Diabetes




The diabetes time-bomb
in Saudi Arabia

 

Diabetes is epidemic in several Gulf countries including the Kingdom of Saudi Arabia (KSA), where its prevalence continues to increase dramatically. Callan Emery spoke to Dr Khaled Al Tayeb, an endocrinologist for Saudi Arabia’s Ministry of Health, to find out more about the prevalence and burden of this disease in the Kingdom, and what can be done to alleviate the problem.

■ Callan Emery: At a recent symposium in Dubai, Saudi-based Dr Tawfiq Al Khoja, Director General, Council of Health Ministers, GCC, said that recent studies in KSA put the figure for diabetes prevalence at 29%, considerably higher than WHO’s estimation. Would you say this 29% is an accurate figure?

■ Dr Khaled Al Tayeb: What we know is that the prevalence of diabetes is dramatically increasing, probably by 0.8% annually. One of the studies showed that almost 50% of individuals more than 30 years of age are either diabetic or prone to be diabetic. There’s more and more information being collected in KSA, but considering all the data we have so far, I think the figure given by Dr Khoja is pretty accurate; maybe even an understatement. The main reason for such a dramatic increase in diabetes prevalence in KSA and other Gulf countries is the rapid rise in socio-economic status and adopting an unhealthy lifestyle, which results in increasing the prevalence of obesity and hence diabetes mellitus.

■ CE: So, it would appear KSA is sitting on a time-bomb with regards diabetes and that something urgent needs to be done to alleviate this epidemic. What can or should be done by the MoH to ease this critical problem?

■ KAT: There is much to be done by the MoH to fight diabetes. First, we should develop and apply a national prevention plan to prevent the ongoing increase in diabetes prevalence. The plan should concentrate on raising public awareness about diabetes, identifying the high-risk individuals and helping them to adopt a healthy lifestyle to limit their likelihood of developing diabetes. This should be coupled with applying lifestyle modifications for those individuals at high risk of developing diabetes, to revert them to normal status. Second, we should take proper medical care of diabetic individuals to help them achieve good control of their disease and prevent or delay its acute and chronic complications. The Ministry of Health has already taken bold action in this respect, establishing 20 diabetes centres all over the kingdom to provide educational, medical and support services to all diabetic individuals. These diabetes centres will also focus on training medical staff. This project could be the basis for better diabetes care in KSA.

■ CE: What can the private sector do?

■ KAT: The private sector should partner with the governmental services in promoting better diabetes care in the region by supporting patient and public education, developing proper tools for management, and sponsoring scientific meetings and research. We still need a lot to be done in this area.

■ CE: Do you think the diabetes and lifestyle awareness programmes that some goverments in the region have initiated are having the desired effect?

■ KAT: I think it is too early to speak about any progress in diabetes prevention in the Gulf area and I am not aware of any such report, but hopefully we will start to see the effect of such ongoing programmes in the near future.

■ CE: KSA has looked at banning fast food advertising targeting children. Has this come into effect? And do you think it is making any difference to children’s eating habits?

■ KAT: It will take time until the mass media comply with such regulations. However, the media is open to everybody all over the world, and I think that such local rules – although very much required – will not have a big effect on the attitude and eating habits of our children. We really need international efforts in this field. What is more important right now is that we educate parents and children about healthy food choices and encourage them to do more physical exercise.

■ CE: Over the next five years or so (longer predictions are difficult to make) do you see the diabetes epidemic increasing further? How will this affect Saudi society?

■ KAT: Unfortunately yes. We still expect the diabetes epidemic to rise in the next five years, and what is alarming is the increase in Type 2 diabetes in children. This of course adds more burden to an already significant health problem in KSA. The huge magnitude of the diabetes epidemic will have a drastic effect on the health of the community with more individuals suffering from its chronic complications (e.g. loss of vision, renal failure, lower limb amputations, ischemic heart disease and strokes). The mortality from diabetes will also rise. In addition, the direct and indirect cost of the disease will be a huge burden on the health system.

■ CE: Can the government cope with the financial burden of treating millions of people for diabetes – paying for chronic mediation, amputations and rehabilitation, etc?

■ KAT: Most likely not, and this is why the only way to deal with this problem is to initiate prevention programmes to reduce the prevalence of diabetes and its complications.

■ CE: Many medical insurance companies refuse to pay for chronic conditions. Is there legislation in place in KSA to prevent this?

■ KAT: Yes, the insurance companies have to provide medical services to diabetic individuals in a similar way to the non-diabetic individuals.

■ CE: The Arab world as a whole has been hit hard by diabetes. Is there any research in the region, that you are aware of, that is looking into the possibility of Arabs being more genetically susceptible to diabetes than other groups of people around the world?

■ KAT: First of all, we should know that there is a big difference in diabetes prevalence among the Arab countries. While prevalence is highest in the Gulf countries – which is home to five of the top 10 countries for diabetes prevalence in the world – the figures are much lower in other Arab countries like Tunisia. The main reason for such a big difference in prevalence is the rapid socioeconomic growth that has occurred in the Gulf countries. As far as genetics is concerned, a few studies have been performed in Arab countries like KSA, Tunisia, UAE, Lebanon and Oman. These studies have clearly shown that there are differences in Arab populations in genetics of Type 2 diabetes. However, these studies have been limited and more investigation needs to be done to identify the genetic risk of Type 2 diabetes in different Arab populations.

■ CE: What advice do you have for doctors in the region, with regards the effort to reverse the diabetes epidemic in the region? What can they do?

■ KAT: First of all I would say that we should teach our junior doctors and medical students all about diabetes and its effects on public health. All doctors can help in fighting this disease. Doctors working in primary care everywhere can share in public awareness, in opportunistic screening of high risk individuals, and early and proper management of people with diabetes. In fact, about 80% of patients with diabetes are managed by the primary healthcare centres, so the role of primary healthcare is very important. It is also important to detect the early occurrence of chronic complications of diabetes and refer patients to specialised centres when necessary.


 Date of upload: 26th Jan 2010