Killing me sweetly

Diabetes is on the rise across the globe, but in the Middle East it has reached epidemic levels with devastating results. David Robinson looks at what’s behind the crisis.

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By  David Robinson Published  February 20, 2005

Killing my sweetly|~|FAT-ATTACK-200.jpg|~|FAT ATTACK: Unheathy foods are widely available in a way they weren’t a generation ago, they are often washed down with sugary drinks.|~|LAWYER Hashim Al Jamal found out he had diabetes about 20 years ago after taking a routine blood test. The discovery changed his life. Despite injecting himself with insulin everyday to combat the type 2 condition, the 60-year-old Jordanian’s health has suffered in many ways. “It’s caused me many problems. I get nervous now and I sleep badly. My mind doesn’t work so regularly,” he says. “Last year my condition led me to have a heart attack.” Al Jamal’s experience is an increasingly common. Diabetes may be on the rise across the globe, but in the Middle East it is nearing pandemic proportions. “Every year the number of people with diabetes in the Gulf states increases by 10%,” says Dr. Khaled Al Rubean, the director of the diabetic centre at King Saud University. “We are going to face a big problem in the future.” Experts say the present number of 3.5 million diabetes sufferers in the region could shoot up to 26 million by 2030. “It is a crisis,” says Dr. Abdulrazzaq Al Madani, a consultant physician and endocrinologist and director of Dubai Hospital. Regional health officials are urging authorities to take drastic action to combat the situation. Twenty four percent of locals in the United Arab Emirates have the disease, says Dr. Al Madani, adding that if not enough is done about the problem then in a few years 50% of the population will either have diabetes or be strongly predisposed to developing it. “One in two people could become diabetic,” he says. “And if we don’t do anything about it, this figure is going to increase and increase.” The World Health Organisation estimates that close to 190 million people across the globe have the disease — a figure expected to surpass 300 million by 2025 making it one of the biggest epidemics in human history. Diabetes attacks the body slowly and stealthily, leading to a common misconception that it’s a relatively benign condition. Initially, it produces only subtle symptoms such as excessive thirst and frequent urination, so the patient is often unaware that anything is wrong. In a healthy body, the pancreas releases the hormone insulin, which transforms blood sugar into energy. Diabetes interrupts the process. Untreated or unrecognised, the disease causes excess blood sugar to build in the veins. It gradually clogs blood vessels, damages body tissue, wrecking the eyes, the kidneys and the heart. This invites a host of terrible fates: strokes, heart disease, high blood pressure, kidney failure, blindness and amputations due to the loss of circulation. “The rise in diabetes has led to heart disease becoming the number one killer in the UAE,” Dr. Al Madani says. “Exceeding even road accidents.” There are two varieties of diabetes. Type 1 — insulin-dependent diabetes — is an inherited auto-immune affliction wherein the pancreas doesn’t produce insulin. This type usually affects children, who have to inject themselves with insulin each day: they are born with the disease, and they will die from it if they do not take insulin regularly. But it is type 2 that has become the real epidemic, accounting for 90% of diabetes cases worldwide. In this form, the pancreas isn’t the problem. It does its job of producing insulin, but for some reason scientists have not been able to work out, it either doesn’t produce enough or the body fails to employ the insulin as it should. The effect can be devastating. Diabetes is now the number one cause of blindness in Saudi Arabia, while the number of young people getting strokes because of the disease and living their lives paralysed is rapidly increasing. Health experts are in general agreement that the main reason behind the epidemic has been the onset of urbanisation leading to a marked increase in obesity. Excess fat upsets the regulation of blood sugar in the body. “The number one reason [for the increase in diabetes] is people moving from villages to the big cities,” says Dr. Abdulaziz Al Twaim, a consultant in paediatrics and endocrinology at King Abdulaziz Medical City in Jeddah. “This is associated with a lifestyle lacking in exercise, spent sitting in offices and driving in cars.” The rapid rise of Western-style fast food chains across the region is regularly blamed for the stark rise in the number of obese people. “Junk food is very bad because the amount of fat is very high,” Dr. Al Madani says. Not only are unhealthy foods now very widely available, in a way they weren’t a generation ago, they are often washed down with sugary drinks. The onset of type 2 diabetes has traditionally been associated with people over 40, but younger people are increasingly being affected. “A few years ago type 2 was not a childhood disease, but now we also see it in children,” Dr. Al Twaim says. People today spend far more time indoors than their forebears, seduced by television or computers. This is an even bigger problem in the Gulf because of its sizzling summer weather. Because of the Middle East’s hot temperatures, people often opt to drive rather than walk. Another problem, says Dr. Al Madani, is traditional Arabic dress. “If you wear trousers you can immediately feel when they get tight and realise you are putting on weight but in a dish dash you don’t feel it.” Consequently people in the Middle East are more inclined to get fat without taking much notice. But the problem is also far greater in the region because Arabs seem to be genetically more at risk than most other populations in the world. “Arabs may be disproportionately affected by the combination of a Westernised lifestyle combined with a genetic tendency,” says Dr. Anthony McCall, professor of diabetes in internal medicine at the University of Virginia. “The switch to an urban, Westernised lifestyle is more toxic environmentally for certain populations,” he says. Another factor behind the high incidences in the Arab world is consanguinity, Dr. Al Rubean says, meaning people who are related by blood or common ancestry. “Arabs tend to marry in the same tribe,” he says. Children born to a consanguineous couple are at increased risk of heath problems such as diabetes as there is a greater risk that recessive genes may then be passed on. Evolution also comes into play. Researchers cite the theory of the “thrifty gene”, which posits that the human body is designed to survive periods of feast and famine — the bountiful seasons of harvest and hunting followed by the inevitable fallow seasons. Food consumed in times of plenty is stored away for later use. Today, despite rampant poverty, there is more food available to the average person — a perpetual state of feast. “What in lean times is a genetic good in plentiful times becomes a genetic bad. Its only recently human beings in most areas of the world have had enough to eat. Most of human kind is designed to survive starvation. We’re not built to lose weight we’re designed to do anything but lose weight,” Professor McCall says. Despite billions being invested in diabetes research, doctors still do not fully understand what the root causes of type 1 and type 2 diabetes are. “The most important thing is to find out where diabetes really comes from,” says Viktor Jörgens, executive director of the European Association for the Study of Diabetes. “We do not know.” After all, many obese people do not develop diabetes, he adds. Health experts have called on policy makers to introduce immediate public health programmes to increase awareness of the disease — which is both preventable and manageable. “If more is not spent on education and care it will become a real crisis,” says Dr. Jörgens. “But if diabetes is well treated nobody has to die from it.” Many health experts advocate setting up qualified diabetes educators for every 500 diabetes patients across the region. Dr. Jorgens says a lot more education should focus on how diabetes suffers use insulin. “It’s only worth using insulin if you know how to use it properly. You need to train people to adjust their insulin dosage on a daily basis; people have to become their own doctors. People need to measure what they are going to eat and then adjust the insulin they take accordingly. There is no point giving someone a bicycle without telling them how to use it.” Dr. Al Twaim says the focus should be on preventing diabetes rather than trying to cure it. Treating someone one with renal failure can cost about US$50,000 per year, Dr. Al Twaim says, compared with prevention though blood monitoring which costs US$1600 each year. “It’s far more cost-effective in the long run,” he says. “We need to pay now in order to save later.” According to the World Heath Organisation, countries spend 2.5% to 15% of their annual healthcare budgets fighting the disease. At the moment Saudi Arabia spends US$800 million treating diabetes every year. While seven regional countries have launched national diabetes programmes, from Lebanon to Saudi Arabia, many doctors say this is simply not enough. Dr. Al Madani says to increasing public awareness is key to stopping the disease sweeping across the entire region. To a large extent, he says, diabetes can be prevented if people maintain a normal body weight, modify their lifestyles, take regular exercise, and eat healthily. “Everybody over the age of 40 should check their blood sugar annually and those that have a family history of diabetes should check at an even younger age,” Dr Al Madani says, adding that the most important thing is to educate Gulf populations about the risks of the disease. “People should understand that diabetes is a serious condition," he says. “But they should also understand that they can prevent diabetes if they work at it regularly.” As the Middle East becomes more developed in technology and science, it is likely there will be greater awareness on the causes and treatment of diabetes. Last week, at the Arab Health exhibition in Dubai, an entire morning was devoted to debating the subject, with leading professors from around the globe flying in specially for the event. Steve Bolze, president and chief executive officer of GE Healthcare (part of the massive GEC empire) explained: “I spent a couple of days at Arab Health and was very impressed with what I saw. On the one hand, yes it is true there are major concerns over health issues, particularly in the Arab world. I would agree that the biggest worry right now is diabetes, which is reaching epidemic proportions. But I genuinely believe that the best way to overcome this problem is through greater awareness." He added: "Everybody in the food industry and other leisure sectors is always promoting their products. What we need to do is promote some of the dangers of such products, and just as importantly, make people more aware of the treatment and symptoms. I don't think it is a problem we cannot overcome." The next couple of years will determine how correct Bolze is. At the current growth rates there is no doubt the disease is out of control. However, increasingly, governments and the medical profession is looking at raising its investment level of awareness and prevention programmes. Bolze says: “I think that has to start with the medical profession. Companies that have financial resources need to push more of them towards educating people. At the end of the day, it's one thing to hear from some government official that eating this or that kind of food, or drinking this or that kind of drink, is bad for you. When you hear exactly the same message from a medical specialist, you are more likely to think twice." Some experts believe that, while diabetes is clearly a major problem in the Arab world, it needs a global approach to tackle it. Rates of the disease are shooting up in Africa, and in particular countries that farm sugar products. The United Nations is considering another world conference on the subject. But as Bolze says: “Any debate is better than no debate." To read the full feature, buy Arabian Business on sale from February 20, 2005. ||**||

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