Access to diabetes education seen as key to fighting Arab world’s invisible enemy

In recent years, cases of Type 2 diabetes have skyrocketed in specific regions, including the Middle East and North Africa. (Shutterstock)
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Updated 22 November 2022
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Access to diabetes education seen as key to fighting Arab world’s invisible enemy

  • Poor diet and sedentary lifestyles blamed for rising cases across the world over the past decade
  • Gulf states now rank among the world’s top nations with the highest prevalence of Type 2 diabetes

DUBAI: 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, 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.




“Access to diabetes education” is the theme of World Diabetes Day. (Shutterstock)

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 Centre 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.




Dr. Sara Suliman. (Supplied)

“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.”

FASTFACTS

* 537m Adults living with diabetes in 2021, predicted to rise to 643m by 2030, 783m by 2045.

* 3/4 Proportion of adults with diabetes who live in low- and middle-income countries.

* 6.7m Number of deaths caused by diabetes in 2021 ​​— 1 every 5 seconds.

Source: International Diabetes Federation

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.




“The system still treats patients episodically — a quick 15 minutes with your doctor every quarter — with a strong emphasis on prescription medications,” said Dr. Ihsan Al-Marzooqi. (Supplied)

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.




Historically, diabetes patients had no choice but to prick their finger several times a day to monitor their blood sugar. (Shutterstock)

“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 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.”


UN could meet with Israel PM despite warrant: UN

Updated 22 November 2024
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UN could meet with Israel PM despite warrant: UN

  • UN Secretary General Antonio Guterres and Netanyahu have not spoken since the war started
  • UN spokesman Stephane Dujarric said UN policy on contacts with people facing arrest warrants dates back to a document issued in 2013

UNITED NATIONS: The arrest warrant issued against Israeli Prime Minister Benjamin Netanyahu over the war in Gaza does not bar UN officials from meeting with him in the course of their work, the UN said Thursday.
UN Secretary General Antonio Guterres and Netanyahu have not spoken since the war started as a result of the Hamas attack against Israel on October 7, 2023, although there have been contacts with the Israeli leader by UN officials in the region.
Guterres has been declared persona non grata by Israel, which accuses him of being biased in favor of the Palestinians. So talks between him and Netanyahu are very unlikely.
After the warrants issued Thursday by the International Criminal Court against Netanyahu, former defense minister Yoav Gallant and Hamas’s military chief Mohammed Deif, UN spokesman Stephane Dujarric said UN policy on contacts with people facing arrest warrants dates back to a document issued in 2013.
“The rule is that there should not be any contacts between UN officials and individuals subject to arrest warrants,” Dujarric said.
But limited contacts are allowed “to address fundamental issues, operational issues, and our ability to carry out our mandates,” he added.
In late October, at a summit of the BRICS countries in Russia, Guterres met with President Vladimir Putin, who faces an arrest warrant from the ICP over the war in Ukraine.
That meeting, during which Guterres reiterated his condemnation of the Russian invasion, angered Ukraine.


Palestinians welcome ICC arrest warrants for Israeli PM and former defense minister

Updated 22 November 2024
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Palestinians welcome ICC arrest warrants for Israeli PM and former defense minister

  • Palestinian Authority calls on UN member states to ensure the warrants for Benjamin Netanyahu and Yoav Gallant, who are accused of war crimes, are acted upon
  • The EU’s chief diplomat, Josep Borrel, says decision is ‘binding’ on all members of the International Criminal Court

LONDON: Palestinians welcomed the decision by the International Criminal Court on Thursday to issue arrest warrants for Israel’s Prime Minister Benjamin Netanyahu and his former minister of defense, Yoav Gallant.

The Palestinian Authority said the court’s decision comes as Israeli forces continue to bomb Gaza in a conflict that has killed nearly 45,000 Palestinians since the Oct. 7 attacks by Hamas, and it hopes the ruling will help to restore faith in international law, the official Palestinian WAFA news agency reported.

Netanyahu and Gallant are the first leading officials from a nation allied with the West against whom the ICC has issued arrest warrants since the court was established in July 2002. It also issued an arrest warrant for Mohammed Deif, the head of the military wing of Hamas. Israeli authorities said in August he was killed by their forces in an attack the previous month, though Hamas have not confirmed this.

All three men are accused of war crimes and crimes against humanity over their actions during the war in Gaza or the Oct. 7 attacks.

The PA said the decision to issue warrants against Netanyahu and Gallant was important because Palestinians “are being subjected to genocide and war crimes, represented by starvation as a method of warfare,” as well as mass displacement and collective punishment.

The PA, which signed up to the ICC in 2015, called on all UN member states to ensure the warrants are acted upon and to “cut off contact and meetings with the international wanted men, Netanyahu and Gallant.” Israel is not a member of the ICC.

The EU’s chief diplomat, Josep Borrel, posted a message on social media platform X on Thursday in which he described the court’s decisions as “binding” on all those who have signed up to it.

“These decisions are binding on all states party to the Rome Statute (the treaty that established the ICC), which includes all EU member states,” he wrote.

Netanyahu, Israel’s longest-serving prime minister who has spent 17 years in office during three spells in charge since 1996, denounced the decision by the ICC to issue the warrant as “antisemitic.”

He said it would “have serious consequences for the court and those who will cooperate with it in this matter.”


Between bomb craters: Taxis stuck on war-hit Lebanon-Syria border

Updated 21 November 2024
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Between bomb craters: Taxis stuck on war-hit Lebanon-Syria border

MASNAA, Lebanon: Stuck in no man’s land on the war-hit Lebanon-Syria border, cab driver Fadi Slika now scrapes a living ferrying passengers between two deep craters left by Israeli air strikes.

The journey is just 2 km, but Slika has no other choice — his taxi is his only source of income.

“My car is stuck between craters: I can’t reach Lebanon or return to Syria. Meanwhile, we’re under threat of (Israeli) bombardment,” said the 56-year-old.

“I work and sleep here between the two holes,” he said.

A dual Lebanese-Syrian national, Slika has been living in his car, refusing to abandon it when it broke down until a mechanic brought a new engine.

His taxi is one of the few that has been operating between the two craters since Israeli strikes in October effectively blocked traffic on the Masnaa crossing.

The bombed area has become a boon for drivers of tuk-tuks, who can navigate the craters easily. 

A makeshift stall, the Al-Joura (pit in Arabic) rest house, and a shop are set up nearby.

Slika went for 12 days without work while waiting for his taxi to be fixed. The car has become his home. A warm blanket covers its rear seats against eastern Lebanon’s cold winters, and a big bag of pita bread sits on the passenger side.

Before being stranded, Slika made about $100 for trips from Beirut to Damascus.

Now, an average fare between the craters is just $5.50 each way, though he said he charged more.

On Sept. 23, Israel intensified its aerial bombing of Lebanon and later sent in ground troops, nearly a year after Hezbollah initiated limited exchanges of fire in support of Hamas amid the Gaza war.

Since then, Israel has bombed several land crossings with Syria out of service. 

It accuses Hezbollah of using what are key routes for people fleeing the war in Lebanon to transfer weapons from Syria.

Amid the hardship of the conflict, more than 610,000 people have fled from Lebanon to Syria, mostly Syrians, according to Lebanese authorities.

Undeterred by attacks, travelers still trickle through Masnaa, traversing the two craters that measure about 10 meters deep and 30 meters wide.

On the other side of the road, Khaled Khatib, 46, was fixing his taxi, its tires splattered with mud and hood coated in dust.

“After the first strike, I drove from Syria and parked my car before the crater. When the second strike hit, I got stuck between the two holes,” he said, sweat beading as he looked under the hood.

“We used to drive people from Damascus to Beirut. Now, we take them from one crater to another.”

Khatib doesn’t charge passengers facing tough times, he said, adding he had been displaced from southern Beirut, hammered by Israeli raids since September. He moved back to his hometown near the Masnaa crossing.

Despite harsh times, a sense of camaraderie reigns.

The drivers “became like brothers. We eat together at the small stall every day ... and we help each other fix our cars,” he said.

Mohamed Yassin moved his coffee stall from the Masnaa crossing closer to the pit after the strike, offering breakfast, lunch, and coffee. “We try to help people as much as possible,” he said.

Farther from the Lebanese border, travelers crossed the largest of the two crevasses, wearing plastic coverings on their shoes to avoid slipping in the mud.

A cab driver on a mound called out, “Taxi to Damascus!” while tuk-tuks and trucks ferried passengers, bags, and mattresses across.

Nearby, Aida Awda Mubarak, a Syrian mother of six, haggled with a tuk-tuk driver over the $1 fare.

The 52-year-old said she was out of work and needed to see her son after the east Lebanon town where he lives was hit by Israeli strikes.

“Sometimes we just can’t afford to pay for a tuk-tuk or a cab,” she said.


Netanyahu says ICC warrant won’t stop Israel defending itself

Updated 21 November 2024
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Netanyahu says ICC warrant won’t stop Israel defending itself

  • “No outrageous anti-Israel decision will prevent us — and it will not prevent me — from continuing to defend our country in every way,” Netanyahu said
  • The premier is accused alongside his former defense minister Yoav Gallant of “war crimes” and “crimes against humanity“

JERUSALEM: Prime Minister Benjamin Netanyahu said Thursday that an arrest warrant issued against him by the International Criminal Court over his conduct of the Gaza war would not stop him defending Israel.
“No outrageous anti-Israel decision will prevent us — and it will not prevent me — from continuing to defend our country in every way,” Netanyahu said in a video statement. “We will not yield to pressure,” he vowed.
The premier is accused alongside his former defense minister Yoav Gallant of “war crimes” and “crimes against humanity” for Israel’s actions in Gaza.
He described Thursday’s decision as a “dark day in the history of nations.”
“The International Criminal Court in The Hague, which was established to protect humanity, has today become the enemy of humanity,” he said, adding that the accusations were “utterly baseless.”
Israel has been fighting in Gaza since October 2023, when a cross-border attack by Hamas militants resulted in the deaths of 1,206 people, mostly civilians, according to an AFP tally of Israeli official figures.
Its retaliatory campaign has led to the deaths of 44,056 people in Gaza, most of them civilians, according to figures from the Hamas-run territory’s health ministry which the United Nations considers reliable.
UN agencies have warned of a severe humanitarian crisis in Gaza, including possible famine, due to a lack of food and medicines.
The court said it had found “reasonable grounds” to believe Netanyahu and Gallant bore “criminal responsibility” for the war crime of starvation as a method of warfare, as well as the crimes against humanity of murder, persecution, and other inhumane acts.
Netanyahu said the court was accusing Israel of “fictitious crimes,” while ignoring “the real war crimes, horrific war crimes being committed against us and against many others around the world.”
In addition to Netanyahu and Gallant, the court also issued an arrest warrant for Hamas military wing chief Mohammed Deif, who Israel said was killed in an air strike last July.
Hamas has never confirmed his death.
Netanyahu mocked the court’s decision to issue a warrant for “the body of Mohammed Deif.”


Italy says would have to arrest Netanyahu after ICC warrant

Updated 21 November 2024
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Italy says would have to arrest Netanyahu after ICC warrant

  • Crosetto believed the ICC was “wrong” to put Netanyahu and Gallant on the same level as Hamas
  • It was not a political choice but Italy was bound as a member of the ICC to act on the court’s warrants

ROME: Italian Defense Minister Guido Crosetto said Thursday his country would be obliged to arrest Israeli Prime Minister Benjamin Netanyahu if he visited, after the International Criminal Court issued a warrant.
The ICC earlier also issued arrest warrants for Netanyahu’s former defense minister, Yoav Gallant, as well as Hamas’s military chief Mohammed Deif.
Crosetto — whose country holds the G7 rotating presidency this year — told RAI television’s Porta a Porta program that he believed the ICC was “wrong” to put Netanyahu and Gallant on the same level as Hamas.
But he said that if Netanyahu or Gallant “were to come to Italy, we would have to arrest them.”
It was not a political choice but Italy was bound as a member of the ICC to act on the court’s warrants, Crosetto said.
Foreign Minister Antonio Tajani had earlier been more cautious, saying: “We support the ICC, while always remembering that the court must play a legal role and not a political role.
“We will evaluate together with our allies what to do and how to interpret this decision.”