HMSDC Update

Diabetes in the Arab world:
An emerging silent epidemic

By Youssef MK Farag and Ajay K. Singh
Harvard Medical School Dubai, Center Institute of Postgraduate
Education and Research, Dubai, UAE and Harvard Medical School, Boston, MA, USA.

Diabetes is a global problem with devastating human, social and economic impact. The impact of diabetes is considerable since at least 171 million people worldwide have diabetes. This figure is likely to be more than double by 2030. The case is even worse in the Developing Countries since the number of people with diabetes will increase by 150% in the next 25 years. It is also expected that the global increase in diabetes will continue because of an increasing in the life span of the general population, rising trends towards overweight/obesity, unhealthy diet practices and sedentary lifestyles. In Developed Countries most people with diabetes are above the age of retirement, while in Developing Countries they are between 35 and 64.

The purpose of this article is to combine the information currently available on diabetes in the Arab world and point to the need for more studies. We propose a “call for action” for a greater emphasis on diabetes care in the Arab world.

We define the “Arab World” as all of the Arabic-speaking countries stretching from the Atlantic Ocean in the west to the Arabian Sea in the east, and from the Mediterranean Sea in the north to the Horn of Africa and the Indian Ocean in the southeast. Our list comprises of 23 countries and territories with a combined population of 313.9 million people spanning the two major continents, Africa and Asia with an annual growth rate of 1.9%. Although the Arabic language is the unifying feature of the Arab world, there is substantial diversity in cultures among countries and within countries. We believe that the burden of the diabetes needs to be viewed through the lens of these socioeconomic and cultural factors.

Information on diabetes in Arab countries

In reviewing the available evidence on the epidemiology of diabetes in the Arab world, it is clear that there is limited information. In 2007, four out of the top five countries with diabetes were high income countries from the Arab world. The five countries with the highest diabetes prevalence in the adult population are Nauru (30.7%), United Arab Emirates (19.5%), Saudi Arabia (16.7%), Bahrain (15.2%) and Kuwait (14.4%) (40). Table 1 depicts the estimated prevalence of diabetes in 2000 and the expected number in 2030 in the Arab countries. Most individuals with diabetes in low and middle income countries are middle-aged (45-64), and elderly (>65years). In Jordan, Libya, Morocco and Oman, data shows that the prevalence of diabetes has increased from approximately 3% prior to 1980 to a current prevalence of 5% to 16%, (prevalence exceeding 10% of the adult population) In Jordan, the leading cause of end-stage renal disease (ESRD) was reported to be diabetes (29.2%). In the United Arab Emirates, 23.3% of patients with ESRD had diabetes as the cause. Therefore, collectively, since 30% of individuals with diabetes develop kidney disease, it is likely that diabetic kidney disease is also a significant burden in the Arab world.

Obesity and diabetes

Excess weight is the most important risk factor for the development of type 2 diabetes even in adolescents. Obesity predisposes to type 2 diabetes by increasing peripheral resistance to insulin-mediated glucose uptake. As in adults, the distribution of excess weight in an abdominal obesity pattern (also called central adiposity) increases insulin resistance and the chance of developing type 2 diabetes in children.

The prevalence of obesity has increased over the past 2 decades. Over 300 million adults worldwide are obese. Obesity affects 16% to 50% of persons with diabetes in the Arab world; 20% to 38% have hyperlipidemia; 24% to 46% have hypertension; and, although data are incomplete, the nephropathy and retinopathy rates appear to be quite high. Moreover, in the Arab world one-third of Arabs are obese and women have particularly higher rates of obesity as defined by a body mass index of 30 kg/cm2 and this figure is rising steadily. In Egypt, the overall ageadjusted prevalence of central obesity among is approximately 28% when identified by waist-hip ratio. Females showed a significantly higher prevalence of central obesity than males based on waist-hip ratio (44.9% versus 12.4%). Central obesity peaked in those who are 65 years and older. In 2004, all the Saudi residents in the Eastern province aged 30 years or more were invited to participate in a community screening for early detection of diabetes and hypertension. The overall prevalence of obesity was 43.8%. The prevalence of obesity in Jordan was reported to be 49.7%. Prevalence of obesity in women was double that in men (59.8% versus 32.7% respectively). In Syria, obesity was found to be 38.2% with prevalence in women nearly one and half times more than men. It is clear that the Arab world has high prevalence of diabetes and the most important risk factor for diabetes, which implies that this population has a significant risk in developing diabetes.

Call for action

Diabetes is not yet curable but could be preventable. This is because obesity is an important risk factor for the development of type 2 diabetes mellitus. We believe that an intensive campaign supported by the media, particularly targeted towards adolescents and young adults is important. Resisting the untoward effects of urbanisation – avoiding fast food and cola drinks rich in fructose, and pursuing a nonsedentary life-style should be the focus of such a media campaign. This campaign should be directed at schools and colleges and other settings frequented by young adults. Developing role models in society who highlight healthy living – movie actors and sports personalities should also be emphasised. The ministry’s of higher education and health could play an important role in this endeavour.

We believe that policy makers and clinicians should consider emphasising diabetes as a public health problem so that a significant proportion of resources might be re-allocated to address diabetes and its related issues since the projected increases in diabetes will surpass the ability of health systems and governments. The current allocation for public health programmes is less than 5% of the health budget in most Arab countries.

In conclusion, diabetes mellitus is an emerging epidemic. Diabetes is potentially preventable through efforts targeted at preventing obesity. To address the problem of diabetes requires the attention of a spectrum of governmental and nongovernmental resources. Most importantly, an emphasis on diabetes as a public health problem is essential.

ate of upload: 30th Sep 2009


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