Fighting against a diabetes epidemic in the Gulf

08 August 2011

Middle East governments are embarking on a multi-pronged strategy to tackle diabetes. It includes surveys to source data, along with targeted health awareness campaigns

Diabetes in numbers

27 million:The number of people with diabetes living in the Middle East

51.1 million: Estimated number of people in the Middle East with diabetes by 2030

Source: International Diabetes Federation

Two years ago, Brussels-based International Diabetes Federation (IDF) released a study showing that diabetes was at epidemic levels worldwide. The study made for grim reading: 300 million people or 7 per cent of the world’s adult population, had diabetes.

We are working … to formulate dietary guidelines for school cafeterias and to implement them

Abdulla al-Hamaq, Qatar Diabetic Association

This is double the number in 2000 and ten times more than in 1985, when there were 30 million cases of diabetes. Without drastic and effective intervention to slow the disease, 435 million people worldwide will have diabetes in 2030, IDF predicted.

Diabetes-related conditions kill more than 4 million people a year. Diabetes can lead to blindness, kidney failure, heart disease and circulatory problems and foot ulcers requiring lower-limb amputations.

Diabetes: A devastating disease

Nearly 27 million people with diabetes live in the Middle East, and this figure is set to rise to 51.1 million by 2030, according to the study. Five of the world’s 10 worst-affected nations are in the GCC, and IDF says that diabetes is “devastating” the UAE, Saudi Arabia, Bahrain, Kuwait and Oman.

Diabetes prevalence in Mena*
Saudi Arabia2221.7
Jordan 17.218.1
*=Among adults aged above 25; Mena=Middle East and North Africa. Source: Imperial College, 2008

A 2008 report by the UK’s Imperial College estimates that a fifth of Saudi nationals have diabetes. Research from the region is equally disturbing. The Doha-based Qatar Diabetic Association (QDA) says diabetes affected 16.6 per cent of the local population in 2008. The same year, in Oman, a health survey found that 12.3 per cent of adults aged above 20 were diabetic and 10-11 per cent of adults were pre-diabetic. A 2010 study by Health Authority Abu Dhabi (Haad) indicates that 21 per cent of the emirate’s nationals are diabetic.

Ali Jaffer Mohamed, health affairs adviser to Oman’s Health Ministry, says that diabetes is “becoming the third cause for hospital admissions, after deliveries and road-traffic accidents” in the country.

All the studies reveal double-digit levels of diabetes across the Arab world. The region faces a severe health crisis that requires urgent intervention.  In 2005, the World Health Organisation has launched a five-year education campaign targeting the four deadliest non-infectious diseases: diabetes, heart disease, cancer and respiratory illnesses. It is prompting regional governments, teaching bodies and health specialists to step up their own healthcare drives.

Over the past 40 years, the Middle East countries have seen a dramatic lifestyle shift. Since the 1970s, oil has transformed the GCC economies into affluent ones. The adopting of more Western-style eating habits have seen a growing preference for a diet of convenience foods and carbonated drinks. Sedentary lifestyles are now the norm.

Globally, obesity levels have risen since the 1980s, says Goodarz Danaei, assistant professor of global health at Boston-based Harvard School of Public Health. A report published in February in medical journal The Lancet shows a steady increase in average adult body-mass index (BMI) measurements over three decades. Trends in Arab countries reflect the global picture. The average adult Arab male BMI score rose from 23.6 in the 1980s to 26.3 in 2008. Average BMI scores for Arab women rose from 25 to 28.2 over the same period. Doctors class a BMI of 25-29.9 as overweight and a BMI of more than 30 as obese. “There is a direct correlation between increased BMI and the spread of diabetes,” Danaei says. “Losing weight is the best way to reduce that risk.”

It is a simple message, but one that regional doctors and healthcare campaigners have struggled to drive home. Type-2 diabetes accounts for up to 95 per cent of all diabetes cases and is linked to poor diet and too little exercise. Traditionally, it affects the middle aged and elderly. Today, more nationals in the Middle East and North Africa (Mena) region are being diagnosed with type-2 diabetes earlier in life.

Lack of diabetes data in the Gulf

IDF figures show that Middle East governments spend $5.6bn a year on treating diabetes. But this does not include the costs of diabetes-related illnesses. Regional governments urgently need accurate data on diabetes prevalence and treatment to calculate the costs.

Countries with high diabetes prevalence
RankingCountry(Percentage of adults with diabetes)
3Saudi Arabia16.8
Source: International Diabetes Federation 2009

The most recent UAE-wide study into diabetes was completed back in 2001. It found that 19.6 per cent of all nationals had diabetes. Since then, Emirates Diabetes Society (EDS) says there have been no new nationwide studies, although EDS is planning to start a new study next year.

The UAE Health Ministry is working with the University of Sharjah to create a national diabetes database. The scheme will gather blood test results from health centres and clinics to determine national diabetes rates. Its findings will shape future strategy to combat the disease.

In Qatar, the Supreme Council of Health and Education, QDA and the Qatar Foundation this summer launched a second national diabetes survey. QDA is campaigning against obesity, targeting school students in particular. It plans to draw up dietary guidelines for school catering and to ban vending machines selling carbonated drinks and sweets.

“We are now tackling the issue of healthy food in school cafeterias,” says QDA executive director Abdulla al-Hamaq. “We are working with the Supreme Council of Education and Health to formulate dietary guidelines for school cafeterias and to implement them.”

Despite the many initiatives, some industry insiders feel regional governments need to do much more to tackle the disease. 

“The region is a hub for diabetes,” says one doctor. “The UAE authorities admit that nearly one in five of the population is diabetic. In fact, diabetes affects half of all nationals aged over 50. With rates of diabetes increasing every year, it is clear that education programmes have not been working.”

If general health messages have struggled to slow the spread of diabetes, future initiatives may be more closely targeted.

Targeted awareness

Abu Dhabi-based Haad is taking that approach. Its second diabetes screening drive for a disease management programme is due to launch next year. The Weqaya Programme aims to reduce non-communicable diseases in Abu Dhabi. Five healthcare companies, yet to be appointed, will earn bonuses for delivering improvements in patient health.

Abu Dhabi Weqaya screening findings
Adults found to be obese or overweight (%)66
Diabetic or pre-diabetic adults (%)44
Adults with abnormal cholesterol (%)50
Adults with at least one risk factor for cvd (%)71
Total social cost to Abu Dhabi over 10 years (AEDbn)300
Cvd=Cardiovascular disease. Source: Haad

Oliver Harrison, Haad director for public health and policy, says that Abu Dhabi spends AED1bn ($3.67bn) a year on treating diabetes. But that figure represents only direct costs. “Diabetes has social costs too, in higher rates of absenteeism from work and premature mortality, and related illnesses,” Harrison says.

So far, Haad has screened 200,000 nationals, creating a personal health report that measures each patient’s risk of having a heart attack, stroke or diabetes within a decade. The patient’s score determines follow-up care. Haad will license five companies to run disease management programmes.

The programme will target workplaces, too, encouraging employers to promote healthier lifestyles to improve their employee average Weqaya scores. A healthy schools project will encourage the emirate’s schools to promote healthy eating and physical exercise and to discourage smoking.

Harrison says it will cost AED210 a patient to implement the Weqaya programme.

UAE-based Green Crescent Insurance says the average diabetic patient in the emirates spends just four hours a year with a doctor – too little support to effectively manage the illness. Green Crescent says that patients with raised blood sugar levels need more support to prevent full-blown diabetes from developing.

The insurance company runs a disease management programme (DMP) that tests policy holders’ blood sugar levels. It refers those that test diabetic or pre-diabetic to a structured programme, based on consultation, education and monitoring.

Green Crescent has offered to run a trial programme for the UAE government, teaching 10,000 diabetic Emirati nationals to manage their condition for one year. If it goes ahead, the government will pay Green Crescent for every patient that successfully manages their blood sugar levels.

Green Crescent medical director Saif al-Jaibeji says that recent US studies suggest that effective diabetes management can save $500,000 a patient over a lifetime, and prevent complications such as eye or kidney disease.

Meanwhile, Qatar is looking to hi-tech research. Weill-Cornell Medical College (Qatar) plans to launch a research centre at its Doha campus to look at diabetes causes, treatment and prevention strategies in Qatar and the wider Middle East.

Qatar University and Georgetown University (Qatar) are developing molecular profiling tools to investigate whether descendants of Arabian Bedouin tribes are genetically more vulnerable to type-2 diabetes than other ethnic groups.

Several studies indicate possible genetic links to obesity and thus to diabetes, Harvard’s Danaei says. “People descended from ancestors exposed to cycles of feast and famine may well have inherited genes that evolved to cope with uncertain food supply.

“More research is needed to see whether this is true for Gulf communities, but I would be very reluctant to play up the genetic element. It might give people an excuse not to modify their lifestyles. What matters is that 12 different trials prove that lifestyle choices, including exercise and a high-quality, low-calorie diet can reduce the risk of diabetes by 50 per cent.”

Mixed messages

For their part, consumers are receiving mixed messages. Fast-food chains, supermarkets and soft drinks companies have targeted the Mena markets since the late 1980s. Sales of soft drinks are expected to increase by more than a fifth between 2009 and 2015, to $14.9bn.

“A reduced intake of soda and sweetened beverages in developed countries can lead drinks manufacturers to shift their attention towards the developing world,” Danaei says. “That can only add to problems in developing countries associated with the spread of the calorie-dense Western diet.”

Mixed messages may make it harder for Gulf health drives to succeed. EDS says that “some” UAE schools have replaced vending machines with water coolers. But it shies away from measures that would clash with the fast food, soft drinks and tobacco industries.

“The UAE is a free economy,” says Abdulrazzak Ali al-Madani, chairman of EDS. “It is difficult to restrict fast food or soft drinks firms. We have to take a step-by-step approach.”

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