Dr Tabinda Dugal, a renowned endocrinologist with extensive international training, has recently shared her expert insights on the latest developments in diabetes, obesity management, and gynaecological endocrinology.
Dr Dugal, who relocated to Doha in 2024, brings a wealth of experience from the Republic of Ireland and the United Kingdom, where she trained and practiced as a specialist in Endocrinology and Diabetes.
A graduate of King Edward Medical University, Dr Dugal earned Membership of the Royal College of Physicians of Ireland and completed specialist training in Dublin and London, receiving Certificates of Specialist Training in Endocrinology and Diabetes.
She has served as a consultant in the NHS, an Honorary Lecturer at the University of Plymouth, and is currently a visiting professor at her alma mater, King Edward Medical University, Lahore.
In an exclusive interview with Qatar Tribune, Dr Dugal emphasized the role of lifestyle modifications in preventing type 2 diabetes.
Excerpts.
Could you explain how lifestyle modifications can help prevent diabetes?
A healthy lifestyle plays a powerful role in preventing type 2 diabetes. Eating a balanced diet rich in vegetables, fruits, whole grains, legumes, lean proteins, and healthy fats helps regulate blood sugar, while limiting refined carbs and sugars prevents spikes in glucose and insulin demand. Portion control and fiber-rich foods further support weight management and insulin sensitivity. Regular physical activity—both aerobic exercise and resistance training—improves glucose use and builds muscle mass, with consistent routines lowering diabetes risk significantly. Managing weight, especially reducing abdominal fat, is crucial, as even modest weight loss can cut progression from prediabetes to diabetes. Avoiding long periods of sitting by taking short breaks helps maintain insulin activity, while good sleep and stress management reduce cortisol and hormonal imbalances that worsen glucose control. Finally, steering clear of smoking and excess alcohol lowers inflammation, prevents weight gain, and protects liver and pancreatic function. Evidence from the landmark Diabetes Prevention Program shows that such lifestyle changes reduce diabetes risk by 58%, and by 71% in people over 60, far outperforming medication alone.
What are some of the latest therapies available for managing diabetes?
Recent advances in diabetes care highlight several important therapeutic updates. Oral semaglutide (Rybelsus) has gained a cardiovascular benefit label in the EU after the SOUL trial showed a 14% reduction in major adverse cardiovascular events in patients with type 2 diabetes and atherosclerotic disease or chronic kidney disease. Semaglutide (Wegovy) has also been approved in the UK to reduce cardiovascular risk in overweight or obese adults with established heart disease. Teplizumab (Tzield), the UK’s first immunotherapy for type 1 diabetes, now offers early intervention by delaying progression from Stage 2 to Stage 3 by about three years. Insulin icodec (Awiqli), a once-weekly basal insulin, is approved in multiple regions and provides similar HbA1c control to daily insulins, while efsitora, another weekly insulin candidate, shows promising trial results with fewer dose adjustments. Meanwhile, SGLT-2 inhibitors are being emphasized earlier in guidelines for cardiovascular and renal protection, and sotagliflozin, a dual SGLT1/2 inhibitor, has been FDA-approved for heart failure. These developments suggest a shift toward therapies that reduce treatment burden, enhance adherence, and expand cardiovascular protection, while also opening new possibilities for early type 1 diabetes intervention and requiring careful management of insulin transitions.
How would you explain gynaecological endocrinology?
Gynaecological endocrinology is a medical field that studies how hormones shape women’s reproductive health throughout life, blending gynaecology (female reproductive care) with endocrinology (hormone science). It covers puberty and menstrual cycle regulation, fertility issues such as PCOS and ovulation disorders, hormonal changes in pregnancy including gestational diabetes or thyroid disease, and the transition through menopause with its symptoms and long-term risks like osteoporosis or heart disease. It also addresses hormone-related conditions such as endometriosis, premenstrual disorders, and certain cancers. In simple terms, it explains how hormones affect periods, fertility, pregnancy, and menopause, helping patients understand symptoms like irregular cycles, infertility, or hot flushes, and guiding treatments such as hormone therapies.
Could you elaborate on the management and medical treatment options for obesity?
Obesity management begins with lifestyle intervention, focusing on nutrition, physical activity, and behavioural therapy. A calorie deficit tailored to age, sex, and activity, alongside Mediterranean or DASH-style diets, reduced ultra-processed foods, and higher protein and fibre intake, supports satiety and weight loss. At least 150 minutes of moderate exercise weekly plus resistance training, combined with reduced sedentary behaviour, typically achieves 5–10% weight loss in 6–12 months, improving metabolic risk. If lifestyle measures are insufficient, pharmacological therapies are added for patients with BMI ≥30 or ≥27 with comorbidities. Options include orlistat, which modestly reduces weight but has gastrointestinal side effects, and newer agents like GLP-1 receptor agonists (liraglutide, semaglutide) or dual GLP-1/GIP agonists (tirzepatide), which can achieve 10–20% weight loss and improve cardiovascular outcomes. For severe obesity (BMI ≥40, or ≥35 with comorbidities), bariatric surgery remains the most effective long-term option, while endoscopic therapies provide less invasive but temporary alternatives. Supportive measures such as sleep hygiene, stress management, and multidisciplinary care enhance outcomes. Long-term strategy requires regular monitoring, relapse prevention, and shifting the focus from weight loss alone to overall health improvement in glycaemia, cardiovascular risk, mobility, and wellbeing.
What strategies would you recommend for providing transitional care to adolescents with endocrine disorders as they transition into adulthood?
Transitional care in endocrinology is a critical process because many conditions begin in childhood but require lifelong management. Poorly planned transfers from paediatric to adult services often result in loss of follow-up, reduced adherence, and worse outcomes. The best approach is structured and gradual: start early (around age 12–14) by building knowledge and self-management skills, and encourage adolescents to participate actively in clinic discussions. Develop individualized transition plans that outline diagnosis, treatment, complications, and goals tailored to each condition. Education should cover medication use, monitoring, and emergency preparedness, supported by structured programmes where available. Psychosocial support is essential, addressing body image, peer pressure, mental health, and independence, while multidisciplinary teams and transitional clinics ensure continuity. Families should gradually hand over responsibility but remain supportive.
Transfers should be warm handovers with direct communication between paediatric and adult teams, followed by close post-transfer monitoring, flexible appointments, and peer support. For example, in type 1 diabetes, early education on carb counting and insulin adjustment evolves into joint clinics, technology training, and adult care focused on autonomy and long-term complication screening. Ultimately, transition is not a single event but a planned, multidisciplinary process that empowers young people to manage their condition confidently as adults.