20 mg Dosage Form: Tablet Dosage Form: Tablet Dosage Form: Tablet
Indications: Duodenal Indications: Schizophrenia, Indications: Acute & chronic Indications: Schizophrenia,
ulcer, gastric ulcer, gastro bipolar disorder, mania, schizophrenia, bipolar ma- manic episodes associated
esophageal reflux disease, psychotic disorder, anxiety. nia, irritability associated with bipolar disorder.
acute stress ulcer & with autistic disorder.
Zollinger Ellison syndrome
& also indicated for the
treatment of acute and
chronic gastritis.

Brand Name: Teles Brand Name: Restonix
Generic Name: Bromaze- Generic Name: Clonaz-
pam BP epam BP
Strength: 3 mg Strength: 0.5 mg & 2 mg
Dosage Form : Tablet Dosage Form: Tablet
Indications: Emotional Indications: Panic disor-
disturbance, anxiety, der, sleep disturbance,
hypertension, dyspnea and seizure, anxiety.
hyperventilation.
Brand Name: Temtac
Generic Name:
Famotidine
Dosage Form: PFS
Strength: 40 mg/5 ml
Indications: Duode-
nal ulcer, gastric ulcer,
gastro esophageal reflux
disease, acute stress
ulcer & Zollinger Ellison
syndrome & also indi-
cated for the treatment
of acute and chronic
gastritis.

THE PHARMA WORLD 19

BAPI NEWS Bangladesh Association Of Pharmaceutical Industries

Participation in Ethiopia’s International Healthcare,
Medical & Pharma Exhibition “Ethio Health 2022”

HE Ambassador of Bangladesh in Addis Aba- participated in International Healthcare, Medi-
ba, Ethiopia has personally initiated to invite cal & Pharma Exhibition” Ethio Health 2022”.
pharma companies of Bangladesh for taking
part in “Ethio Health 2022” held during 03-05 In the event, the Pharma Manufacturers/
March 2022 in Addis Ababa, Ethiopia to make Exporters displayed their world class products
Bangladesh a Focus Country. A delegation from which would ultimately open the door for ex-
Bangladesh Aushad Shilpa Samity headed by ploring Bangladeshi Pharma products in Ethio-
Mr. SM Shafiuzzaman, Secretary General, BASS pian market.

20 THE PHARMA WORLD

Seminar on BAPI NEWS
“Preparedness
of the
Pharmaceutical
Sector for LDC
Graduation”
held

Members of the EC & Advisory Committee of BASS Mr. Abdul Muktadir, Sr Vice-President, BAPI and
participated in a Seminar on “Preparedness of members of the EC & Advisory Committee attend-
Pharmaceutical Sector for LDC Graduation” on ed the Seminar and exchanged views regarding
10th August, 2022 jointly organized by Support impact of LDC Graduation upon Pharma Indus-
to Sustainable Graduation Project (SSGP), ERD & try and stressed the need for continuing TRIPS
Business Initiative Leading Development (BUILD). Waiver until 2033. BAPI Senior Vice President Mr.
Abdul Muktadir called for negotiating with WTO
The Seminar aimed at taking stock of the ini- for extending the TRIPS transition period relating
tiatives and preparedness that are already un- to pharmaceutical products for Bangladesh until
derway to address the challenges of the loss of 01 January, 2033.
TRIPS waiver.

Mr. Salman F Rahman, MP, Honbl’e Adviser to
the Prime Minister on Private Industry and In-
vestment, Mr. Nazmul Hassan, MP, President, BAPI
Mr. SM Shafiuzzaman, Secretary General, BAPI,

Workshop on Jointly organized by UN Department of and challenges of graduation to identify
“South-South Economic and Social Affairs (UNDESA) pathways to address them collaborate-
Exchange on and the United Nations Resident Coor- ly in devising their Smooth Transition
Preparing Smooth dinator’s offices in Bangladesh, a work- Strategy (STS), to identify key interna-
Transition shop was held during 23-25 August, 2022 tional support for the STS of each coun-
Strategies: where Mr. SM Shafiuzzaman, Secretary try and devise a plan for advocacy and
Graduating Cohort General, BAPI, nominated representa- advocated jointly and separately for
of 2021” held at tive from ERD, Ministry of Finance par- effective international support for the
Bangkok, Thailand. ticipated. implementation of mentioned coun-
try’s STS.
The prime objective of the exchange
was to re-energize the Smooth Transi- A delegation comprising fifteen of-
tion Strategy (STS) formulation process ficials from each country - government
allowing Bangladesh, Lao PDR and officials, private sector, academia, re-
Nepal, to learn from industry/sector search institutes, civil society stake
experts, share ideas and benefit from holders attended the technical sessions
each other’s experience. The workshop of the workshop and contributed large-
was an unique opportunity for the 3 ly for implementation of the objective
Countries to discuss common issues of the workshop.

THE PHARMA WORLD 21

BAPI NEWS 13th Asia Pharma Expo-2022 Held

Bangladesh Aushad Shilpa Samity(BASS) and GPE Expo Pvt Ltd, India Jointly organized the 13th ASIA
PHARMA EXPO on complete pharma Manufacturing held during19-21 May 2022 at Bashundhara Conven-
tion City, Dhaka. Over 700 Exhibiting Companies from 35 Countries like India, USA, UK, Germany, Italy,
Taiwan, South Korea, Switzerland, Japan, Spain, Thailand, UAE, Ireland, Singapore, Denmark participated
in the mega event.

ASIA PHARMA EXPO have played a vital role in the area of diversification of finished pharmaceutical
products and raw materials as well as for the exploration of global market.

Discussion meeting held between representative of CYTIVA, a US
Headquartered global provider of Biotechnologies and services
for Therapeutics & members of EC & Advisory Committee of BASS

A discussion meeting was
held on 27 September, 2022
at BAPI office between CYTI-
VA and members of the EC &
Advisory Committee of BASS
to assess the possibility of
exploring Biopharma capa-
bilities in Bangladesh. Rep-
resentatives from CYTIVA dis-
cussed in the meeting that
Bangladesh has lucrative
commercial opportunities for
manufacturing Biopharma
products in the Country.

Creation of Active The government has taken positive ini- Park having Common Effluent Treatment
Pharmaceutical tiative for setting up API Industrial Park Plant (CETP) for treating the industrial
Ingredients (API) at Gazaria, Munshiganj in order to encour- waste Generated from operations.
Industrial Park. age the local pharma manufacturers and
also to boost up large scale production of The work for setting up of CETP is near-
API and export globally. The total project ing completion. Once API Industrial Park
area measuring 200 acres and 41Industrial starts operation, pharma companies will
plots have already been handed over to be able to source at least 40% of their raw
27 BAPI members. Now the API Industrial materials from the complex reducing reli-
Park is almost ready for operation. The API ance of importing & expecting huge vol-
ume of export of API’s from Bangladesh.

22 THE PHARMA WORLD

NEWS

International Scientific Seminar
organized by Bangladesh
Endocrine Society

Diabetes is one of the major health bur- India. He focused on different aspects of
dens in Bangladesh. Type-2 diabetes the most updated Chronic Kidney Dis-
is the leading cause of chronic kidney ease management. He also focused on
disease which may lead to various life- “Finerenone” a drug which is recently
threatening conditions like kidney di- approved by the USFDA for slowing the
alysis, kidney failure, and kidney trans- progression of CKD with Type-2 dia-
plant. Heart disease and kidney disease betes & its usage as a novel treatment
are closely related to diabetes and cut- throughout the world.
ting-edge development in the existing
treatment system is enormously impor- Dr. Shahjada Selim, Associate Profes-
tant. Studies have shown that patients sor, Department of Endocrinology, BSM-
having type-2 diabetes, associated with MU & General Secretary, Bangladesh En-
kidney disease possess a three-fold docrine Society was also present as the
higher risk of death from cardiovascular keynote speaker from Bangladesh. He
events, which generates concern among focused on the current status of diabetic
doctors and patients. An international kidney disease in Bangladesh and vari-
scientific seminar was held recently at ous aspects of its modern medical man-
an esteemed hotel of the city, organized agement. Professor Dr. Zafar A. Latif, Ex
by the Bangladesh Endocrine Society, Director-General, BIRDEM was the chief
aiming for proper medical management guest, and the Chairperson; Prof. Dr. SM
of heart disease and kidney disease due Ashrafuzzaman, Professor, Ibrahim Med-
to diabetes. Everest Pharmaceuticals ical College & Senior Consultant, Ibra-
Limited was the scientific partner of this him Cardiac Hospital and Research In-
event. stitute was also present at the meeting.
All the renowned endocrinologists of
In this scientific seminar, emeritus Bangladesh were present and expressed
Professor Dr. Ashok L. Kirpalani, the for- their opinions and they were confident
mer president of the Indian Society of in transmitting the most modernized &
Nephrology and Indian Society of Hy- complete management of Diabetic Kid-
pertension was present as the keynote ney Disease to everyone. Finally, AKM
speaker. Many of his articles and medi- Anwarul Hoq, the CEO of Everest Phar-
cal books are being used as textbooks in maceuticals Ltd. gave the closing speech
various countries of the world including by thanking everyone.

THE PHARMA WORLD 23

The first scientific conference
of “Bangla Liver Caucus
(BaLiCa)” held

Beximco wins The first scientific conference of Prof. BD Goswami, Former Head,
“Acquistion “Bangla Liver Caucus (BaLiCa)” or- Gastroenterology, Guwahati Medical
of the Year” ganized by Forum for the Study of College; Prof. Alka Deshpande, Dean,
Liver Diseases Bangladesh was held Indian College of Physicians; Prof.
Beximco Pharma has won the pres- at Haque Kitchen and Residency, Pradeep Bhowmik, Medicine, Agar-
tigious Global Generics & Biosimi- adjacent to Padma Bridge, with the tala Government Medical College,
lars Awards 2022 in the category of aim of strengthening and expand- Prof. Nandini Chatterjee, Medicine,
‘Acquisition of the Year’. Mr Rabbur ing mutual and scientific collabora- IPGMER & SSKM Hospital, Kolkata,
Reza, COO of the company, received tion between Bengali speaking liver Dr.  Amit Kalwar, Associate Professor,
the award in a grand ceremony held specialists and experts interested in Medicine, Silchar Medical College,
in Frankfurt, Germany recently, says a liver treatment. Dr.  Elina Petrukhina, Guwahati  and
company Press release. Mantosh Dey, CEO, Sanata Healthcare
100 liver specialists from Bang- joined the Padma BaLiCa conference.
ladesh and India attended the con-
ference under the chairmanship of Among others, Selimur Rahman,
Balika Coordinator and Forum Chair- President, Association for the Study of
man and Head of Interventional Liver Disease Bangladesh, Md. Helal
Hepatology Division of Bangaband- Uddin, Director, Forum for the Study of
hu Sheikh Mujib Medical University Liver Diseases Bangladesh, Dr. Kakan
Professor Manun Al Mahtab.  Hon- Nag, CEO, Globe Biotech, Dr. Nazneen
orable Prime Minister delivered Sultana, CSO, Globe Biotech, Dr.  Md
a speech on this occasion.  In her Mohiuddin, Senior Manager, Globe
speech, she praised the liver special- Biotech and Debashish Saha, Deputy
ists of Bangladesh and said,  “Liver Sales Manager, Beacon Pharmaceuti-
specialists in Bangladesh are play- cals attended the conference.
ing a commendable role in treat-
ing liver disease patients.  Our liver It is to be noted that on the oc-
specialists have jointly developed casion of Liver Cancer Awareness
a new drug called Nasvac to treat Month, Professor Pradeep Bhowmik,
patients with hepatitis B. Expensive Medicine, Agartala Government Medi-
treatment for incurable hepatitis-C cal College, discussed on oral chem-
is being made free by the govern- otherapy in the treatment of liver
ment. Liver specialists of the coun- cancer.  Professor Mamun Al Mahtab
try are contributing to the service of (Swapnil), discussed the latest treat-
patients by using new medical tech- ment method of liver cancer treat-
nologies including stem cells in the ment, the immune check point inhibi-
treatment of liver patients. tors. Beacon Pharmaceuticals was the
scientific partner for the event.

24 THE PHARMA WORLD

Eskayef makes history with US FDA approval
for injectable manufacturing facility

Eskayef Pharmaceuticals
Limited, one of the
leading pharmaceutical
companies of Bangladesh,
has been accredited with
the prestigious US FDA
approval for its injectable
manufacturing facility.

This is the first and only injectable “In this journey, our sharp focus is at the global level, as a manufacturer
manufacturing site in Bangladesh to on technology driven molecules and with the highest quality products
achieve such a stringent accreditation, complex products which are already in for the people of Bangladesh and
according to a press release issued by the pipeline to address unmet patient across the world,” Simeen Rahman
Eskayef Pharmaceuticals Limited. needs. I believe the exceptionally tal- added. 
ented individuals at Eskayef will differ-
This approval will allow Eskayef entiate us from others. Eskayef Pharmaceuticals Limited is
to export injectable pharmaceutical one of the organisations of Transcom
products from the state-of-the-art fa- “Unwavering commitment to group founded by the late Latifur Rah-
cility to the US market.   quality has always been at the man, a towering symbol of ethical busi-
forefront of Eskayef’s drive to serve ness in Bangladesh.
“It is a moment of great pride for humanity. Earlier this year, we received
Eskayef. Being a Bangladeshi compa- US FDA approval for our oral products Eskayef has been producing medi-
ny, we are now able to showcase our and now this approval for injectable cines for 32 years and currently ex-
strength in the US Market with our products has solidified our position, ports its medicines to 67 countries
high-tech injectable products,”  said across six continents of the world.
Simeen Rahman, Group CEO of
Transcom Limited and Managing Di-
rector & CEO of Eskayef Pharmaceu-
ticals Limited. 

Congrats Prof. Mahtab honoured
for Excellence
in Research’

Prof. Dr. Mamun Al Mahtab (Swapnil),
Head, Department of Interventional
Hepatology, Bangabandhu Sheikh Mu-
jib Medical University has been award-
ed the “Vice Chancellor Award for Re-
search Excellence Award-2022” by the
institute. Prof. Swapneel was given this
award for his outstanding contribution
in liver research and overall progress
in various research fields. Prof. Swap-
neel received the award from Hon’ble
Minister Mr. Yafes Osman and Vice
Chancellor Prof. Dr. Sharfuddin Ahmed.

THE PHARMA WORLD 25



Orion celebrates tance of community pharmacists and the recruitment of hospital pharma-
‘World Pharmacist hospital pharmacists and appreciated cists. The event was concluded by cut-
Day’ the Government’s recent initiative on ting cake to commemorate the day.

Orion Pharma Ltd. celebrated “World
Pharmacist Day” at Orion House on
25th September 2022 with a round-
table discussion on the importance
of pharmacists in modern healthcare
system. The event was presided over
by the Company Director and Trustee
of Orion Pharma Welfare Trust Mrs.
Arzuda Karim & Executive Director of
Orion Pharma Ltd. S. M. Noor Hossain.

The theme of this year’s world
pharmacist day was “Pharmacy- unit-
ed in action for a healthier world”.
The event kicked off with opening re-
marks from Mrs. Arzuda Karim where
she congratulated pharmacists and
appreciated their hard work. Later Mr.
Noor Hossain discussed the impor-

Renata’s Rajendrapur General Facility of Renata ucts, Rolip (Rosuvastatin) is also sold in
Rajendrapur has been approved by USFDA, says a Bangladesh.
Facility gets company Press release. The inspection
USFDA approval was triggered with Metoprolol Tartrate Presently, the UK and EU are major
tablets. export markets for Renata. However,
with this approval, Renata hopes to
Renata has seven products (ANDAs) make inroads into the US market with
registered in the US. Of these prod- plain generics, Para IV and NCE-1 filings.

THE PHARMA WORLD 27



Seminar on Pharma Packaging Organized
by Khan & Deen in Partnership with
Germany’s Uhlmann Group

Khan & Deen Traders and the Uhl- the sector has grown has grown to 3.5 with Uhlmann Group has jointly or-
man Group has organised a seminar billion USD and is expected to rise to ganised a daylong seminar in Bangla-
recently, highlighting how businesses 5 billion USD by 2025. WTO/TRIPS al- desh, titled, “Revolutionizing Pharma
from Germany and Bangladesh can lows Bangladesh to enjoy the pharma Packaging by Uhlmann”. The seminar
work together for their mutual benefit patent waiver till 2033, which gives highlighted four vital significances
and what Germany can offer to help tremendous boost to local industries of packaging in any pharmaceutical
companies from Bangladesh to stay to grow that fast. product, such as, Containment, Pro-
competitive in a striving market. tection, Communication and Conveni-
Due to its strategic location in the ence.
With more than 70 years’ exper- Indo-Pacific region and its growing
tise in pharmaceutical packaging, importance as a strong political and The technology providers in the
Uhlmann Pac-Systeme  is the world›s economic actor, Bangladesh is an im- industry are always researching and
leading system supplier for the pack- portant economic and political part- evolving new solutions which can
aging of pharmaceuticals in blisters, ner of Germany. make the packaging more unique and
bottles and cartons. They have been effective for pharmaceutical compa-
very successful in Bangladesh as well The bulk of imports from Germany nies. H. E. Achim Troster, Ambassador,
catering to the requirement of the in- to Bangladesh have traditionally been Embassy of The Federal Republic of
dustries achieving sales turnover of machines and tools, not only to the Germany inaugurated the seminar by
Euro 15–20 million per annum alone. pharmaceutical sector. With a lead- delivering his speech. Major General
They have established themselves as ing global market position, mechani- Mohammad Yousuf, DGDA, delivered
the major supplier. cal engineering is one of the largest his important note as a Special Guest
branches of industry in Germany. In at the event. Mr. S. M Shafiuzzaman,
The largest sector after textile, 2018, the German mechanical engi- Secretary General, Bangladesh Asso-
there are 284 registered companies to neering sector counted almost 6,700 ciation of Pharmaceutical Industries
produce medicine. It is the most mod- companies. In total, more than one and Mr. Mahbubul Karim, Chief Op-
ern and technologically advanced million people are employed in Ger- erating Officer, Incepta Pharmaceuti-
sector, meeting compliance mostly many mechanical engineering. cal Ltd. also graced the occasion with
and engaging white collar profession- their presence.
als. From 20 million US billion in 1982, Taking these thoughts into consid-
eration, Khan&Deen in partnership

THE PHARMA WORLD 29

International Diabetes remains the leading cause different aspects of the most updated
Scientific of Chronic Kidney Disease (CKD) Chronic Kidney Disease management.
Seminar and approximately 30% of 40% of He also focused on “Finerenone” a
organized by patients with Type-2 diabetes have drug which is recently approved by
Bangladesh been estimated to have CKD over- the USFDA for slowing the progres-
Renal time, poorly controlled diabetes can sion of CKD with Type-2 diabetes & its
Association cause damage to blood vessel clus- usage as a novel treatment through-
ters in the kidneys. This can lead to out the world.
30 THE PHARMA WORLD kidney damage and high blood pres-
sure, in turn causing cardiovascular Professor Dr. Shamim Ahmed, Ex-
morbi-mortality. Treatment to pre- director and Professor of the National
vent diabetic kidney disease should Institute of Kidney Diseases and Urol-
early–before kidney damage devel- ogy was also present in that scientific
ops. seminar as the keynote speaker from
Bangladesh. He highlighted the cur-
Studies have shown that patients rent status of Chronic Kidney Disease
having type-2 diabetes, associ- in Bangladesh and various aspects of
ated with kidney disease possess a its modern medical management.
three-fold higher risk of cardiovas-
cular death which generates concern Professor Dr. Muhammad Rafiqul
among doctors and patients. An in- Alam, President of Bangladesh Renal
ternational scientific seminar was Association as the chief guest; Pro-
held at Dhaka Club organized by the fessor Dr. K B M Hadiuzzaman, Sec-
Bangladesh Renal Association, aim- retary General of Bangladesh Renal
ing for proper medical management Association as a special guest and
of heart disease and kidney disease as the chairperson, Professor Dr. Mu-
due to diabetes. Everest Pharmaceu- hammad Nazrul Islam, Head of the
ticals Limited was the scientific part- Department, Nephrology, BSMMU
ner of this event. were present in that seminar. All the
renowned nephrologists of Bangla-
In this scientific seminar, emeritus desh were present, and expressed
Professor Dr. Ashok L. Kirpalani, the their opinions and they were confi-
former president of the Indian Soci- dent in transmitting the most mod-
ety of Nephrology and Indian Society ernized & complete Management of
of Hypertension was present as the Diabetic Kidney Disease to every-
keynote speaker. Many of his articles one. Finally, AKM Anwarul Hoq, the
and medical books are being used as CEO of Everest Pharmaceuticals Ltd.
textbooks in various countries of the gave the closing speech by thanking
world including India. He focused on everyone.

Bangladeshi researchers come up
with a fest to prevent & diabetes

Bangladeshi researchers have come to getting diabetes, according to the test,” said Madhu, who is also a for-
up with a test to identify people likely researchers. mer faculty member at USA’s Harvard
to develop type-2 diabetes in the fu- Medical School and an adviser to the
ture, bringing the possibility of pre- On the contrary, an IAP level higher BADAS.
vention closer to reality. than 115 units would mean there are
chances of protection from develop- Madhu and his team have also de-
Through a five-year study, re- ing diabetes. veloped a food supplement for those
searchers at the Diabetic Association at risk of getting diabetes, which has
of Bangladesh (BADAS) have devel- Along with Madhu, a total of 14 been approved recently by the Bang-
oped a kit to measure the deficiency researchers – 13 of them Bangladeshi ladesh Medical and Research Council
of Intestinal Alkaline Phosphatase and one American – from multiple (BMRC) for trial on humans.
(IAP) – the root cause behind type-2 local and foreign universities,
diabetes. conducted the research by studying If the new food supplement is as
a cohort of 574 non-diabetic people effective when trialled on humans as
“We have proven that eliminating aged between 30 and 60 from 2015 to it proved to be in mice, it will put an
diabetes from the world is quite pos- 2020. end to the sufferings of hundreds of
sible by identifying people at risk of thousands of type-2 diabetic patients
getting diabetes and undertaking pre- Currently, the Directorate General across the globe, Madhu said.
ventive measures accordingly. Now of Drug Administration (DGDA) is re-
we need support to take this inven- viewing the approval application for Speaking about the invention, Na-
tion to people’s doorsteps,”Said Dr. the kit to measure IAP level, according tional Professor AK Azad, president
Madhu S Malo, the lead investigator to Madhu. of BADAS, earlier said, “We think this
in the study. IAP levels lower than 65 breakthrough study can greatly con-
units per gram of stool would mean “If everything goes to plan, people tribute to the prevention of diabetes
there is a deficiency, which can lead will be able to measure their IAP at worldwide.”
labs, to know if they are at risk of get-
ting diabetes ... at a cost of Tk 500 per

Popular brings
HPvax

Currently, more than 5 crore women in
Bangladesh are at risk of cervical can-
cer and 11,000 die every year.

Women can develop cervical can-
cer at any age. Cervical cancer is called
the ‘silent killer’, as most cases remain
non-symptomatic. About 75 percent of
cervical cancers are caused by Human
Papillomavirus Types 16 & 18.

As a step to eradicate Human Pap-
illomavirus and prevent cervical can-
cer, Popular Pharmaceuticals brought
to Bangladesh, a USFDA Approved
and WHO prequalified Source Vaccine,
HPvax (Recombinant Human Papillo-
mavirus Vaccine Types 16 & 18 BP). All
women aged 9-45 can easily prevent
cervical cancer with HPvax Vaccine.

THE PHARMA WORLD 31



Latest trends in eight major pharmacy sectors described NEWS

Transformation of pharmaceutical educa- formation, community pharmacy, hospital
tion, which includes expansion of the num- pharmacy, industrial pharmacy, military and
ber of pharmaceutical education institutions emergency pharmacy, and social and ad-
globally and a large shift to online learn- ministrative pharmacy. The changes identi-
ing, is one of several major current trends fied have been classed into six major trend
in pharmacy identified by the FIP Board of groupings as follow:
Pharmaceutical Practice.
l Transformation in pharmaceutical edu-
The findings are presented in the cation; l Expanding scope of practice; l
board’s  “Trend analysis report amid the Pandemic and natural disaster preparation;
COVID-19 pandemic, 2021-2022”. The report l Cultural and environmental concerns; l
contains directions identified by each of Increased investment in data systems and
FIP’s sections, covering academic pharmacy, automation; and l Health security, economic
clinical biology, health and medicines in- and distribution concerns.

Guiding principles for quality Inequities in pharmacy
assurance of pharmacy and education must be
pharmaceutical sciences addressed, FIP says
education set out by FIP as it introduces
a new toolkit
Standards for assuring the quality of pharmacy
and pharmaceutical sciences education are de- A new resource to help academic
scribed in a new  Statement of Policy  from FIP. institutions, policymakers, educa-
“As additional roles for pharmacists are increas- tors, faculty members and students
ingly recognised, many countries have under- address inequities in pharmaceutical
taken a major transformation of pharmacy and education is launched by the FIP. The
pharmaceutical sciences education.  development of the toolkit is part of
the federation’s EquityRx programme
“Not all countries have a national system and work towards  FIP Development
for quality assurance (QA) of education, leav- Goal 10 (Equity and equality) in align-
ing adherence to international or regional QA ment with the United Nations Sus-
standards as an option for higher education tainable Development Goal 4, which
institutions, and this leads to heterogeneity in aims to ensure inclusive and equita-
workforce competencies. Quality assurance is ble quality education and promote
important for maintaining the quality of edu- lifelong learning opportunities for all.
cation in order to support the development of Expected outcomes when inequities
an adequate and appropriate pharmaceutical are addressed include increased ac-
workforce,” explained Banan Abdulrzaq Mukha- cess to pharmaceutical education and
lalati, chair of FIP’s Quality Assurance of Phar- improved teaching and learning.
macy and Pharmaceutical Sciences Education
Policy Committee.

New diabetes The FIP published a “Knowledge and skills reference guide for professional develop-
reference ment in diabetes”. As well as supporting pharmacists to up skill themselves as their
guide focuses careers develop, the new FIP publication is intended to guide the design and deliv-
on helping ery of education and training programmes by continuing professional development
pharmacists providers. The guide acknowledges that there are some barriers to and regulations
achieve required around providing diabetes-related services in some countries but emphasises that
competencies “the incorporation of pharmacists into multidisciplinary diabetes care teams should
always be strongly considered by clinicians and health policymakers”.

The authors write: “By expanding the full potential of pharmacists in the delivery
of diabetes care and associated services, we get closer to offering optimal health
services to patients making sure that no one is left behind.”

THE PHARMA WORLD 33



“No matter how advanced the INTERVIEW
treatment of diabetes becomes,
patient education will remain
the most essential part”

hind this is the lack of awareness and education among
common people.

National Professor Dr. A K Azad Khan Why is diabetes called the mother of all diseases?
President
Diabetic Association of Bangladesh It is the mother of all diseases because diabetes can
Chairman affect the whole body—every tissue of the body. It can
Board of Trustees Bangladesh Uni- create illness in every system of the body. Death due to
versity of Health Sciences (BUHS) diabetes is not something you can see very often because
people hardly die directly due to diabetes or high blood
As an eminent endocrinologist of glucose. However, they die due to the complications cre-
the country, would you please tell ated by diabetes—like kidney disease, stroke, gangrene,
us about your valuable observation heart disease etcetera, which all have a common root
regarding the prevalence of cause: diabetes. This is why it is called the mother of all
Diabetes in Bangladesh? diseases and rightly so. I’ll tell you about the time when
we were medical students; syphilis was considered the
Diabetes is an epidemic, almost mother of all diseases because syphilis can also affect all
throughout the world. It was recog- systems of the body. So, we were taught, and it was also
nised as an epidemic first by IDF, sub- in the textbook, that if you know syphilis well, then you
sequently by WHO, and then by the know medicine as a whole. This is now true for diabetes—
United Nations in 2006. The UN offi- if someone knows diabetes well, he knows medicine.
cially declared November 14 as World
Diabetes Day, in response to growing What are the available treatment options and
concerns and to create awareness what factors should be considered regarding the
about the health and economic threat best option for an individual with diabetes?
posed by diabetes. United Nations has
identified that Diabetes is a threat to From the treatment point of view, we can say that dia-
human existence. A fact that is not so betes is of two types— one is completely insulin depend-
well known and not much appreci- ent, as in they don’t produce any insulin in the body. For
ated by common people is that this this type, insulin is the only treatment. Insulin is essential
prevalence is spreading alarmingly in for life. We have to keep in mind that all hormones are
developing countries. In developed needed for a healthy life. However, all of them are not
countries they have the means to needed for survival. I’ll give you an example, we used to
create awareness and take measures castrate bulls so that we can plow the land with them. Al-
to reduce the incidence; however in though they cannot procreate, they don’t die because of
countries like Bangladesh the number castration. Testosterone is not essential for survival. But
is still rising. The main obstacle be- insulin is. Non-insulin dependent diabetes is of various
types. So, the treatment options are also many.

For the brevity or simplicity of the topic we can catego-
rize the treatment like this:

one, where we can treat one group by increasing insu-
lin supply/ stimulating insulin formation and secretion.
Secondly, by improving insulin sensitivity, meaning bet-
ter response of tissues to insulin. Thirdly, by excreting out
glucose through the kidneys. There are also many other
modes through which diabetes can be treated. So, you see,
the treatment needs to be individualized. I’ll give an exam-
ple, if somebody is obese and diabetic, for him the main

THE PHARMA WORLD 35



treatment is that he must lose weight. For type-2 or non- physician. Not in the sense that he should choose his own
insulin dependent diabetes, the treatment definitely needs insulin and dosage, this is a doctor’s job. The patient and a
to be individualized. doctor should discuss and based on the individual condi-
tion the doctor will choose the type and dose of insulin
Nocturnal hypoglycemia has always been a best for that particular patient. A diabetic patient must be
nightmare for Insulin users. What other adverse educated about the disease, so that he is a part of the de-
effects should the patients on insulin therapy cision that is being taken. For example, some insulin can
be aware of? How could these be avoided? be very expensive. So, the patient should ask doctor to
choose the type which would be more cost-effective. Many
Nocturnal hypoglycaemia is a great concern for insulin times, our poor people have to sell their property for treat-
users because they get hypoglycemia during sleep. And ment. This should not be the case.
sometimes it may become very serious, and they are una-
ware of it. But insulin can cause hypoglycemia anytime, not You see, during the COVID times, people could not
only at night. The main difference between a diabetic and come to the center. So, unless you know how to control
non-diabetic person is a normal person can produce as it and prevent it yourself, there will be some complica-
much insulin as where needed but this is not the case for a tions. Therefore, no matter how advanced the treatment
diabetic patient. So, when insulin is given to the patient, it becomes or newer technology is invented, patient educa-
will work regardless of whether he has eaten or not; wheth- tion will remain the most essential part in the treatment
er he exercises or not. So, when his stomach is not full and of diabetes.
on top of it if exercise is done it is natural for him to become
hypoglycaemic due to intake of insulin. If the time of taking As the president of the Diabetic Association of
insulin and food is not matched or balanced, hypoglycae- Bangladesh (DAB), what in your opinion, has
mia ensues. So to prevent hypoglycemia the patient must been the greatest achievement of DAB regarding
be educated about insulin and his life should be regulated care for diabetic patients? What role DAB playing
or disciplined. When he takes insulin, he must take the ap- in advancing novel research and educating
propriate dose and must not forget to take food at proper the next generation of health experts?
time. In our diabetic association, Dr. Ibrahim used to put a
signboard everywhere, which said “Discipline is Life”. So, for What I’m about to say, many people may not agree with
a diabetic person, discipline truly is life. it. But I think this is very important. I said before that for
prevention, patient education and awareness about the en-
While there’s no cure for diabetes, what is your vironmental factors is important. Now, you will hear many
advice for prevention and control of diabetes? healthworkers and doctors saying, “we’re trying hard”. I’ll
mention the tobacco industry as an analogy. They are still
Prevention is always better than cure for any disease. For able to influence people to smoke, take up despite ciga-
some diseases, we don’t know how to prevent them, while for rettes being so distasteful to start with. There are cautions
many diseases prevention is very easy. For example, we have written on the packages and warnings before advertise-
prevented smallpox, and we almost eradicated polio. This ments of cigarettes, but people are still smoking. In my
has been possible due to mass vaccination programmes. We opinion, smoking is still persisting because of the greed
have reduced malaria by mosquito control. But the preven- of western imperial powers. But I must admire one thing,
tion of diabetes is much more complex as it is a multifac- that is they know what language to use to motivate people
torial disease. This is the result of both environmental and for this. They are linking smoking with smartness, manli-
genetic factors. There is no way to virtually change the gene. ness, romance … surprisingly, even with good health! As op-
It is inherited. We cannot choose the parents. Similarly, par- posed to that, we doctors are hardly any match to them. We
ents also cannot choose their offspring. This is God-gifted. need to study the language and methods to motivate and
I’ll give you an example. If you plant a seed in soil, suppose educate patients. In recent years, DAB has taken two pro-
a coconut tree, it will germinate and produce a coconut tree. grammes, which I believe, is going to be a game-changer.
But, if you keep the seed in your suitcase, it will not germi- We realised that our people are very much motivated by
nate—it will decompose and die. For the seed to grow into a religious leaders. So, we have recruited mosque imams and
tree, it needs, soil, water, sunlight, air — all types of nutrient. trying to educate people through their khutbahs. There are
So the soil here is the environment. Prevention lies with the many other projects and affiliated associations that has
environment which is your lifestyle. If you follow a healthy arranged direct education of the patients. There are train-
diet, exercise regularly and lead a disciplined life, diabetes ing programmes for physicians and educators on Diabetes
can be largely prevented. Educators Training.

Diabetes treatment and approaches have Many major research programmes are continuing, the
changed a lot in recent years. What is the main focus of which are on diabetes in rural population,
most important in your opinion? maternal and child health, diabetes prevention interven-
tion, excellence in biomedical research etc. All in all, we
The single most important component is patient educa- are putting special emphasis on the preventive aspects of
tion. A diabetic patient must know how to become his own diabetes.

THE PHARMA WORLD 37

“Graduation of Bangladesh from LDC will be
an additional strength for us in promoting the
Medicines as manufactured in Bangladesh”

Prosenjit Chakraborty for captive consumption as part of the be very clear and updated while tar-
General Manager backward linkage. We are also increas- geting a country to export. It is also
International Marketing & Business ing our presence in veterinary, poultry true that in certain markets you can
Development and aqua through introduction of new export products without registration
Square Pharmaceuticals Ltd. medicines and vaccines in the country. and that is without no delay.

Square needs no introduction. Square’s products are exported to Is there anything the Bangladesh
But as an integral part of the 46 countries including USA and UK. missions/embassies abroad can do
company, would you please Square has won Export  Trophy Gold to support export of medicines?
enlighten our readers about for 10 times as largest pharmaceutical
Square Pharmaceuticals exporter of Bangladesh. Bangladesh missions abroad can
and its global footprint? be the spokespersons to promote
How export of medicines is Bangladesh’s   pharma capabilities
Square is by far the largest phar- different from other exports and to different chambers of commerce
maceuticals company in Bangladesh. why it is a very lengthy process? and health regulatory authorities of
It is maintaining the leadership po- potential medicine importing coun-
sition in the industry since 1985. In As consumption or use of medi- tries. Potential countries mean where
Y2020-21, company’s gross turnover cines can affect human or animal Bangladesh has possibility & capabil-
was Taka 5800 crore. IQVIA has re- health, thus its manufacturing and ities of exporting medicines. We have
ported Square’s market share as 19% distribution are monitored with a to acknowledge that all the countries
in their last market audit report. We specific and defined set of regula- in world are not our potential cli-
have now 16 manufacturing units in tions. The manufacturers are obliged ents. BAPI (Bangladesh Association
operation in two countries – Bangla- to demonstrate practice of Good Man- of Pharmaceuticals Industry) can pre-
desh and Kenya. The manufacturing ufacturing Practice (GMP) as stated by pare a list of potential markets and
units have GMP certification from US- the importing country. We call it as the missions in abroad can focus on
FDA of USA, UKMHRA of England, AN- GMP clearance or certification by the those with a set time driven targets.
VISA of Brazil, SAHPRA of South Africa, country to import. For example, to
TMDA of Turkey and PICS of Malaysia. export to USA you need to take GMP Globally, Bangladesh is well known
The minimum GMP standard that we clearance from US FDA (United States for RMG capability and the Missions
are maintaining in all manufacturing Food and Drug Authority). can leverage that strength while pro-
units is PICS. We are equipped with moting Pharma Industry. Bangladesh
plastic made (pharma grade HDPE Initiation of export process starts embassies are now very active on iden-
and PET) primary packaging compo- with GMP clearance followed by ap- tifying export potentials. They are now
nents, paper made secondary packag- proval of product application (Prod- working very closely with the industry
ing components and number of APIs uct Dossier). The product approval professionals.   In relation to that, my
time varies from country to country. request to the embassy diplomats is to
General understanding is that you can assist us on fastest and hassle free visa
expect product approval within 6 to 36 approval while we travel for business
months after GMP clearance. In many development.     
countries/markets like USA and EU
approval of 2nd application of similar What are the basic regulatory
dosage forms will be faster than the considerations for marketing
previous. In many other markets the generic products in a foreign
approval process is lengthy because country? For which markets
of huge backlog of filed applications. (non-regulated, semi-
Other reason of delay is internal and regulated or regulated) BE/
that is weakness in documentation BA Studies are mandatory?
of the product filed by the manufac-
turer cum exporter. Your knowledge The basic regulatory considera-
on regulatory requirements should tions for successful product registra-
tion are manufacturer’s GMP certifica-

38 THE PHARMA WORLD

tion, good API supported by Drug Master File Parliament can take same decision to declare all FACE TO FACE
(DMF), validation reports of manufacturing pro- medicines available in Bangladesh till the date
cess & analytical method and stability data of of graduation are off patent. Besides, we also
the product in the asked stability zone (most of need to develop capability of manufacturing API
the Bangladeshi companies have stability data of such on-patent medicines.
for zone IVA condition only where many poten-
tial markets demand stability data in zone IVB Bangladesh restricts import of medicines
and II conditions). which are sufficiently manufactured in the
country. With or before the graduation from
BE/BA study is not a requirement in applica- LDC, Bangladesh might be asked to remove
tion filing of all dosage forms. You can file liq- such import restriction as an obligation to com-
uid injectable (solution) and oral solution with- ply with GATT Article III on National Treatment.
out any clinical data (BE/BA) in any country you The local industry should take this into con-
want. ASEAN countries require BE/BA data of sideration in preparing themselves from fierce
solid dosages (tablet, capsule, suspension) dur- price and promotional competitions from out-
ing filing and certainly not for all. Some of the siders. In any case, for the protection of local
African states requires BE data for solid dosage industry, Bangladesh does not agree to comply
but many of them accept comparative dissolu- with GATT Article III then importing countries
tion data in approval process. In some coun- may impose anti-dumping duty on the medi-
tries, you need to file clinical end point data for cines imported from Bangladesh. To avoid any
registration of dermatological products, nasal import duty on our export, Bangladesh should
sprays and inhalers for asthma. Markets in EU, pursue for modification in exemption clauses
USA, Canada, Brazil, Japan, China, Saudi Arabia of the ‘Agreement on Subsidy and Countervail-
and Australia require clinical data for solid dos- ing Measure’ before the graduation from LDC.
age (except BCS-I & III, Biopharmaceutics Clas-
sification System, drugs), dermatological, nasal In terms of exports, where does our
spray and inhalation products to approve.   pharma industry stand now? What are
some of the challenges the industry
Does socioeconomic strength of is facing in export of medicines? What
individual countries factor into are the solutions in your opinion?
international accreditation process?
In terms of export, Bangladesh pharma in-
The regulatory agencies of medicine import- dustry still stands at infancy. Challenges those
ing countries give approval of GMP at individual the industry is facing are most of internal in na-
company level. Socio-economic condition of ture. The critical challenge is very few number
individual countries does not influence that of medicines to export to big markets.  In com-
approval process. Bangladesh has achieved all panies there is lack of synchronization between
international and stringent GMP accreditations the desires of receiving GMP certifications from
in LDC status, such first approval came in 2007. big pharma markets and development of prod-
ucts for those targeted markets. Companies are
What impact would LDC-graduation have on developing most of their products targeting
the export of medicines? What can be done Bangladesh regulatory requirement which is
to tap its potential and maintain our position comparatively at lower level in terms of docu-
in the global pharmaceuticals market? mentation requirement than the regulatory
requirements of big pharma markets of the
Graduation of Bangladesh from LDC to de- world. You should have a minimum number of
veloping country will definitely improve the products in your export basket which can fulfill
image of Bangladesh to the consumers/cus- basic requirements of product registration of
tomers of our products. It will be an additional targeted markets. Development of products for
strength for us in promoting the medicines as export requires financial investment and return
‘manufactured in Bangladesh’. on investment (RoI) usually takes much longer
time than other export sectors like IT, RMG or
The negative impact will be losing business of FMCG. But it is also true that amount of profit
on-patent medicines. In maintaining our current and product life cycle both are much higher &
business of patented medicines Bangladesh can longer respectively in pharma sector than the
follow the policy change that India did in 2005. others. As often comparison comes among the
In the time of implementing TRIPS agreement on sectors thus patience is required while you are
patent, India declared all medicines available in investing in this industry. It’s a common chal-
India till 2004 as off patent through an amend- lenge for the entrepreneurs.
ment in the section 3(d) of Indian Patent Act 1970
[the Patent Act (amendment) 2005]. Bangladesh

THE PHARMA WORLD 39

It has been observed that in Bangladesh most of invest- ing those products at very affordable cost to patients in
ments in pharma sector are for making facilities to achieve Bangladesh. Some of those medications are also exported
GMP approvals from stringent regulatory authorities rather to many countries. Waiver on implementation of pharma-
than investing on products for those markets. It is a chal- ceutical patents in the country makes the local companies
lenge again for entrepreneur  in allocating of expensive to manufacture such products. Bangladesh graduation to
fund. Industry leaders need to revisit their future invest- developing country will put a bar on manufacturing of such
ment decision to give highest priority on developing right patented drugs in future. But if you consider the sale of
products over construction of expensive manufacturing such products in value term than you will find that sale is
units. GMP approval from stringent authority like USFDA in-significant considering the total turnover of the respec-
does not come from the look or size of the manufacturing tive manufacturing companies.
unit. The GMP approval is given by observing the level of
data integrity one is maintaining inside his company and Bangladesh’s strength will be to manufacture small
the robustness of manufacturing and quality control pro- molecules medicines at competitive scale of economy for
cess he has there. In fact, Bangladesh is losing its competi- 7 billion people of least developed and developing coun-
tiveness to India on transfer price or conversion cost for tries. By the end of 2030, generic market size of Africa will
her relatively higher expenses on building and equipment be US dollar 70 billion, South America will be US dollar 51
of the factories built. billion and ASEAN market size will be US dollar 30 billion.
By the end of this decade highest growth of generic sales
As the pharma export is in infancy stage thus the indus- is expected in Africa and ASEAN zones taking sales of 2021
try requires effective supports from the policy makers. Ef- as base year. We need to emphasize on business devel-
fective support means such support that truly contributes opment activities in Africa, ASEAN and South America with
to increase the export volume. Let’s take example of Bang- a strong product basket. Those markets allow branding of
ladesh’s pharma export to USA. USA is the largest generic our products which ensures greater return on the invest-
pharma market in the world. The generic market size will ment. To earn maximum from those markets physical pres-
be around US Dollar 156 billion by the end of year 2030. ence with own marketing team is essential and at no delay
Encouraging news is that by the end of current fiscal year, we need to start activities for gaining knowledge on those
USA will be the largest export destination of Bangladesh markets.
pharmaceuticals with value close to US Dollar 50 Million.
This value would be doubled, if the duties and taxes on Pharmaceutical companies of Bangladesh should put
the import of plastic bottles could be waived. The medi- more focus on contract manufacturing or private labelling
cines (tablets & capsules) which are exported to USA are businesses for North American and European countries.
required to be packed in plastic made containers and this Market growth trend is showing that size of global generic
kind of containers are not manufactured in Bangladesh. A pharma market will be US dollar 590 billion by the end of
Bangladeshi manufacturer cum exporter pays 128% as du- 2030 where most of the sales will be from regulated mar-
ties and taxes (total tax incidence) on import price when kets of North America and Europe.  Like RMG sector, phar-
they purchase those from India. This tax amount is also ma sector should focus on to be the preferred contract
making Bangladesh less competitive in competition with manufacturing hub of western pharmaceutical companies.
India. Not only this, our exporters are obliged to pay 44% Couples of companies have already demonstrated their ca-
as tax (as total tax incidence) when they transfer payments pability by obtaining GMP certifications from USA, UK and
outside of the country for unavoidable outsourced servic- EU. Companies in Bangladesh are now holding 40 ANDAs
es like conducting of chemical analysis of products, per- (Square, Beximco, ACI, Acme, Eskayef and Healthcare) and
forming of clinical trials or paying GMP application fees, more than 20 Market Authorizations (MA) for European
product registration fees, etc. All of these additional costs markets. By end of Y2025 the numbers of such product
are included in the COG and thus our COG becomes less approvals will much higher than it is today. We will see
competitive than India in the competition. To inform you, 3 /4 companies more with USFDA and EU GMP approvals
in last fiscal year India’s pharma export to USA was US Dol- soon. As CMO or in doing private label the companies will
lar 7 Billion.     have no liability for sale and marketing of the manufac-
tured products. The companies will manufacture and sup-
Globally, more and more new highly priced and ply products to the markets as per the forecast received
specialized medicines are coming onto the market. from the buyers. To be a successful CMO the key factor is to
What is your strategy to stay at the top? have a commendable transfer price or conversion charge.
For attracting CMO business from USA and EU, Bangladesh
Specialty medications are for treating complex dis- should invest more to build facilities (at reasonable cost)
ease conditions or diseases which are very uncommon. for hormonal drugs, cytotoxic drugs, general injectable and
Definitely such medications are very expensive in west- conventional solid dosages.
ern world. But in Bangladesh you will find many of the
specialty medications to treat liver infection, cardiac dis- To avoid any future export obstacles industry needs to
eases, certain cancers, kidney diseases and infertility are ensure more engagement of women in the company’s de-
already available. Bangladeshi pharma companies are sell- cision making positions and to maintain a good effluent
treatment system in manufacturing set-ups.

40 THE PHARMA WORLD

Number of T1D Cases Expected CONCERN
to Double Worldwide by 2040

In 2040, researchers predict between 13.5 and 17.4 million
type 1 diabetes (T1D) cases globally, reflecting a 60%
to 107% increase in cases compared with 2021

Approximately 8.4 million people around T1D incidence, prevalence, association mortal-
the world lived with type 1 diabetes (T1D) ity, and life expectancy in 201 countries.
in 2021, and this number is predicted to
rise to 17.4 million by 2040, according to a recent Incidence and mortality data were available
modelling study. from 97 and 37 countries, respectively, and data
from an expert survey were used to estimate
The study was conducted by researchers T1D diagnosis rates. Random-forest regression
from the United States, Canada, Australia, and of published T1D mortality data was used to
Luxembourg. These researchers also estimated model estimated mortality, and life expectancy
around 3.1 million individuals with T1D would was calculated using life tables.
have been alive in 2021 if they had not died pre-
maturely as a direct result of poor T1D care, and These estimates were validated against ob-
that an additional 700,000 individuals would served prevalence data from 15 countries. The
still be alive if they had not died due to a lack authors found between 8.1 and 8.8 million peo-
of diagnosis. ple lived with T1D globally in 2021. Of this group,
1.5 million (18%) were aged younger than 20
The researchers set a discrete-time illness- years, 5.4 million (64%) were aged between 20
death model (Markov model) to data on T1D and 59 years, and 1.6 million (19%) were aged
incidence and associated mortality to estimate 60 and older. “There is a systemic trend towards
other published estimates having lower paedi-
atric prevalence and higher adult prevalence
than in our model,” the authors noted.

In 2021, half a million new cases of T1D were
diagnosed, with a median age of onset of 39
years. Further, roughly 35,000 individuals who
did not receive a T1D diagnosis died within 12
months of symptom onset.

“The burden of type 1 diabetes in 2021 is vast
and is expected to increase rapidly, especially
in resource-limited countries,” the authors said,
noting 1.8 million, or one-fifth, of individuals
living with T1D globally in 2021 lived in low-in-
come or lower–middle-income countries.

Additionally, the mean remaining life expec-
tancy for a 10-year-old diagnosed with T1D in
2021 ranged from 13 years in low-income coun-
tries to 65 years in high-income countries.

In 2040, researchers predict between 13.5
and 17.4 million prevalent type 1 diabetes (T1D)
cases, reflecting a 60% to 107% increase in glob-
al cases compared with 2021.

Source:  American Journal of Managed Care



“The Department of endocrinology INTERVIEW
of BSMMU, since its inception, has
been providing comprehensive
care to diabetic patients”

Prof. Dr. Md. Farid Uddin should a diabetic patient undergo regularly?
Founder Chairman & Course Co-Ordinator
Dept. of Endocrinology, BSMMU, Dhaka. Yes, people with diabetes need to change their medi-
President, ACEDB (Association of Clinical cations over time. Factors that determine which drugs
Endocrinologist and Diabetologist of should be prescribed first and then which should subse-
Bangladesh) quently be added in includes –

As an eminent endocrinologist l individual profile (severity of initial symptoms, de-
of our country, would you gree of obesity) l glucose-lowering efficacy l pro-
please describe the prevalence tective properties in relation to cardiovascular and
of diabetes in Bangladesh? renal complications l adverse effect profile (hypo-
glycaemia, weight gain) l renal function l drug fac-
Diabetes mellitus has become a tors (mechanism of clearance/metabolism) l ability
global pandemic. The Prevalence of or willingness to self-inject l occupation (e.g. driving,
Diabetes Mellitus is increasing day working at heights) l cost-benefit outcome
by day in Bangladesh. As per IDF
2021, the Age-adjusted comparative Investigations:
prevalence of Diabetes among the l Regular SMBG (Self-monitoring of blood glucose)
population aged 20-79 years is 14.2% 6 times/day l HbA1C l Serum creatinine l Fasting
in Bangladesh. Bangladesh has the lipid profile l SGPT l CBC with ESR l Urine R/M/E
second-highest prevalence of DM in l For screening of Renal complications: Early morn-
South East Asia. 13.1 million people ing Urine for microalbumin, Urine ACR, eGFR. l For
are currently living with DM in Bang- screening of eye complications: Annual Digital reti-
ladesh. The overall prevalence of GDM nal photography (Fundal photography) l For screen-
in Bangladesh is 20- 35%. Bangladesh ing of Foot complications: Annual comprehensive
is 8th in prevalence in the world and examination of the feet,10g monofilament test.
is projected to become 7th in 2045.
Among them, 43.5% of people are un- Hypoglycemia has always been a nightmare for
diagnosed — estimating 5.7 million in diabetic patients. How could this be avoided?
total. Almost 1 in 2 adults with DM are
unaware that they have Diabetes. Patient education is fundamental to the prevention of
hypoglycemia. Risk factors of hypoglycemia should be dis-
Do people with diabetes need cussed. The importance of regular blood glucose monitor-
to change their medications ing and the need for glucose readily available should be
over time? What investigations stressed. A review of insulin and carbohydrate manage-
ment during exercise is useful. Advice for patients when
travelling should be addressed. Relatives and friends also
need to be familiar with the signs & symptoms and man-
agement of hypoglycemia.

Why is diabetic neuropathy considered
a “forgotten complication”?

Diabetic Neuropathy (DN) is the most common complica-
tion of diabetes affecting at least 50% of individuals. It in-
volves somatic sensory motor nerves as well as autonomic
nerves. The duration of diabetes & Glycated haemoglobin
levels has been associated with a high incidence of neurop-
athy. The clinical presentations are diverse — ranging from
diabetic peripheral neuropathy (DPN) to diabetic autonomic

THE PHARMA WORLD 43



neuropathy (DAN). Up to 50% DPN may ity decreases, diet habits shift towards Environmental chemicals:
be asymptomatic, and they are less high-energy foods and body mass in- Several environmental chemicals and
likely to seek medical attention and dex (BMI) and upper body adiposity particularly endocrine-disrupting
many are totally unaware of the con- increase considerably. Socio-economic chemicals (EDCs) are responsible for
dition. Furthermore, primary physician progress, occurring even in the rural ar- the increasing prevalence of Diabe-
and even endocrinologists fail to ex- eas of countries has adversely affected tes. One such endocrine disruptor is
amine patients’ feet to detect painless the proportion of people affected with Bisphenol A, a chemical compound of
DPN. Specific treatment of underlying lifestyle disorders such as obesity, polycarbonate plastic, which is used
nerve damage other than improved gly- diabetes, HTN and cardiovascular dis- in many food and water containers
cemic control is currently not available. eases. Recent studies also showed that (e.g., bottles and food cans with epoxy
the conversion rate of IGT to diabetes is resin coatings), as well as in dental
It is for this reason DN is often con- high, probably on account of the influ- sealants which lead to a potential hu-
sidered to be a forgotten complica- ence of lifestyle transitions. man exposure and is believed to be
tion of diabetes. associated with increased prevalence
Diabetes in the youth: of Diabetes. We have found high level
What are the main challenges Asian populations develop diabetes of serum bisphenol-A in diabetic pa-
related to symptomatic treatment at a younger age than Western popu- tient.
of painful diabetic neuropathy? lations. It may also be related to an
interplay of higher rates of central Endocrinology emerged as a
Diabetic neuropathic pain is exceed- obesity, insulin resistance, genetic Department of BSMMU under
ingly difficult to diagnose. No single predisposition, and/or influence of your chairmanship. What, in your
test can provide a definitive diagnosis adverse intrauterine influences pre- opinion, has been the greatest
and only a symptomatic diagnosis is sent among the Asian population. achievement of the department
possible. There is no single best agent regarding care for diabetic
for diabetic neuropathic pain, and Anthropometric characteristics: patients? What is the role of the
therapy should be tailored to each pa- Several studies in Asian populations department in advancing novel
tient’s preferences and comorbidities. have highlighted the “metabolically research and educating the next
obese” phenotype among normal- generation of health experts?
Unfortunately, despite numerous weight individuals. This phenotype,
medication trials, many patients have characterized by greater abdominal The Department of endocrinology
persistent pain. Lack of clinical evi- obesity despite a normal BMI, less mus- of BSMMU, since its inception, has
dence regarding which treatment op- cle mass, higher percentage of body fat been providing comprehensive care
tions are likely to work best for which and increased propensity for insulin to diabetic patients both indoor and
patient is another drawback. The cur- resistance compared with the Western outdoor basis. We are also provid-
rently available systemic therapies pro- population, renders higher susceptibil- ing health education to the patients
vide few affected patients with mean- ity for diabetes in Asian populations. regarding diet and exercise. Besides
ingful pain relief and are further limited providing services, we have done
by unwanted adverse effects, such as Smoking and alcohol use: various research works which have
drowsiness and dizziness, and the need The risk of diabetes is shown to be been published in renowned journals.
for multiple daily dosing. There is heter- higher by 45% in smokers than among We have done work on Ramadan and
ogenicity of treatment response and no non-smokers. Smoking increases the diabetes. The fatwa of checking blood
effective medication that reverses loss risk of central obesity and insulin re- sugar and using insulin during fasting
of sensation. DPN is not curable, only sistance, and nicotine exposure has has been collected under my supervi-
progression can be slowed through im- several other deleterious effects. The sion. Besides, we have done work on
proved glycemic control. increasing use of alcohol also increas- childhood obesity and diabetes, bis-
es the risk for diabetes and other phenol exposure in diabetes, young
Diabetes continues to be an metabolic diseases. diabetes & various time-demanding
increasingly prevalent disease topics. We are also producing quali-
amongst the population. Genetic susceptibility: fied endocrinologists who provide
Why do you think it is The prevalence of T2D is high among services to the people of this country.
becoming an epidemic? Asian populations by virtue of a high This department has been observing
genetic susceptibility and enhanced awareness programs as part of educa-
Urbanization and socioeconomic interaction with environmental trig- tion for a long time. If other institu-
transition: gers. Exposure to a high-fat diet and tions including government & private
The escalating prevalence of diabetes lower levels of physical activity are the medical colleges follow the diabetes
seen in the last two to three decades common factors that trigger gene-en- services given by BSMMU & BADAS, we
can be attributed mostly to the change vironment interaction. can achieve the NCD goal smoothly in
in lifestyle as a result of rapid socioeco- Bangladesh.
nomic growth. Urbanization and inter-
nal rural-to-urban migration result in
several adverse impacts; physical activ-

THE PHARMA WORLD 45



“Our pharmaceutical Companies INTERVIEW
are manufacturing world-
class diabetic medicines”

Prof. Dr. SM Ashrafuzzaman As a renowned physician of Bangladesh, would
Professor & Ex-Head you please describe the prevalence of Diabetes in
Dept. of Endocrinology, BIRDEM our country and what is the global scenario?
Sr. Consultant & Professor
(Honorary), ICHRI According to the International Diabetes Federation news (IDF):
President, Bangladesh Endocrine Bangladesh is one of the 6 countries of the IDF SEA (South
Society (BES) East Asia) region. 425 million people have Diabetes in the
world and 82 million people in the SEA Region; by 2045, this
will rise to 151 million. There were 6,926,300 cases of Diabetes
in Bangladesh in 2017. Latest news is that, Diabetes affect 463
million adults in 2019 according to IDF. Total adult popula-
tion :100,113,000. Prevalence of Diabetes in adults :6.9%. Total
cases of Diabetes in adults:6,926,300.
According to WHO, its global prevalence was about 8% in
2011 and is predicted to rise to 10% by 2030. The prevalence
is increasing in Bangladesh also. The estimated prevalence in
Bangladesh is 12.5% (8.5%–12.8%), and in South East Asia it is
8.7% (7.4%–9.7%) (Age 20-79 years of population).
According to others, the prevalence of Diabetes Mellitus
in Bangladesh is 10 %. About eighty Lacs (8 million) people
are suffering from Diabetes. Only 50 % know that they have
Diabetes. More alarming is that, equal number or more are
in prediabetes state. They will be diabetic if awareness and
prevention program fails.

World Diabetes Day has recently been observed. As
the world’s largest hospital in treating Diabetes, what
is the standard of treatment in your hospital?

The theme for diabetes awareness month and World Dia-
betes Day 2022 (14 November) is “education to protect tomor-
row”. Bangladesh Diabetes Association (BADAS), BIRDEM, all
the affiliated centers of BADAS, other non-government as well
as Government organizations, also tremendously observed
the Day this year. They hold Rally, Camp, Free screening,
awareness program, talk show in different TV and other print
or electronic media including FM radio. I myself attended Ra-
dio ABC FM 89.2 for a live one-hour program on this occasion.

Regarding standard of treatment in our hospital is accept-
able. It is best in the country in respect to Diabetes. Even then
there are many windows where we can improve to reach the
World standard. I think it is a pleasure that, we can confi-
dently say that nobody need to go abroad for the manage-
ment of diabetes. We can give World class management of
Diabetes in our country.

Is there any link between Diabetes and Hypertension?

Yes. There is a strong relation between Diabetes and hy-
pertension (HTN). 50% of diabetic patients are hypertensive.
Persons having Diabetes eventually may develop HTN or Hy-

THE PHARMA WORLD 47

pertensive patients may be diagnosed national organizations all over the care for the management of diabetes
with Diabetes in course of time. So, all world. BADAS (Bangladesh Diabetic and its complications. We have stand-
diabetic should be checked for high Somity) is founded by Late National ard infrastructure, Logistics of all world
blood pressure in each visit by the Professor Md Ibrahim in 28 February standard type of medication for diabe-
physician as well as all hypertensive 1956. Every year the day is celebrated tes & manpower. BADAS has MoU with
subjects should have screening for di- with dignity as “Diabetes Shewa Di- Nepal, Bhutan etc to train manpower
abetes once yearly preferably by OGTT. bosh”. It is now largest NGO of the and to cooperate their government for
World in the management of Diabetes development of diabetes care through
How Hypoglycemia can be avoided under the leadership of Prof AK Azad “Ibrahim Health Care Model”. So, me as
in treating Diabetes with insulin? Khan, President of BADAS. It has now well as we are proud of the BADAS as
expanded its service throughout the well as other Governmental (BSMMU,
Hypoglycemia or Low blood glu- country though more than 110 Affili- DMC) and autonomous private/corpo-
cose (<3.9 mmol/L or <70 mg/dl) is im- ated centers and more than 30 hospi- rate Institutions, who are serving dia-
portant and not an uncommon com- tals. We have NHN, BIHS, BUHS, HCDP, betic patients in the country.
plication of Diabetes management. RVTC, ICHRI. Moreover, BADAS is work-
It can be lowered by proper diabetic ing for manpower development of Our pharmaceutical Companies are
education to the patient (Subject). To IMC and BADAS Nursing Institute, DLP manufacturing world-class diabetic
follow the instructions of diet at due (Distance Learning Program). BADAS is medicines including insulin. Private
time and quantity, less Hypoglyce- giving huge support to the poor dia- health sector including laboratories
mic medicine (newer Oral or Insulin betic and children with Diabetes. So, are giving standard support for the
or Combination) and regular moni- many more services yet to mention investigations. Physicians are mostly
toring with frequent adjustment of BADAS in the field of Diabetes. trained. Moreover, Approximately
the dose particularly Insulin. Among 400 endocrinologists are serving for
the various types of insulin, some of Diabetes is an increasingly diabetic subjects. Para-professionals
them has less Hypoglycemic property prevalent disease amongst the (nurse and others) are now trained
i.e. the analogue Insulins. population. Has there been marked enough especially in secondary and
improvement in its management tertiary centers. Bangladesh Endocrine
How do you evaluate the and treatment over the last few Society (BES) is also working hard for
role of BIRDEM in the years in our country compared professional skill development.
management of Diabetes? to advanced countries?
As President of BES, I have taken
Very important question. Role of I don’t have any data to show head various steps for the standard manage-
BIRDEM in the management of Dia- to head comparison with the foreign ment of diabetes including improve-
betes is tremendous and highly ap- institute. But we are giving standard ment in diabetic education. So, I believe
preciated by the GoB, NGOs, inter- no diabetic patient should go abroad
for the management of diabetes.

M MYTH: Diabetes is caused by eating too much sugar.
REALITY: Eating too much sugar does not cause diabetes. Type 1 diabetes is an au-
VRS toimmune disorder where the body’s immune system accidentally attacks and de-
stroys insulin-producing cells in the pancreas. Type 2 diabetes, on the other hand,
MYTH VS progresses when insulin-producing cells are unable to produce enough insulin,
REALITY or when the insulin that is produced doesn’t work properly (ie insulin resistance).
Type 2 diabetes is caused by a combination of genetic and lifestyle factors. You can
help reduce your risk by staying at a healthy weight, exercising most days of the
week, and eating a healthy diet.

MYTH: People with diabetes need to follow a ‘special diabetic diet’.
REALITY:  There is no such thing as a ‘diabetic diet’. Just like everyone, if you are
living with diabetes you will benefit from eating a healthy diet that includes a wide
variety of foods – including fresh fruit and vegetables, fibre and healthy protein.
The American Diabetes Association suggests that people with diabetes get their
carbohydrates from vegetables, whole grains, fruits, and legumes. Avoid foods that
are high in fat, sodium, and sugar.

48 THE PHARMA WORLD

Lifestyle intervention in older adults with type 2 diabetes DIABETES UPDATE

Lifestyle modification is important for improving glycemia in type 2 diabetes mellitus. In a recent
trial, 100 older adults (mean age approximately 72 years) were randomly assigned to an intensive
lifestyle intervention (diet and exercise to achieve a 10 percent body weight loss) for six months
or a control intervention (monthly educational group sessions). After one year, intensive lifestyle
modification led to greater reductions in A1C (mean difference 0.9 percent) and body weight (mean
difference 8.1 kg), but also caused more episodes of mild hypoglycemia than the control interven-
tion. This trial supports the practice of providing older adults with counseling regarding lifestyle
modification, provided the risk of hypoglycemia is minimized through close monitoring and empiric
reductions in glucose-lowering therapy in selected individuals.

Combination VEGF inhibitors for diabetic
pharmacotherapy macular edema
for painful
diabetic Intravitreal vascular endothelial growth factor (VEGF) in-
neuropathy hibitors are initial therapy for most patients with diabetic
macular edema and impaired visual acuity. The selection of
In a multicenter trial of 130 a particular agent depends on cost of care as well as treat-
patients with painful diabetic ment efficacy and specific details of the ophthalmic history
neuropathy who were given and retinal examination. In a recent trial comparing afliber-
initial monotherapy with  ami- cept with a progressive regimen (bevacizumab first, with a
triptyline,  pregabalin, or  du- switch to the more costly aflibercept if specific ophthalmic
loxetine, those whose pain did criteria for suboptimal response were met), the mean im-
not improve at six weeks were provement in visual acuity over two years was similar in the
given a second agent from a two groups. During the two-year trial, 70 percent of eyes in
different pharmacologic class. the bevacizumab group were switched to aflibercept. This
At 16-week follow-up, combi- cost-saving step-up approach may be suitable for some pa-
nation strategies consisting of tients with diabetic macular edema.
pregabalin added to amitripty-
line, amitriptyline added to pre- Romosozumab in patients with
gabalin, or pregabalin added to moderate kidney impairment
duloxetine all provided greater
benefit than monotherapy, and Romosozumab has been shown to increase bone density
each strategy provided similar and reduce vertebral and nonvertebral fractures compared
(approximately 50 percent) pain with both placebo and  alendronate. In a retrospective
reduction relative to baseline analysis (over 11,000 postmenopausal women with osteo-
pain. These results support the porosis, 6299 with mild [eGFR 60 to 89 mL/min/1.73 m2] or
strategy of combination phar- moderate [eGFR 30 to 59 mL/min/1.73 m2] kidney impair-
macotherapy for patients with ment), the magnitude of benefit for romosozumab was
painful diabetic neuropathy similar across different eGFR thresholds. Romosozumab is
that does not respond to initial an effective treatment to prevent fracture in patients with
monotherapy. eGFR ≥30 mL/min/1.73 m2.

Bariatric surgery and diabetes remission Source: Up To Date

In several one-year trials comparing bariatric surgery with lifestyle/medical management in pa-
tients with type 2 diabetes and obesity, surgery reduced weight and improved glycemia more ef-
fectively. Studies evaluating the long-term durability of these findings are ongoing. In a prospective
observational study of 316 patients with type 2 diabetes previously participating in randomized tri-
als of surgery versus medical/lifestyle therapy, diabetes remission (glycated hemoglobin [A1C] ≤6.5
percent for three months without medication) at three years was achieved in 37.5 and 2.6 percent of
patients, respectively. Surgical treatment of obesity is an option to treat type 2 diabetes in selected
patients who meet weight and/or comorbidity criteria.

THE PHARMA WORLD 49