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.”


Israel hits Beirut’s southern suburbs for first time in days, Reuters witnesses say

Updated 3 sec ago
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Israel hits Beirut’s southern suburbs for first time in days, Reuters witnesses say

BEIRUT: Israel carried out air strikes early on Friday on Beirut’s southern suburbs, Reuters witnesses said, the first strikes there in nearly a week.

At least 46 Palestinians killed in Israeli strikes, hospital hit, says Gaza ministry

Updated 01 November 2024
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At least 46 Palestinians killed in Israeli strikes, hospital hit, says Gaza ministry

  • Strike on hospital torches medical supplies, officials say
  • Israel says militants were hiding in hospital

CAIRO: At least 46 Palestinians were killed in Israeli military strikes across the Gaza Strip on Thursday, mostly in the north where one attack hit a hospital, torching medical supplies and disrupting operations, the enclave’s health officials said.
Israel’s military has accused the Palestinian militant group Hamas of using Kamal Adwan Hospital in Beit Lahiya for military purposes and said “dozens of terrorists” have been hiding there. Health officials and Hamas deny the charge.
Later on Thursday, an Israeli airstrike on two houses in the Nuseirat camp in central Gaza killed at least 16 Palestinians, medics at Al-Awda Hospital in the camp told Reuters. The dead included a paramedic and two local journalists, they added.
Northern Gaza, where Israel said in January it had dismantled Hamas’ command structure, is currently the main focus of the military’s assault in the enclave. Earlier this month it sent tanks into Jabalia, Beit Hanoun and Beit Lahiya to flush out militants it said had regrouped.
Eid Sabbah, director of nursing at Kamal Adwan — which is in Beit Lahiya — told Reuters some staff suffered minor burns after the Israeli strike hit the third floor of the hospital.
There were no reports of any casualties at the hospital, which Israeli forces stormed and briefly occupied last week. Israel said it had captured around 100 suspected Hamas militants in that raid. Israeli tanks are still stationed nearby.
The health ministry in the Hamas-run Gaza Strip called for all international bodies “to protect hospitals and medical staff from the brutality of the (Israeli) occupation.”
The Israeli military has said its forces are operating in the hospital area based on intelligence about the presence of terrorists and terror infrastructure in the vicinity.
“During the operation, it was found that dozens of terrorists were hiding in the hospital, with some even posing as hospital staff,” said the military in a statement following Thursday’s strike.
Medical charity Médecins Sans Frontières (MSF) said on Thursday that one of its doctors at the hospital, Mohammed Obeid, had been detained last Saturday by Israeli forces. It called for the protection of him and all medical staff who “are facing horrific violence as they try to provide care.”
The Gaza war began after Hamas-led militants attacked Israel on Oct. 7, 2023, killing some 1,200 people and taking 251 hostages back to Gaza, according to Israeli tallies.
Israel’s subsequent assault on Gaza has killed more than 43,000 Palestinians and reduced most of the enclave to rubble, Palestinian authorities say.


Iraq tries to avoid regional fight as militias fire at Israel

Updated 01 November 2024
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Iraq tries to avoid regional fight as militias fire at Israel

  • Kataib Hezbollah, the most powerful of the armed factions, said Israel and the US would have to pay a price for Israel’s strikes on Iran last week

BAGHDAD: Nervously watching Israel’s destructive campaigns in Gaza and Lebanon, Iraq is working to avoid being drawn into the growing regional conflict as Iran-backed armed groups launch attacks on Israel from Iraqi soil, sources familiar with the matter say.
Two decades after the US-led invasion that toppled Saddam Hussein, Iraq is experiencing relative stability with high revenue from oil sales funding a service-based agenda that has turned much of the country into a construction site.
Iraq does not have diplomatic relations with Israel and Prime Minister Mohammed Shia Al-Sudani’s government is wary of regional conflicts that could affect its delicate balancing act between Washington and Tehran, both states it is allied with.
Spillover from regional conflict resulted in months of tit-for-tat attacks between Iran-backed armed groups and US forces stationed in Iraq and the region that only subsided after Iran intervened in February.
But Sudani’s government has not been successful in a push to convince the Islamic Resistance in Iraq — a coalition of Iran-backed armed groups — to stop firing rockets and drones at Israel, according to four sources in Iran-backed armed groups and two government advisers.
Two visits to Iran by Iraq’s top security officials in the past two months, seeking Tehran’s help to rein in its allied Iraqi factions, failed, the sources said.
“The Iraqi delegation received a cold reception in Tehran ... The answer was: those groups have their own decision and it is their call to decide how to support their brothers in Lebanon and Gaza,” said a senior Iraqi security official briefed on the visits.
Baghdad turned to Washington, asking US officials to intervene with Israel to prevent retaliation for the attacks, including one that killed two Israeli soldiers and wounded more than 20 on Oct. 4, the sources said, the first time such an attack has been reported to cause fatalities.
“Washington was understanding of the repercussions of possible Israeli strikes in Iraq and pledged to help,” said an Iraqi foreign ministry official.
A spokesperson for the US embassy in Baghdad did not immediately respond to a request for comment.
Four militia sources said the Kataib Hezbollah and Nujaba groups, which are leading the attacks on Israel, have warned the prime minister against pressuring them to halt their actions and vowed to continue their attacks as long as Israel continued its Gaza and Lebanon operations.
The issue has divided parties in Iraq’s ruling coalition, all of whom are sympathetic to the Palestinian cause and view Israel as an enemy, though some differ over how involved Iraq should be in the regional confrontation.
Shiite leaders discussed the risk of repercussions from attacks on Israel and possible Israeli retaliation during two meetings in October, said Ahmed Kenani, a Shiite lawmaker from the ruling alliance.
Key players in the Shiite coalition view direct confrontation with Israel as counterproductive and potentially damaging to Iraq, according to four Shiite lawmakers.
“Those groups who have the rockets and drones should go to Gaza and Lebanon to fight Israel rather than pushing Iraq toward destruction,” said Iraqi PM adviser Abul Ameer Thuaiban.
Kataib Hezbollah, the most powerful of the armed factions, said Israel and the US would have to pay a price for Israel’s strikes on Iran last week.
Senior Iraqi security sources told Reuters ahead of that attack that any strike by Israel against Iran outside what the sources called the established rules of engagement could prompt pro-Iran armed groups to significantly expand their attacks on Israel and US assets in the region.


Blinken says ‘good progress’ made toward Lebanon ceasefire deal

Updated 31 October 2024
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Blinken says ‘good progress’ made toward Lebanon ceasefire deal

  • Said that Washington “working very hard” on concluding arrangements on a deal
  • US has stopped short of calling for an immediate ceasefire in Lebanon

WASHINGTON DC: US Secretary of State Antony Blinken said Thursday that negotiators have made “good progress” toward a deal that would bring a ceasefire in Israel’s offensive in Lebanon.
The top US diplomat said that Washington was “working very hard” on concluding arrangements on a deal that would include the withdrawal of Hezbollah from the border region with Israel.
“Based on my recent trip to the region, and the work that’s ongoing right now, we have made good progress on those understandings,” Blinken told reporters.
“We still have more work to do,” he said, calling for a “diplomatic resolution, including through a ceasefire.”
Two senior US officials, Amos Hochstein and Brett McGurk, met Thursday with Israeli Prime Minister Benjamin Netanyahu, who said that any deal on Lebanon must guarantee Israel’s security.
Unlike in the year-old war in Gaza, the US has stopped short of calling for an immediate ceasefire in Lebanon and has largely backed Israeli strikes against Hezbollah, while voicing concern for the fate of civilians.
Blinken called again for implementation of UN Security Council Resolution 1701, dating from 2006, which calls for the disarmament of non-state groups in Lebanon and a full Israeli withdrawal from the country.
“It’s important to make sure that we have clarity, both from Lebanon and from Israel, about what would be required under 1701 to get its effective implementation — the withdrawal of Hezbollah forces from the border, the deployment of the Lebanese Armed Forces, the authorities under which they’d be acting, an appropriate enforcement mechanism,” Blinken said.
Defense Secretary Lloyd Austin, speaking alongside Blinken and their South Korean counterparts, said there was an “opportunity” in Lebanon.
“We’re hopeful that we will see things transition in Lebanon in a not too distant future,” Austin said.


Israel says another rocket barrage from Lebanon kills 2 in Israel, hours after 5 were killed

Updated 31 October 2024
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Israel says another rocket barrage from Lebanon kills 2 in Israel, hours after 5 were killed

  • The attack came as senior US diplomats were in the region to push for ceasefires in Lebanon and Gaza

TEL AVIV: Israel’s rescue service said projectiles fired from Lebanon on Thursday killed two more people in northern Israel, raising death toll there to seven in what’s been the deadliest rocket barrage since the Israeli military’s invasion of southern Lebanon.
Magen David Adom, Israel’s main emergency medical organization, said its medics confirmed the deaths of a 30-year-old man and 60-year-old woman in a suburb of the northern city of Haifa. They also treated two other people who suffered mild injuries and were hospitalized.
The Israeli military said that roughly 25 rockets crossed into Israel from Lebanon as part of the volley that struck an olive grove where people had gathered for the harvest.
The deadly attack came just hours after officials in Metula, in northern Israel, said that five people were killed, including four foreign workers, in a rocket barrage Thursday that struck an Israeli agricultural area.
The back-to-back attacks made Thursday one of the deadliest days for civilians in Israel since the Israeli military invaded southern Lebanon on Oct. 1 as part of a widening campaign against the Lebanon-based Hezbollah militant group.
The attack came as senior US diplomats were in the region to push for ceasefires in Lebanon and Gaza, hoping to wind down the wars in the Middle East in the Biden administration’s final months.
The Hezbollah militant group has been firing rockets, drones and missiles into Israel, and drawing retaliatory strikes, since Hamas’ Oct. 7, 2023 attack out of the Gaza Strip triggered the war there. Hezbollah and Hamas are allies backed by Iran.
The conflict along the border escalated into a full-blown war last month, when Israel launched a wave of heavy airstrikes across Lebanon and killed Hezbollah’s top leader, Hassan Nasrallah, and most of his deputies. Israeli ground forces pushed into Lebanon at the start of October.
The Metula regional council reported Thursday’s attack, without detailing the number or type of projectiles used. The nationalities of the workers were also not immediately known.
Metula, Israel’s northernmost town which is surrounded by Lebanon on three sides, has suffered heavy damage from rockets. The town’s residents evacuated in October 2023, and only security officials and agricultural workers remain.
The Hotline for Refugees and Migrants, an organization that advocates for foreign workers, said authorities had put them in danger by allowing them to work along the border without proper protection.
Agricultural areas along Israel’s border, where much of the country’s orchards are located, are closed military areas that can only be entered with official permission.
Hezbollah’s newly named top leader, Sheikh Naim Kassem, said in a video statement Wednesday that the militant group will keep fighting Israel until it is offered ceasefire terms it deems acceptable. He said it has recovered from a series of setbacks in recent months, including attacks using explosive pagers and walkie-talkies that was widely blamed on Israel.
“Hezbollah’s capabilities are still available and compatible with a long war,” he said.
Earlier on Thursday, the Israeli military warned people to evacuate from more areas of southern Lebanon, as airstrikes in different parts of the country killed eight people, according to Lebanon’s state-run National News Agency.
Israel has warned people to evacuate from large areas of the country, including major cities in the south and east. Some 1.2 million people have been displaced since the escalation in September.
Thousands of people have fled from Baalbek, the main city in Lebanon’s eastern Bekaa Valley, and surrounding areas after Israeli evacuation warnings and aerial bombardment on Wednesday.
Jean Fakhry, a local official in the Deir Al-Ahmar region, some 17 kilometers (10 miles) to the southeast, said the main highway “turned into a parking lot.” He said around 12,000 displaced people are staying in the area, with most being hosted in private homes.
At one of the shelters, families with luggage were still arriving on Thursday.
“Our homes were destroyed,” said Zahraa Younis, from the village near Baalbek. “We came with nothing — no clothes or anything else — and took shelter here.”
More than 2,800 people have been killed and nearly 13,000 wounded in Lebanon since the conflict began last year, according to the Lebanese Health Ministry.
In Israel, rockets, missiles, and drones launched by Hezbollah have killed at least 68 people, about half of them soldiers. More than 60,000 Israelis from towns and cities along the border have been evacuated from their homes for more than a year.