Access to diabetes education seen as key to fighting Arab world’s invisible enemy

Special Access to diabetes education seen as key to fighting Arab world’s invisible enemy
In recent years, cases of Type 2 diabetes have skyrocketed in specific regions, including the Middle East and North Africa. (Shutterstock)
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Updated 22 November 2022

Access to diabetes education seen as key to fighting Arab world’s invisible enemy

Access to diabetes education seen as key to fighting Arab world’s invisible enemy
  • Poor diet and sedentary lifestyles blamed for rising cases across the world over the past decade
  • Gulf states now rank among the world’s top nations with the highest prevalence of Type 2 diabetes

DUBAI: Controlling the sweet tooth is not the only lifestyle choice that will determine whether or not an individual will develop diabetes in the course of their lifetime. The chronic disease, which has seen an alarming rise in cases across the world over the past decade, has been linked to sedentary lifestyles, unhealthy diets and obesity.

Inadequate knowledge about the prevention and management of the condition in many countries led the International Diabetes Federation to make “access to diabetes education” the theme of World Diabetes Day for the third consecutive year.

Every year, campaigns are launched around the world on Nov. 14 to help raise awareness about the disease, which, as of 2021, affected 537 million adults between the ages of 20 and 79 worldwide.




“Access to diabetes education” is the theme of World Diabetes Day. (Shutterstock)

In recent years, cases of Type 2 diabetes have skyrocketed in specific regions, including the Middle East and North Africa — particularly in the Gulf Cooperation Council area. Countries such as Kuwait, Saudi Arabia and Bahrain now rank among the top 10 nations with the highest prevalence of Type 2 diabetes.

In the UAE, as many as one in five people have diabetes, with Type 2 being the most common form, according to Cleveland Clinic Abu Dhabi. This number is expected to double by 2040.

In response to this seemingly inexorable increase in cases, health experts are examining everything from lifestyle trends to technological advancements and healthcare systems to determine what can be done to slow the spread and identify how much is down to genetics.

According to Dr. Sara Suliman, consultant endocrinologist and diabetologist at the Imperial College London Diabetes Centre in Abu Dhabi, variables such as urbanization, changing climate, mobility and food availability influence rates of diabetes in different areas.

“The GCC, being one of the richer areas in the world, has seen far more use of cars, far more easy access to food, including high-calorie food, and is one of the leading areas in the world as far as an increase in diabetes cases is concerned,” she told Arab News.

The situation is just as worrying in other countries of the Middle East and North Africa. Data from 2021 shows that 73 million adults (aged 20-79) across the MENA region are living with diabetes — a figure that is estimated to grow to 95 million by 2030 and 136 million by 2045.

“Until very recently, we were hanging a lot of things on genes. We do know if one parent has diabetes (Type 2), then there is a 40 percent chance of an individual getting diabetes, and that if two parents have diabetes, then there is an 80 percent chance of the individual becoming affected,” said Suliman.

In fact, not only is Type 2 diabetes preventable, it can also be reversed through a complete change in lifestyle. Unfortunately, this is not the case for Type 1.

With genetics accounting for only 5-10 percent of cases, Type 1 diabetes is thought to be caused by an autoimmune reaction, which leads the body to attack itself, destroying the cells in the pancreas responsible for producing insulin.




Dr. Sara Suliman. (Supplied)

“For Type 1 diabetes, the treatment is insulin and will always be insulin. But with Type 2, we have different options,” said Suliman.

It is no secret that excessive consumption of fizzy drinks, energy shots, sweetened juices and processed junk foods tops the list of diets that result in high blood sugar levels (or blood glucose levels).

An unhealthy diet coupled with a lack of regular exercise, fewer than seven hours of sleep per night and poor hydration significantly increases the risk of obesity as well as type 2 diabetes, said Suliman.

“Obesity is another major problem in the Gulf countries,” she said. “For example, 50 percent of children in Kuwait are at the moment either overweight or obese.”

FASTFACTS

* 537m Adults living with diabetes in 2021, predicted to rise to 643m by 2030, 783m by 2045.

* 3/4 Proportion of adults with diabetes who live in low- and middle-income countries.

* 6.7m Number of deaths caused by diabetes in 2021 ​​— 1 every 5 seconds.

Source: International Diabetes Federation

Studies predict that at least 10 countries in the MENA region will have more than a million children suffering from obesity by 2030.

Looking at the problem through a different lens, Dr. Ihsan Al-Marzooqi, co-founder and managing director of Glucare Health, says although bad habits significantly impact rates of diabetes, there is another side to the story.

“While it is easy to blame patients for their lifestyle choices, the reason we see this growth is because, over the past 40 years, healthcare providers have not changed their model of care to tackle the root cause of the disease,” he told Arab News.

“Despite all the advances we have seen in healthcare, the system still treats patients episodically — a quick 15 minutes with your doctor every quarter — with a strong emphasis on prescription medications.”

Describing diabetes as “fundamentally a behavioral problem,” Al-Marzooqi highlighted the need for healthcare providers to focus on innovating care models that provide a more consistent follow-up approach that emphasizes changes in behavior.




“The system still treats patients episodically — a quick 15 minutes with your doctor every quarter — with a strong emphasis on prescription medications,” said Dr. Ihsan Al-Marzooqi. (Supplied)

To achieve this, providers need to consistently record new sets of personal data for each patient, a practice Al-Marzooqi says has not yet evolved in MENA countries.

Critiquing current care models, he says patients have little knowledge about the effect of their actions on their health, adding that this has resulted in a large number of poorly controlled diabetics in the GCC.

“We believe that most patients simply do not have agency over their own health, as in they cannot contextualize the extent of how their lifestyle choices can ultimately affect their diabetes outcome,” he said.

At the same time, “providers will always advise their patients on lifestyle modification, but none will actually track the advice they give.”

According to Al-Marzooqi, the outcome is evident in the data collected, which indicates that almost 75 percent of managed diabetics in the GCC with access to care are classified as “poorly controlled.”

Highlighting predictions of a regionwide “tsunami” of healthcare bills as a result of the situation, he says diabetes need not be a costly disease to manage.




Historically, diabetes patients had no choice but to prick their finger several times a day to monitor their blood sugar. (Shutterstock)

“The complications from poorly controlled diabetes are what lead to almost a quarter of healthcare budgets being spent on diabetes,” he said.

To end this cycle, Al-Marzooqi says governments should incentivize healthcare providers by rewarding them for clinical outcomes as opposed to the current fee-for-service models.

If a value-based reimbursement model is put into practice, he argues, providers who innovate and invest in new modalities, such as digital therapeutics, will end up with a better engaged and better managed population. This, in turn, could reduce future complications, thereby reducing the overall cost.

On the upside, Gulf governments have been making efforts to raise awareness about the disease. Early education and training on managing the condition and promoting healthy lifestyles are now widespread at schools and universities in the region, says Suliman.

Some governments have got municipalities to set up public walkways and running tracks and outdoor gyms and ministries to launch nationwide fitness campaigns to encourage people to get active.

Another example of state intervention is the sugar tax in the UAE, announced in 2019, which applies a 50 percent tax on all sugar-sweetened beverages.

From a technological standpoint, treating diabetes has also come a long way, says Suliman. Historically, diabetes patients had no choice but to prick their finger several times a day to monitor their blood sugar and self-inject insulin when needed.

“We are now spoiled for choice,” she said. Significant progress has been made in the development of glucose sensors and insulin pumps. These devices allow patients to keep track of their sugar levels with live updates on their mobile phones.

Additionally, patients who are in need of insulin on a daily basis have the choice of installing a sensor and pump device that can take care of tracking and applying the right dosage needed to avoid the traditional method of injection.

“There are signs that we can at least flatten the curve,” said Suliman, who believes the younger generation is more conscious of better lifestyle choices.

“The problem is, the rise in diabetes cases has been so steep as to be scary, and if the pessimistic forecasts come true, it would be even scarier.”

She added: “We all have to move in the same direction.”


Family home of ‘heroine’ Iranian climber demolished amid hijab row

Family home of ‘heroine’ Iranian climber demolished amid hijab row
Updated 04 December 2022

Family home of ‘heroine’ Iranian climber demolished amid hijab row

Family home of ‘heroine’ Iranian climber demolished amid hijab row
  • Elnaz Rekabi’s house lacked permit, says state news agency
  • Athlete was ‘forced to apologize’ after contest abroad

LONDON: The home of the Iranian climber who competed abroad without wearing a headscarf has been demolished, according to reports.

Elnaz Rekabi flouted Iran’s mandatory dress code during a competition in South Korea, but claimed it had fallen off inadvertently.

She had been forced to apologize, according to the BBC.

Protesters across Iran have hailed Rekabi, who had been whisked back from South Korea and was met by dozens of cheering supporters at the airport.

Widespread protests have rocked Iran for months following the death of 22-year-old Kurd Mahsa Amini, who died on Sept. 16 after her arrest in Tehran for an alleged breach of the dress code.

A video purportedly showing the ruins of the Rekabi family house with sports medals on the ground started circulating this week and Davood, Rekabi’s brother, is seen crying in the clip.

Tasnim news agency confirmed that the house had been demolished, but said it was due to Rekabi’s family not having a valid permit for its construction, and that it had taken place before she had competed abroad.

It is not clear when the viral footage was shot.

In October, the US criticized the Iran regime’s treatment of Rekabi and warned that the “world was watching.”

State Department spokesman Vedant Patel told reporters: “The Iranian regime and its leaders have a long history of abusing the rights of women and violating their freedom of expression, including through threats, through intimidation and violence.”


Yemen foreign minister meets Italian counterpart

Yemen foreign minister meets Italian counterpart
Updated 04 December 2022

Yemen foreign minister meets Italian counterpart

Yemen foreign minister meets Italian counterpart

Minister of Foreign Affairs Ahmed bin Mubarak, met on Sunday with the Italian Deputy Prime Minister and Minister of Foreign Affairs, Antonio Tijani, and discussed the political, security and humanitarian situation in Yemen.

Tijani affirmed Italy's support for efforts being made to resume negotiations to reach a peaceful resolution and end the conflict, stressing the importance of renewing and extending the armistice.

Mubarak thanked the Italian government for its firm and continuous political support of the Yemen’s internationally recognised government in its endeavor to establish peace, restore state institutions and end the Houthi coup, state news agency SABA reported.

Mubarak touched on the repeated Houthi attacks civilians, civilian infrastructure, and oil installations.

Mubarak also discussed his government’s decision to classify the Houthi militia as a terrorist organization, and called for support from the international community to implement that decision.

Mubarak spoke about the Houthi militia ties with the Iranian Revolutionary Guards and Lebanon’s Hezbollah, and their smuggling of Iranian weapons and drones.


Former British Daesh bride ‘will die without medical aid’ in Syrian camp, neurologist warns

Former British Daesh bride ‘will die without medical aid’ in Syrian camp, neurologist warns
Updated 04 December 2022

Former British Daesh bride ‘will die without medical aid’ in Syrian camp, neurologist warns

Former British Daesh bride ‘will die without medical aid’ in Syrian camp, neurologist warns
  • UK government inaction in Layla case amounts to ‘barbarism,’ says Dr. David Nicholl

LONDON: A former British Daesh bride detained in a prison camp in northeast Syria will die without medical intervention, with the UK government’s inaction amounting to “barbarism,” a neurologist told The Times.

The woman in her 40s, who is known by the pseudonym Layla, first traveled to Syria to join Daesh during the country’s conflict.

Following the collapse of the terror group and detainment of thousands of former fighters and their families, Layla — who is epileptic and partially paralyzed as a result of a shrapnel wound — has repeatedly appealed for medical aid through National Health Service consultant neurologist Dr. David Nicholl.

But despite his repeated warnings to the government that Layla will die without urgent medical aid, the government has yet to respond.

He first examined her via an online meeting late last year. Following another Zoom video call in November, Nicholl found that Layla’s condition had significantly worsened, with shrapnel in her neck having moved dangerously close to the aorta.

He said: “She’s ill and at risk of dying and needs to be got out of there and brought back immediately. It’s utterly inhumane.”

Layla, who has a university degree and held a high-level public sector job in the UK before traveling to Syria with her husband, suffered a stroke in 2019. “She has had life-changing neurological injuries as a consequence of her stroke,” Nicholl added.

“She does not speak Arabic so it is hard for her to understand the medical advice she is being given.

“It troubles me that my previous assessment has still not been acted on, the case for her urgent transfer still remains.

“Everything about this is a mess. Her son is also vulnerable and watching all this and is in a place where no child should be.”

Layla spoke to the Sunday Times in June, claiming: “I was never a threat.” She added: “Whatever people think I have done I am prepared to face trial. I made a mistake, why should my son pay?

“Life in the camp is really, really hard. It’s hard to walk on the stones with my crutches. I am embarrassed to have to ask for help for everything, and the tent is so hot and when it’s windy the whole tent moves.”

Human rights group Reprieve has also appealed to the UK government to act urgently and rescue Layla.

The organization sent a letter to Foreign Secretary James Cleverly that said: “Her condition has become critical and a local doctor told her that without urgent surgery, she will die. She requires immediate medical assistance that cannot be provided in northeast Syria.”

In response to the appeals, Cleverly told The Times: “I am not comfortable going into specific cases. They are difficult, they are sensitive, we do always look at the cases.”


Iran scraps morality police after months of deadly protests

Iran scraps morality police after months of deadly protests
Updated 04 December 2022

Iran scraps morality police after months of deadly protests

Iran scraps morality police after months of deadly protests
  • The morality police — known formally as the Gasht-e Ershad or “Guidance Patrol” — were established under hard-line president Mahmoud Ahmadinejad

TEHRAN: Iran has scrapped its morality police after more than two months of protests triggered by the arrest of Mahsa Amini for allegedly violating the country’s strict female dress code, local media said Sunday.
Women-led protests, labelled “riots” by the authorities, have swept Iran since the 22-year-old Iranian of Kurdish origin died on September 16, three days after her arrest by the morality police in Tehran.
“Morality police have nothing to do with the judiciary” and have been abolished, Attorney General Mohammad Jafar Montazeri was quoted as saying by the ISNA news agency.
His comment came at a religious conference where he responded to a participant who asked “why the morality police were being shut down,” the report said.
The morality police — known formally as the Gasht-e Ershad or “Guidance Patrol” — were established under hard-line president Mahmoud Ahmadinejad, to “spread the culture of modesty and hijab,” the mandatory female head covering.
The units began patrols in 2006.
The announcement of their abolition came a day after Montazeri said that “both parliament and the judiciary are working (on the issue)” of whether the law requiring women to cover their heads needs to be changed.
President Ebrahim Raisi said in televised comments Saturday that Iran’s republican and Islamic foundations were constitutionally entrenched “but there are methods of implementing the constitution that can be flexible.”
The hijab became mandatory four years after the 1979 revolution that overthrew the US-backed monarchy and established the Islamic Republic of Iran.
Morality police officers initially issued warnings before starting to crack down and arrest women 15 years ago.
The vice squads were usually made up of men in green uniforms and women clad in black chadors, garments that cover their heads and upper bodies.
The role of the units evolved, but has always been controversial even among candidates running for the presidency.
Clothing norms gradually changed, especially under former moderate president Hassan Rouhani, when it became commonplace to see women in tight jeans with loose, colorful headscarves.
But in July this year his successor, the ultra-conservative Raisi, called for the mobilization of “all state institutions to enforce the headscarf law.”
Raisi at the time charged that “the enemies of Iran and Islam have targeted the cultural and religious values of society by spreading corruption.”
In spite of this, many women continued to bend the rules, letting their headscarves slip onto their shoulders or wearing tight-fitting pants, especially in major cities and towns.
Iran’s regional rival Saudi Arabia also employed morality police to enforce female dress codes and other rules of behavior. Since 2016 the force there has been sidelined in a push by the Sunni Muslim kingdom to shake off its austere image.


State news: Iran executes 4 people it says spied for Israel

State news: Iran executes 4 people it says spied for Israel
Updated 04 December 2022

State news: Iran executes 4 people it says spied for Israel

State news: Iran executes 4 people it says spied for Israel
  • Executed prisoners identified as Hossein Ordoukhanzadeh, Shahin Imani Mahmoudabadi, Milad Ashrafi and Manouchehr Shahbandi

TEHRAN: Iranian authorities executed four people Sunday accused of working for Israel’s Mossad intelligence agency, the state-run IRNA news agency said.
IRNA said the country’s powerful Revolutionary Guard announced the arrests of a network of people linked to the Israeli agency. It said members stole and destroyed private and public property and kidnapped individuals and interrogated them.
The report said the alleged spies had weapons and received wages from Mossad in the form of cryptocurrency.
Israel and Iran are regional arch-enemies.
IRNA identified the executed prisoners as Hossein Ordoukhanzadeh, Shahin Imani Mahmoudabadi, Milad Ashrafi and Manouchehr Shahbandi.