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.”


Iranian women in anti-regime protests being targeted in breasts and genitalia, say medics

Iranian women in anti-regime protests being targeted in breasts and genitalia, say medics
Updated 9 sec ago

Iranian women in anti-regime protests being targeted in breasts and genitalia, say medics

Iranian women in anti-regime protests being targeted in breasts and genitalia, say medics
  • Doctors and nurses, working in secret to avoid arrest and potential punishment, said they have noted the practice

LONDON: Women are being targeted at anti-regime protests by Iranian security forces focusing their shotgun fire at faces, breasts and genitals, according to interviews with medics across the country.

Doctors and nurses, working in secret to avoid arrest and potential punishment, said they have noted the practice after noticing women arriving for treatment with different wounds.

The medics said men more commonly had shotgun wounds to their legs, buttocks and backs, while shots to the eyes of women, men and children were also common.

The Guardian reportedly spoke to 10 medical professionals, who warned that the severity of the injuries could leave hundreds of young Iranians with permanent damage.

“I treated a woman in her early 20s, who was shot in her genitals by two pellets. Ten other pellets were lodged in her inner thigh,” one doctor told the newspaper.

“These 10 pellets were easily removed, but those two were a challenge because they were wedged in between her urethra and vaginal opening.”

Photographs seen by The Guardian showed bullet wounds all over bodies from so-called birdshot pellets, with X-rays showing evidence of tiny shot-balls in flesh.

Another doctor from Karaj, a city near Tehran, said medics believed security forces were shooting at the genitals of women because they have “an inferiority complex and they want to get rid of their sexual complexes by hurting these young people.”

Protests have been raging across Iran demanding the overthrow of the clerical rulers of the country following the death in morality police custody of Mahsa Amini.

The Iranian woman was arrested for not properly covering her hair, and the doctor who treated her wounds told The Guardian they found the experience of treating Amini “harrowing,” adding: “She could have been my own daughter.”

Meanwhile, the first death penalty on a demonstrator involved in the recent protests was carried out on Thursday by the Tehran regime.


China can help bring end to Yemen war, says official

China can help bring end to Yemen war, says official
Updated 08 December 2022

China can help bring end to Yemen war, says official

China can help bring end to Yemen war, says official
  • Beijing can persuade Tehran to stop supporting Houthis, government analyst tells Arab News

RIYADH: Yemeni experts and officials have called on China to do more to help bring an end to the country’s civil war by helping peace talks and by increasing economic and humanitarian aid.

“Yemen needs China’s assistance,” Najeeb Ghallab, undersecretary at Yemen’s Information Ministry and a political analyst, told Arab News.

“Achieving peace in Yemen is in China’s interest because it will revitalize Yemen’s ports, which would aid China’s Belt and Road Initiative and open the nation to Chinese businesses.” 

His comments come as Rashad Al-Alimi, the leader of Yemen’s Presidential Leadership Council, is traveling to Riyadh to attend an Arab-Chinese summit on Friday.

Ghallab said that can press Iran to cease supplying and funding its proxy militias across the Middle East, including Yemen. “China can persuade Iran to stop supporting its organizations, particularly the Houthis in Yemen,” he said.

The UN Yemen envoy Hans Grundberg’s efforts to end the war have come to a standstill after the Houthis refused to extend a ceasefire that ended in October, and threatened to strike oil infrastructure in regions under government control. 

The Houthis have said they would not extend the ceasefire until the government pays public workers in regions the group controls.

Al-Alimi is expected to update President Xi Jinping on Houthi efforts to thwart peace, and to request Chinese assistance to end the conflict and aid Yemen’s recovery.

China has taken a neutral stance from the warring parties for almost a decade but backed international peace measures to bring an end to the conflict.

Beijing typically expresses support for the UN-led efforts to end the war and urges the internationally recognized government of Yemen and the Iran-backed Houthis to achieve peace. 

In 2011, China backed the GCC-brokered peace initiative that led to the removal of former Yemeni president Ali Abdullah Saleh after major demonstrations inspired by the Arab Spring. 

It voted in favor of UN Security Council Resolution 2216 in 2015, which condemned the Houthi takeover and reduced penalties on Houthi leaders and Ahmed Saleh, the son of the former president’s son.

Samuel Ramani, associate fellow at the Royal United Services Institute, told Arab News, however said that Beijing has maintained a pragmatic and impartial approach to the conflict to retain connections with regional powers, including Iran.

“China wants to balance positive relations with Saudi Arabia, the UAE and Iran, and likely views detachment from the Yemen war as the most effective means of preserving good relations with all regional powers,” he said.

“China is very selective in its engagement in conflict resolution in the Middle East and is unlikely to transfer its somewhat more assertive role in promoting Israeli-Palestinian peace to the Yemeni theatre.”

He added that for the time being, its role will be limited to areas that do not indicate support for any group, such as humanitarian aid and economic investment.


Lebanon MPs again fail to fill vacant presidency

Lebanon MPs again fail to fill vacant presidency
Updated 08 December 2022

Lebanon MPs again fail to fill vacant presidency

Lebanon MPs again fail to fill vacant presidency
  • Ninth session to elect president: Hezbollah opponent Moawad’s votes are equal to ‘blank’ votes
  • Parliament Speaker Nabih Berri reiterates calls for dialogue among MPs to find consensus candidate 

BEIRUT: Lebanon’s divided parliament failed to elect a new president on Thursday for a ninth time, with many MPs spoiling their ballots, including one who cast a vote for “Nelson Mandela.”

Hezbollah opponent Michel Moawad won the support of 39 MPs, but fell well short of the required majority.

Parliament Speaker Nabih Berri adjourned the session and announced a new meeting next Thursday, the last session for 2022.

Berri reiterated calls for dialogue among MPs to find a consensus candidate to prevent the process dragging on for months.

Only 105 of 128 MPs showed up for the vote on Thursday and many of them spoilt their ballots.

For the first time, and after eight parliamentary sessions, the number of blank ballots cast by Hezbollah and its allies was equal to the number of votes received by Mouawad.

This tie came against the backdrop of the dispute that arose between Hezbollah and its Christian ally in Lebanon, the Free Patriotic Movement, since the Cabinet session last Monday.

According to a parliamentary observer, the FPM decided to stop casting blank ballots as before and distribute its votes in a calculated manner.

Although the session failed to elect a president, the FPM’s move sent a calculated message to Hezbollah on its open decisions by leaking some of its deputies’ votes in favor of Mouawad, thereby reducing the number of blank votes, the observer said.

The winning candidate requires at least 86 votes in the first round of voting, and an absolute majority of 65 votes in subsequent rounds.

The parliament again failed to hold a second round for loss of quorum after the withdrawal of Hezbollah, the Amal Movement and MPs from other blocs.

Nine MPs voted for “The New Lebanon,” five for Issam Khalifeh and three for the customs chief Badri Daher, who is in detention in relation to the investigation into the Beirut port explosion.

Former deputy Ziad Baroud, legal expert and candidate Salah Honein, and activist and candidate Fawzi Bou Malhab received one vote each.

One vote contained the inscription “For Lebanon,” and another “the agreement.” One vote was cast for “Nelson Mandela,” in addition to canceled votes.

The results of the ballot showed that the FPM deputies amounting to 17 chose their options carefully, as they did not direct all their votes toward Mouawad.

Some votes containing the inscriptions “Mouawad,” “Michel” and “Mouawad Badri Daher” were annulled, among others.

Hezbollah and the FPM deputies did not give any statement after the session, but engaged in a quick side talk.

The Amal Movement MPs avoided discussing the dispute between Hezbollah and the FPM.

MP Ali Hassan Khalil said every party should review its stances, so “we can move forward with this dialogue.”

He said: “We are keen on preserving the relationships between the political forces and we don’t intervene in this matter.

“Everyone should know that the only way to overcome this crisis is through dialogue and communication.”

Mouawad said that “what happened emphasized the solid stances of the blocs voting for me. Some wanted to send a message but they cannot keep doing so till the end. What is happening is disgusting.”

The MP said that he is refusing to get caught up in what he calls “the votes exchange.”

He said: “What is needed is a sovereign president and not a consensual one in the negative sense.”

The dispute between Hezbollah and the FPM has deteriorated to this point for the first time.

A few hours before the parliamentary session, Hezbollah issued a statement in response to Gebran Bassil’s harsh criticism of the party, accusing it of failing to fulfill its promises.

The accusation came against the backdrop of Hezbollah’s participation in the Cabinet’s session seen by the FPM as an illegal way to take over the presidential prerogatives.

Hezbollah affirmed in its statement that the party did not promise anyone that the cabinet won’t convene unless upon the approval of all its components, and therefore, there was no reason for Bassil to consider this move a broken promise.”

The statement added: “Hezbollah didn’t promise the FPM that it won’t attend the Cabinet’s urgent meetings if the ministers of the party (the FPM) boycott it.”

Hezbollah said that “using the language of betrayel and distrust is an unwise and inappropriate behavior.”

Hezbollah said “what Lebanon needs today is communication and dialogue.”

Lebanon has been quick to confirm the safety of Rafik Hariri International Airport and those traveling through it.

Interior Minister Bassam Mawlawi said that they will continue to “combat smuggling at all border crossings in cooperation with all security and military bodies.”

He made the remarks after inspecting the airport security service and meeting with officers on Thursday.

The visit followed a report on Al-Arabiya–Al-Hadath channel that security sources warned that Iran’s Revolutionary Guards were using Iranian airline Meraj flights to transport weapons and equipment to Hezbollah.

Regarding the landing of Iranian airline flights linked to the Revolutionary Guards at Beirut airport, Mawlawi said: “We are keen on enforcing the laws and protecting Lebanon.”

Fadi Al-Hassan, Lebanon’s Civil Aviation director-general, denied the claims.

Al-Hassan said the timing of the “baseless” report harmed the airport’s reputation.

The Meraj company is not affiliated with any party, he said.

The airline operated its first flight to Beirut’s international airport on Nov. 14, and meets all the security requirements, Al-Hassan said.

David Hill, former US assistant secretary of state, met with Berri in other developments.

Hill said in a statement that the situation in Lebanon was not hopeless and that political will is needed to carry out reforms.


Egypt says it is not at risk of bankruptcy

Egypt says it is not at risk of bankruptcy
Updated 08 December 2022

Egypt says it is not at risk of bankruptcy

Egypt says it is not at risk of bankruptcy
  • Cabinet says external debt structure is positive amid rising inflation
  • The Cabinet added that Egypt aimed to maintain fiscal discipline and reduce the budget deficit to 5.6 percent of GDP

CAIRO: Egypt’s government has rejected claims that the country is exposed to bankruptcy risk due to its debts and the cost of servicing them during rate rises and inflation.
It also cited a report on the performance of the Egyptian economy from June to November.
The Cabinet said Egypt’s ratio of external debt to GDP was 34.1 percent, below the maximum risk limit of 50 percent.
The report said the structure and diversity of Egypt’s external debt instruments including loans, deposits, issued bonds and short-term credit facilities, were positive.
The Cabinet said that most of Egypt’s external debt was medium and long-term. Around two-thirds of foreign debt was also at fixed interest rates — which mitigates the risks of international rate increases.
It added: “In light of the successive economic crises that the world witnessed during the previous periods, governments all over the world tended to adopt expansionary economic policies to mitigate the consequences of the negative effects of these economic crises on families and companies.
“Such policies led to a significant rise in levels of global indebtedness, which rose to a record 350 percent of the global GDP by the end of the second quarter of 2022.”
The Cabinet added that Egypt aimed to maintain fiscal discipline, reduce the budget deficit to 5.6 percent of GDP, and achieve the first surplus from the state’s general budget permanently at 0.2 percent of the GDP.
These measures would contribute to reducing indebtedness and achieving financial and economic stability for the country’s general budget and ensure safety for current and future generations, said the statement.
The Cabinet statement came as Egypt’s Central Agency for Public Mobilization and Statistics announced on Thursday that the general index of consumer prices rose by 2.5 percent to 140.7 points in November.
The annual inflation rate in November rose to 19.2 percent, compared to 16.3 percent in October, said an agency statement.
The annual inflation rate in urban areas rose during November to 18.7 percent, compared to 16.2 percent in October.
The agency’s statement attributed the rise to prices increase for bread and grain by 52.1 percent, meat and poultry by 30.3 percent, fish and seafood by 38 percent, dairy products and eggs by 40 percent, and coffee and tea by 23.1 percent.
It also cited price increases in tobacco products by 0.3 percent, clothing by 2.1 percent, footwear by 1.3 percent, home furnishings by 2.6 percent, and appliances by 3.1 percent.


US climate envoy hails holding COP28 in UAE

US climate envoy hails holding COP28 in UAE
Updated 08 December 2022

US climate envoy hails holding COP28 in UAE

US climate envoy hails holding COP28 in UAE
  • Fossil fuel economies should be encouraged to lead the transition to clean energy, says John Kerry

WASHINGTON: The US has hailed the decision to hold next year’s 28th UN climate change conference in the UAE.
Special Presidential Envoy for Climate John Kerry said that fossil fuel economies should be encouraged to lead the transition to clean energy, the Emirates News Agency reported on Thursday.
“It’s very exciting that the UAE, an OPEC member, is going to host COP28, and it’s so important that you have an oil and gas producing nation step up and say we understand the challenge of the climate crisis,” he told Reuters.
“The UAE leadership has taken very smart steps because they know that what’s coming out of the ground is not forever, either physically or politically, and they’re looking at what the new world is going to look like.”
“If there are going to be new forms of energy, they want to be among the providers of it, just as they are today.”
Kerry said that this year’s COP27 conference, held last month in Egypt, nudged the world closer to the goal of the 2015 Paris Agreement to limit the rise in global temperatures to 1.5C above pre-industrial times.
He praised the announcement of 30 upgraded national climate plans along with the summit’s headline agreement on “loss and damage” to help vulnerable countries reeling from climate-driven extreme weather and rising seas.