Diabetes has reached epidemic proportions in the Middle East and as prevalence continues to increase it will place a heavy burden on regional governments unless urgent action is taken to reverse the trend. Middle East Health reports from two landmark meetings held recently in Dubai that looked at the current situation and strategies to combat the disease.
The number of people aged 20 to 79 years with diabetes in the Eastern Mediterranean and Middle East (EMME) region will nearly double from the 24.5 million this year to 44.5 million in 2025. Moreover, the number of people with impaired glucose tolerance (IGT) or pre-diabetes will increase from 22.4 million to 38.6 million during the same period.
These staggering figures provided by The International Diabetes Federation (IDF) were highlighted by diabetes experts in two symposia in Dubai recently to emphasise the enormous burden that diabetes is set to place on healthcare systems across the region, unless a concerted effort by governments and the private sector is taken to reverse this runaway trend.
The experts from across EMME came together to discuss diabetes at two separate events in Dubai earlier this year. One of these experts was Dr Oussama Khatib, WHO regional advisor for non-communicable diseases. Read Middle East Health’s exclusive interview with Dr Khatib on page 50.
The first of these symposia held in February and sponsored by pharmaceutical company Sanofi Aventis, saw the launch of a campaign entitled “DEVOTED” or “Developing actions for better Outcomes in Diabetes care” and focused on how effective modern treatment strategies and ongoing support can significantly improve the daily life for people with diabetes and diabetes complications.
The following issues were
highlighted at the symposium.
Over the past three decades major social and economic changes have occurred in many of these countries. These include progressive urbanisation, decreasing infant mortality and increasing life expectancy.
Rapid economic development among the more wealthy oil-producing nations has been associated with extraordinary social change resulting in the adoption of an increasingly Western lifestyle which is reflected in changes in diet and nutrition, a move to a more sedentary lifestyle with an increasing prevalence of smoking and obesity. These socioeconomic changes are believed responsible for an explosion of diabetes across the region.
According to recent studies, six countries in the region – United Arab Emirates, Bahrain, Kuwait, Saudi Arabia, Egypt and Oman – are among the world’s 10 highest with regards to diabetes prevalence, and a similar situation applies for IGT prevalence in these countries. As with many other countries with high diabetes prevalence, the onset of type 2 diabetes is becoming increasingly prevalent in adolescents.
Spotlight on children
The second event in Dubai to focus on diabetes was the Arab Children Health Congress (ACHC), held in March. At this event regional and global healthcare leaders, as well as several children with diabetes, came together to discuss the issue and develop a series of key strategy recommendations on tackling the disease in the region.
Congress delegates said the strategic plan would be put to ministries of health in the region with the aim of affecting change in regional health policies. The plan focuses on improvements at the regional, national and school levels.
Recommendations at the regional and national levels focused on adopting rules and regulations aimed at implementing preventative measures and protecting the rights of children with diabetes, while recommendations for the school looked at ways in which to strengthen the capacity of schools and the capabilities of personnel in caring for children with diabetes through a number of clearly defined initiatives.
Her Royal Highness Princess Haya Bint Al Hussein who launched the ACHC in an effort to create a platform for challenged Arab children to discuss health issues and to raise public awareness, said: “I am extremely proud of the outcome of this year’s congress. The shared experiences of children with diabetes coupled with the knowledge and expertise of the healthcare professionals at the Congress have resulted in a clear set of recommendations on how to tackle the diabetes issue effectively. I am convinced that we can now move forward and see some positive results. Our children are our future and I strongly believe that through the initiatives put forward by the Congress, we will be able to ensure a brighter future for all.”
In addition to the recommendations, the panel also elected the new ACHC ambassador representing children with diabetes. Omani national Habiba Malik Al Tawqi, who was diagnosed with diabetes at the age of two, assumes her new role as the 2007 ambassador for the Congress. Habiba has had both her legs amputated and has had kidney transplant as a result of diabetes related complications. Her experiences will allow her to shed light on living with diabetes.
diabetes and treatment options
Type 1 diabetes results from beta-cell destruction, usually leading to absolute insulin deficiency. Consequently, people with type 1 diabetes must inject insulin to survive. Type I diabetes most commonly occurs during childhood.
Type 2 diabetes results from a progressive insulin secretion defect on the back of insulin resistance. During the development of type 2 diabetes, cells gradually lose sensitivity to the effects of insulin – insulin resistance.
The resulting high blood glucose causes the pancreas to secrete more insulin, bringing the blood glucose back under control. The cycle of worsening insulin resistance and increased insulin secretion eventually reaches a point at which the amount of insulin secreted can no longer overcome the insulin resistance, and the hyperglycaemia of type 2 diabetes ensues. In type 2 diabetes, insulin deficiency is relative because insulin is still produced, though not in sufficient quantities.
Type 2 diabetes – also known as adult – onset diabetes – is usually diagnosed after the age of 40, although many of those diagnosed people may have had the disease for several years without realising it. However, the disease is increasingly being diagnosed in children and adolescents, which is largely explained by the increasing prevalence of obesity in this sector of the population.
Diabetes treatments are aimed at lowering high glucose levels in the blood, in order to delay complications.
Insulins are given as a substitute (type 1 diabetes) or a supplement (type 2 diabetes) to natural insulin secretion. Modern insulins closely resemble human insulin but have been modified to target glucose at different times of the day:
- Basal insulins are effective at all times, targeting fasting glucose (the background level of glucose, i.e. during sleep and between meals) as well as post-prandial glucose (the glucose surge that occurs after meals)
- Bolus insulins target post-prandial glucose only
People with type 1 diabetes must inject insulin, usually using a basal-bolus regimen, which consists of mealtimes boluses of rapidacting insulin and longacting basal insulin injection.
An oral inhalation insulin delivery mechanism, which does away with then need for injections, has recently been approved by various medical regulatory authorities and marketed worldwide.
The treatment of type 2
diabetes is in line with the
progressive nature of the
disease. Insulin resistance
and insulin insufficiency
steadily worsen over time and, as a result, the average
blood glucose level rises
unrelentlessly. Type 2
diabetes treatments consist of
diet and exercise measures,
oral antidiabetics, insulin
and combinations thereof.
The average level of blood
glucose (HbA1c) should be
monitored at least every 3
months to ensure that the
current treatment is still
Study shows CVD rises in proportion
A new study shows that as rates of diabetes have risen in the United States, the proportion of cardiovascular disease (CVD) linked to diabetes has also increased.
These findings emphasise the need for increased efforts to prevent diabetes and to aggressively treat and control CVD risk factors among those with diabetes, according to the investigators from the long-standing Framingham Heart Study.
The researchers compared risk factors for CVD and cardiovascular “events” such as heart attacks in Framingham study participants from two different time periods. The first group was examined between 1952 and 1974 and the more recent group was examined between 1975 and 1998.
A total of 9,540 individuals age 45 to 64 were evaluated. The risk attributable to diabetes was 5.2% in the earlier time period, compared to 7.8% in the later period. Most of the increased risk was observed among men. The scientists also reported that the prevalence of diabetes among those with CVD almost doubled between the earlier and later time periods and there was also an increase in the prevalence of obesity.
“Increasing cardiovascular disease burden due to diabetes: The Framingham Study” is published in the 27 March issue of Circulation and can be accessed online here: http://circ.ahajournals.org
Insulin free with stem cell therapy
A therapy that includes stem cell transplantation induced extended insulin independence in patients with type 1 diabetes mellitus, according to a preliminary study in the April 11 issue of JAMA.
Type 1 diabetes mellitus (DM) results from a cellmediated autoimmune attack against pancreatic beta cells. Beta-cell preservation has been shown to be an important target in the management of type 1 DM and in the prevention of its related complications. Researchers in Brazil and the US conducted a study to examine the effect of highdose immunosuppression followed by autologous nonmyeloablative hematopoietic stem cell transplantation (AHST) to preserve beta-cell function in 15 newly diagnosed patients with type 1 DM. AHST, which uses a patient's own blood stem cells, involves the removal and treatment of the stem cells, and their return to the patient by intravenous injection.
During a 7 to 36-month follow-up, 14 patients became insulin-free (one for 35 months, four for at least 21 months, seven for at least six months; and two with late response were insulinfree for one and five months, respectively). Among those, one patient resumed insulin use one year after AHST. The only severe adverse effects were pneumonia in one patient and endocrine dysfunction.
European Society of Cardiology publishes new guidelines
The European Society of Cardiology (ESC) has released their “Guidelines on diabetes, pre-diabetes and cardiovascular diseases”. The 2007 Guidelines were published in the European Heart Journal (doi:10.1093/ euroheartj/ehl261).
The guidelines provide a guide for management and offers recommendations for individual patients with diabetes based on a thorough review of the literature by a team of experts in the field.
The authors point out that it “is high time that diabetologists and cardiologists join forces to improve quality management in diagnosis and care for the millions of patients who have both cardiovascular and metabolic diseases.
The cardio-diabetologic approach not only is of the utmost importance for the sake of those patients, but also instrumental for further progress in the fields of cardiology and diabetology.” It is for this reason that the comprehensive 2007 Guidelines have been developed to incorporate “diabetes and cardiovascular diseases”.
The 2007 Guidelines can be downloaded from www.escardio.org
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