Rise in diabetes strains Middle East health services

From The NY Times:

DUBAI — Rapidly increasing diabetes rates in the Middle East and North Africa are giving rise to concerns about containing the epidemic and the financial burden of health care costs to the region’s governments.

“There is absolutely no doubt that diabetes is one of the major problems our region is dealing with; we have extremely high rates and continuously rising trends,” said Dr. Ala Alwan, the assistant director general for noncommunicable diseases and mental health at the World Health Organization.

“This all leads to low productivity, loss of household income and a rise in health care costs. Now we have clear evidence that such catastrophic expenses can drive families below the poverty line.”

Six countries in the region are among the top 10 globally with the highest prevalence of diabetes. They include the United Arab Emirates, showing the second-highest rate in the world — behind only the tiny Pacific island state of Nauru — followed by Bahrain, Egypt, Kuwait, Oman and Saudi Arabia.

The International Diabetes Foundation estimates that 26.6 million adults in the Middle East and North Africa currently have diabetes, accounting for 9.3 percent of the world’s adults with the disease. The region spends $5.5 billion annually on diabetes, accounting for 14 percent of its total health care expenditure. In Qatar, expenditure is as high as $2,960 per person.

The figures are already worrying, but the foundation predicts worse to come. It says that over the next 20 years the number of people with diabetes in the region will almost double, reaching 51.7 million by 2030.

The disease greatly increases the risk of serious, costly illnesses and conditions, according to a briefing book prepared by the foundation for the region.

In Egypt, for example, 42 percent of people with diabetes experience early-stage eye disease and 5 percent are legally blind, the book shows. The disease also raises the risk of heart attack; in the United Arab Emirates, more than 10 percent of people diagnosed with diabetes have coronary heart disease.

Diabetes is the leading cause of non-traumatic lower-limb amputations, which has afflicted 5 percent of Jordanians with the disease. In Saudi Arabia, 54 percent of people with diabetes show signs of early-stage kidney disease.

The reason for disproportionately high prevalence of diabetes in the Middle East lies mainly in lifestyle choices, according to doctors. Dr. Alwan points to the lack of physical activity, saying that up to half the region’s adults are physically inactive — and as many as 70 percent of women in, for example, Saudi Arabia.

Tobacco also adds to the risk of cardiovascular disease linked to diabetes, he said, with up to 55 percent of men in the region saying they smoke regularly.

Obesity rates in the Middle East and North Africa are among the highest in the world, particularly in the Gulf and, again, lifestyle choices are mainly to blame.

“Diabetes and obesity are global problems, but the concern is the rapidity of increase in this region, and while we can’t change genetics, we can change lifestyle choices,” said Dr. Ghassan Darwiche, head of the Rashid Center for Diabetes and Research at Sheik Khalifa Hospital in Ajman, United Arab Emirates.

“It is actually cheaper to eat fast food than cook healthy food at home here,” Dr. Darwiche added. “ There is an overrepresentation of cheap fast food in the region, and we need to involve fast food companies in this.”

Exercise, healthy eating and proper stress management can all contribute to reducing diabetes risk — something that seems simple enough. The problem lies in the fact that diabetes is not viewed as a serious disease, according to a diabetes awareness survey completed in 10 countries in the Middle East and North Africa in November by Novo Nordisk, a global health care company.

Seventy-four percent of people at risk of developing diabetes have never been told that they are at risk, according to the survey, which was based on interviews with 3,000 respondents in Algeria, Egypt, Iran, Iraq, Jordan, Lebanon, Morocco, Saudi Arabia, Tunisia and the United Arab Emirates.

While 83 percent of respondents agreed that prevalence of diabetes was rapidly increasing, 40 percent of those at risk considered diabetes to be a benign condition that was not always severe and 37 percent had never been screened or had a blood sugar measurement.

Health ministries in the region are working to improve these statistics by providing accessible screening opportunities for people and by training more doctors and nurses. In the Emirates, 75 nurses are currently enrolled in diabetes education programs financed by the government. Screening centers are placed in shopping malls, like the Mega Mall in Sharjah and Lulu Mall in Fujeirah, to encourage more people to check their blood sugar levels.

“We need to engage every corner in this country, from the companies in the private sector to government institutions to shopping malls,” said Dr. Mahmoud Fikri, chairman of the National Diabetes Committee and chief executive for health policies affairs in the United Arab Emirates Ministry of Health. “We need to strengthen community participation and build a partnership for diabetes control.”

The ministry has also established an online registry for diabetes patients and health care providers, in a concerted effort to provide more data to help tackle the problem. With more accurate statistics and better-trained health care providers, the aim is to focus more effort on awareness and education about the risks of diabetes.

“If we continue, there is a bleak inheritance for future generations,” said Dr. Hanif Hassan Ali Al Qassim, the minister of health in the Emirates. “We want the MENA region to have high-performing economies that offer people healthy and productive lives,” he said, using the acronym for the Middle East-North Africa region.

He added that heavy financial burdens were being placed on regional governments and that diabetes-related illnesses currently consumed 13 percent of the Emirate’s health care budget.

Former President Bill Clinton, whose foundation aims to raise diabetes awareness worldwide, was a keynote speaker at a MENA Diabetes Leadership Forum last month in Dubai.

“This whole region is in the midst of a burst of modernization, with so many exciting things going on,” Mr. Clinton said. “But it can all be interrupted if we don’t block this diabetes epidemic.”