Lifestyle Diseases

The HbA1c test: How early diagnosis can help stem the rising prevalence of diabetes across the Middle East


When you consider the most recent figures for diabetes prevalence in the Middle East, the importance of identifying those people at risk of developing the disease appears self evident. The International Diabetes Federation reported in 2011 that 9.1% of the Middle East’s adult population had diabetes – some 32.8 million people. More staggering still, this figure is expected to almost double to nearly 60 million by 2030. The mortality figures related to the disease also do not make for encouraging reading: a little over 10% of all deaths in adults in the Middle East are attributable to diabetes. It really goes without saying that these are big, big numbers.

The region contributes six of the world’s top ten countries for diabetes prevalence in adults aged between 20 and 79. Kuwait, Lebanon, Qatar, Saudi Arabia, Bahrain and the United Arab Emirates (UAE) all feature on this roll-call; all of them recording a percentage diabetes prevalence of over 19% of their total adult population. The global prevalence of diabetes and impaired glucose tolerance (IGT), itself a hugely concerning figure, was recorded at 8.3% in 2011.

What has caused this situation can be attributed to a range of factors – from the growing population and rising age demographics, through to the potential impact that the increased affluence of the region’s citizens has on their nutrition and physical activity levels. Simply put, diabetes prevalence – in common with other lifestyle diseases – has increased as life expectancy rises and economic development contributes to changes such as less physical activity, unhealthy nutrition and consequent rising levels of obesity.

At the same time, healthcare expenditure on diabetes throughout the region was expected to be around US$10.9 billion in 2011, only 2.3% of the total global figure for spending on the disease. Whilst this figure is expected to double over the next two decades, the level of spending is still, proportionally, relatively low.

Taken together, the situation requires even more focus to ensure that it does not continue to grow or even spiral out of control. It is therefore essential that the healthcare industry look seriously at every possible diagnosis technique to ensure that diabetes is caught as early as possible.


The measurement of hemoglobin A1c (HbA1c) blood levels is a widely accepted technique for monitoring long-term glucose control in diabetic individuals. Previous studies have shown that improving HbA1c control can greatly reduce the risk of further complications from diabetes – such as kidney disease, eye damage or amputations. The risk of such complications can be reduced by as much as 35% with as little as a 1% reduction in a person’s HbA1c levels. As a direct result, the American Diabetes Association has recommended that anyone with diabetes should have their HbA1c levels tested at least once every six months and every three months if their HbA1c levels are not meeting treatment goals.

The medical community has, more recently, recognized the clinical value of the HbA1c test in the diagnosis of diabetes – with several major associations such as the American Diabetes Association, the International Diabetes Federation and the European Association for the Study of Diabetes accepting the tests value in diagnosis at an International Expert Committee in 2009. The conclusion was based on several advantages when compared with the traditional method of measuring blood glucose levels – not least the convenience of the test, which was cited as a significant benefit since it can be conducted at any time and requires no preparation by the patient. It compares very favorably with fasting plasma glucose measurements where fasting must occur at least eight hours prior to testing. The HbA1c test also requires just a single test measurement of blood, as compared to blood glucose testing that requires that the patient undergo serial blood draws over a number of hours.

The relative ease with which the test can be performed is also an important attribute because it offers the potential for larger-scale public screening of the disease. Type 2 diabetes presents relatively few symptoms during the first few years, and those that do appear may not be readily identified as being diabetes. For example, symptoms such as increased thirst and frequent urination, increased hunger, weight loss, fatigue or blurred vision, are potential diabetic symptoms that are also readily identified with other conditions. Subsequently, many studies into the incidence of diabetes have frequently found that a significant proportion of those diagnosed had not previously known they had the condition. As such, anything that can speed up and simplify the process of diagnosis has an evident utility in increasing the number of people undergoing testing for diabetes.

Another crucial recent development has been the acceptance of the HbA1c test as a measure of identifying those patients that are at risk of developing diabetes. The 2012 edition of the ‘Standards of Medical Care in Diabetes’ report from the American Diabetes Association stated that HbA1c values of between 5.7% and 6.4% could signify a prediabetic state in an individual. Such a finding, made early enough, allows a doctor time to discuss the necessary lifestyle changes and disease management options with the patient, and presents a real opportunity for patients to ‘pull back from the brink’ of developing diabetes. Catching the disease at such an early point therefore presents the prospect of halting the number of mounting cases before they even begin.

Looking ahead

The region is facing a real challenge to combat the rising pervasiveness of diabetes around the Middle East, and it is therefore imperative that companies and suppliers such as Siemens continue to innovate to ensure the tools are there to meet this crisis. The use of the HbA1c test for the diagnosis of diabetes, as well as for identifying those at risk of developing the disease, is now a proven part of this tool kit and offers some real and crucial advantages over other established methods.

Data show Sanofi’s Lyxumia added to basal insulin lowers blood sugar especially when Fasting Plasma Glucose is controlled

Sanofi announced in September that new GetGoal-L sub-analysis results showing that reductions in HbA1c with Lyxumia (lixisenatide), when added to basal insulin, were greatest in patients with type 2 diabetes who had well-controlled baseline fasting plasma glucose (FPG). Sanofi says these findings are consistent with the efficacy profile of Lyxumia, which shows a clinical and statistically significant reduction in HbA1c across different patient populations.

The results also showed that reductions in body weight with Lyxumia, when added to basal insulin, were greatest in this group. The GetGoal-L sub-analysis was shared during an oral presentation at the 49th Annual Meeting of the European Association for the Study of Diabetes, in Barcelona, Spain. Professor Josep Vidal, Endocrinology and Nutrition, University of Barcelona, said: “The study showed that Lyxumia is an effective post-prandial glucose lowering option that improves HbA1c levels when added to basal insulin.

We analyzed data from patients who were not at their target HbA1c level, despite controlled fasting plasma glucose, and we found that a treatment regimen that targets postprandial glucose, as well as fasting plasma glucose, could be an effective choice for these patients.” Sanofi explains that as type 2 diabetes progresses over time, patients treated with basal insulin may no longer maintain their target HbA1c level (average blood sugar levels over the past 2 to 3 months), despite typically sustaining good control of FPG with basal insulin.

For these patients, Lyxumia can significantly reduce HbA1c by primarily reducing post-prandial glucose levels through its complementary action with basal insulin. Targeting both FPG and post-prandial glucose could be an effective way to lower HbA1c in certain patients with type 2 diabetes.

Lyxumia (lixisenatide)

 Lyxumia (lixisenatide) is a glucagonlike peptide-1 receptor agonist (GLP- 1 RA) for the treatment of patients with type 2 diabetes mellitus. GLP-1 is a naturally-occurring peptide hormone that is released within minutes after eating a meal. It is known to suppress glucagon secretion from pancreatic alpha cells and stimulate glucose-dependent insulin secretion by pancreatic beta cells.
Lyxumia is currently approved in in Europe for the treatment of adults with type 2 diabetes mellitus to achieve glycemic control in combination with oral glucose-lowering medicinal products and/or basal insulin when these, together with diet and exercise, do not provide adequate glycemic control. Lyxumia is also approved in Mexico, Australia, Japan and Brazil for the treatment of adults with type 2 diabetes.


Heart disease in the UAE

Many of the career-oriented young executives, who live by the clock, do not understand the impact of their lifestyle and busy schedule on their health and life in total. According to World Health Organization’s figures, every 2 seconds one person dies of cardiovascular disease. Heart disease is on the prowl in the Gulf, claiming more and more victims, both male and female, in the prime of their lives and career. A good number of persons do not have any symptoms or signs of any illness and often claim to be healthy, until they have an attack. Heart disease accounts for 25% of all the deaths in the UAE and remains the leading cause of death. Moreover, it is alarming to note that more and more young people, in their thirties and forties, are the victims of this deadly disease. It is also worrying to note that 25% of the persons suffering from a heart attack die within an hour and half, even before the victim reaches the hospital. It is also of great concern that more Indians are affected by heart disease than any other ethnic group. The youngest patient I looked after in the UAE following a heart attack is a 21-year-old Indian. What is to be blamed for the ever-increasing number of deaths due to heart disease? It is the influence of affluence? The rapid socio-economic changes – changes in lifestyle, unhealthy eating and insufficient physical activity, coupled with stress associated with this modern working environment – all have contributed to this.

Who is at risk?

Heart attacks strike both men and women, but often more men than women in the younger age group. However, some people are more likely than others to have a heart attack because of the “risk factors” they may have. While some of these risk factors like being male, increasing age, family history of heart attack are not modifiable, all other risk factors including smoking, high blood pressure, high cholesterol, diabetes, overweight, diabetes, lack of exercise and stress can be modified. Risk factors do not add their effects in a simple way, but they multiply each other’s effects several fold. So it is very important to prevent or control risk factors that can be modified.

How can we prevent heart disease?

There is enough scientific evidence that the chances of suffering heart attack can be prevented or reduced by identifying the risk factors and modifying them. l Aim for a healthy weight l Quit smoking l Know your blood pressure l Reduce high blood cholesterol l Manage diabetes l Manage stress l Be physically active each day

Prevention is better than cure

In the modern era of changing lifestyle, eating habits and stressful environment taking care of these factors can prevent unexpected loss of life. As the old adage goes: “A stitch in time saves nine”.


Bellagio Declaration – scientists call for efforts to protect healthy food policies

Public health and nutrition scientists are calling for greater efforts to protect healthy food policies from being undermined by the lobbying forces of multi-national food corporations, or Big Food and Big Soda as they have been called. A meeting on the progress of obesity prevention efforts in low and middle income countries in Bellagio, Italy in June, has released its Bellagio Declaration at the International Congress on Nutrition in Granada, Spain on September 18, 2013. The Declaration calls on governments and other organisations to take specific actions to counteract the influence of Big Food which has successfully blocked healthy food policies in many countries.

“The stories which came out from many presentations from developing countries which are battling the obesity epidemic followed a common pattern,” said the meeting convener, Professor Barry Popkin from the University of North Carolina. “Governments see the rising tsunami of obesity flooding over their countries, but as soon as they put up serious policies to create healthier food environments they get hammered by the food industry.” The policies which predictably provoke this response are regulations to reduce the marketing of unhealthy foods to children, front-of-pack labelling systems to help consumers readily assess the healthiness of the food, and taxes on unhealthy foods like sugar-sweetened beverages, according to Prof Carlos Monteiro, University of Sao Paulo, a co-convener and one of Brazil’s leading public nutrition researchers. The country experiences, published in a series of papers in September in Obesity Reviews, show that the obesity epidemic is rising very fast in many developing countries, rapidly catching up or overtaking undernutrition as the dominant nutrition problem. This is creating a double burden of co-existent overnutrition and undernutrition within many populations or even within households. The Director General of the World Health Organisation, Dr Margaret Chan, has recently called the lobby forces of Big Food and Big Soda one of the biggest challenge that countries face as they try to reduce obesity and diet-related chronic diseases. She outlined some of the tactics the food industry have been using such as front groups and lobby groups, promises of self-regulation, lawsuits, and industry-funded research. The Bellagio Declaration calls on WHO to develop norms for government engagement with the private sector so that partnerships are not detrimental to nutrition goals. “We have written to Dr Chan to strongly support WHO in its work with governments and non-government organisations to increase the transparency and accountability systems within food policy development,” said Professor Boyd Swinburn from the University of Auckland and Co- Chair of the International Obesity Task Force, “The first priority for food policies is to improve nutritional outcomes for the population, not the bottom lines of multinational corporations.” The Bellagio meeting was held under the auspices of the International Obesity Taskforce and the International Union of Nutritional Sciences, led by its immediate Past President, Professor Ricardo Uauy, University of Chile, and was funded by the Rockefeller Foundation.

Bellagio Declaration

Papers from the Bellagio Meeting on Program and Policy Options for Preventing Obesity in the Low- and Middle-Income Countries published online by Obesity Reviews and available at:

 Date of upload: 20th Nov 2013


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