The Arab world’s invisible enemy
Health experts call for care reform and more awareness as cases of Type 1 and 2 diabetes continue to rise across Middle East
Controlling the sweet tooth is not the only lifestyle choice that will determine whether or not an individual will develop diabetes in the course of their lifetime. The chronic disease, which has seen an alarming rise in cases across the world over the past decade, has been linked to sedentary lifestyles, unhealthy diets and obesity.
Inadequate knowledge about the prevention and management of the condition in many countries led the International Diabetes Federation to make “access to diabetes education” the theme of World Diabetes Day for the third consecutive year.
Every year, various campaigns are launched around the world on Nov. 14 to help raise awareness about the disease, which, as of 2021, affected 537 million adults between the ages of 20 and 79 worldwide.
In recent years, cases of Type 2 diabetes have skyrocketed in specific regions, including the Middle East and North Africa — particularly in the Gulf Cooperation Council area. Countries such as Kuwait, Saudi Arabia and Bahrain now rank among the top 10 nations with the highest prevalence of Type 2 diabetes.
In the UAE, as many as one in five people have diabetes, with Type 2 being the most common form, according to Cleveland Clinic Abu Dhabi. This number is expected to double by 2040.
In response to this seemingly inexorable increase in cases, health experts are examining everything from lifestyle trends to technological advancements and healthcare systems to determine what can be done to slow the spread and identify how much is down to genetics.
According to Dr. Sara Suliman, consultant endocrinologist and diabetologist at the Imperial College London Diabetes Center in Abu Dhabi, variables such as urbanization, changing climate, mobility and food availability influence rates of diabetes in different areas.
“The GCC, being one of the richer areas in the world, has seen far more use of cars, far more easy access to food, including high-calorie food, and is one of the leading areas in the world as far as an increase in diabetes cases is concerned,” she told Arab News.
The situation is just as worrying in other countries of the Middle East and North Africa. Data from 2021 shows that 73 million adults (aged 20-79) across the MENA region are living with diabetes — a figure that is estimated to grow to 95 million by 2030 and 136 million by 2045.
“Until very recently, we were hanging a lot of things on genes. We do know if one parent has diabetes (Type 2), then there is a 40 percent chance of an individual getting diabetes, and that if two parents have diabetes, then there is an 80 percent chance of the individual becoming affected,” said Suliman.
In fact, not only is Type 2 diabetes preventable, it can also be reversed through a complete change in lifestyle. Unfortunately,
this is not the case for Type 1. With genetics accounting for only 5-10 percent of cases, Type 1 diabetes is thought to be caused by an autoimmune reaction, which leads the body to attack itself, destroying the cells in the pancreas responsible for producing insulin.
“For Type 1 diabetes, the treatment is insulin and will always be insulin. But with Type 2, we have different options,” said Suliman.
It is no secret that excessive consumption of fizzy drinks, energy shots, sweetened juices and processed junk foods tops the list of diets that result in high blood sugar levels (or blood glucose levels).
An unhealthy diet coupled with a
lack of regular exercise, fewer than seven hours of sleep per night and poor hydration significantly increases the risk of obesity as well as Type 2 diabetes, said Suliman.
“Obesity is another major problem in the Gulf countries,” she said. “For example, 50 percent of children in Kuwait are at the moment either overweight or obese.”
Studies predict that at least 10 countries in the MENA region will have more than a million children suffering from obesity by 2030.
Looking at the problem through a different lens, Dr. Ihsan Al-Marzooqi, co-founder and managing director of Glucare Health, says although bad habits significantly impact rates of diabetes, there is another side to the story.
“While it is easy to blame patients for their lifestyle choices, the reason we see this growth is because, over the past 40 years, healthcare providers have not changed their model of care to tackle the root cause of the disease,” he told Arab News.
“Despite all the advances we have seen in healthcare, the system still treats patients episodically — a quick 15 minutes with your doctor every quarter — with a strong emphasis on prescription medications.”
Describing diabetes as “fundamentally a behavioral problem,” Al-Marzooqi highlighted the need for healthcare providers to focus on innovating care models that provide a more consistent follow-up approach that emphasizes changes in behavior.
To achieve this, providers need to consistently record new sets of personal data for each patient, a practice Al-Marzooqi says has not yet evolved in MENA countries.
Critiquing current care models, he says patients have little knowledge about the effect of their actions on their health, adding that this has resulted in a large number of poorly controlled diabetics in the GCC.
“We believe that most patients simply do not have agency over their own health, as in they cannot contextualize the extent of how their lifestyle choices can ultimately affect their diabetes outcome,” he said.
At the same time, “providers will always advise their patients on lifestyle modification, but none will actually track the advice they give.”
According to Al-Marzooqi, the outcome is evident in the data collected, which indicates that almost 75 percent of managed diabetics in the GCC with access to care are classified as “poorly controlled.”
Highlighting predictions of a regionwide “tsunami” of healthcare bills as a result of the situation, he says diabetes need not be a costly disease to manage.
“The complications from poorly controlled diabetes are what lead to almost a quarter of healthcare budgets being spent on diabetes,” he said.
To end this cycle, Al-Marzooqi says that governments should incentivize healthcare providers by rewarding them for clinical outcomes as opposed to the current fee-for-service models.
If a value-based reimbursement model is put into practice, he argues, providers who innovate and invest in new modalities, such as digital therapeutics, will end up with a better engaged and better managed population. This, in turn, could reduce future complications, thereby reducing the overall cost.
On the upside, Gulf governments have been making efforts to raise awareness about the disease. Early education and training on managing the condition and promoting healthy lifestyles are now widespread at schools and universities in the region, says Suliman.
Some governments have got municipalities to set up public walkways and running tracks and outdoor gyms and ministries to launch nationwide fitness campaigns to encourage people to get active.
Another example of state intervention is the sugar tax in the UAE, announced in 2019, which applies a 50 percent tax on all sugar-sweetened beverages.
From a technological standpoint, treating diabetes has also come a long way, says Suliman. Historically, diabetes patients had no choice but to prick their finger several times a day to monitor their blood sugar and self-inject insulin when needed.
“We are now spoiled for choice,” she said. Significant progress has been made in the development of glucose sensors and insulin pumps. These devices allow patients to keep track of their sugar levels with live updates on their mobile phones.
Additionally, patients who are in need of insulin on a daily basis have the choice of installing a sensor and pump device that can take care of tracking and applying the right dosage needed to avoid the traditional method of injection.
“There are signs that we can at least flatten the curve,” said Suliman, who believes the younger generation is more conscious of better lifestyle choices.
“The problem is, the rise in diabetes cases has been so steep as to be scary, and if the pessimistic forecasts come true, it would be even scarier.”
She added: “We all have to move in the same direction.”