Despite medical advances, education and awareness, diabetes is on the rise in the UAE.
According to the atlas of the International Diabetes Federation (www.idfatlas.org), in the UAE, there are approximately one million people with Type 1 and Type 2 diabetes, with approximately 450,000 of those cases being undiagnosed, making it more of an issue now than ever before.
On World Diabetes Day (November 14), it is imperative that we review the steps being taking by health care professionals and diabetics to resolve this issue.
Unless residents set personal goals and go offensive on the diabetes prevention path, there is very little that doctors can do on their own, say endocrinologists and experts.
Gulf News looks at the challenges for diabetics and how they can be overcome.
Big obstacles
1) Poor blood sugar control
Dr Mohammad Hassanein, consultant endocrinologist of Dubai Hospital, said that poor blood sugar or glycaemic control impact the environment people live in and the lifestyle they adopt. “In a study on prevalence of diabetes on Indian people, it was found that diabetes was on the rise in the urban population and its prevalence was lower in the rural population. Similarly, diabetes was rise in Indians living in the UK and other countries. This indicates that although people may be from the same genetic pool, their environment and their lifestyle has a definite impact in the occurrence, incidence and rise of diabetes. In cities, people live more sedentary lifestyles and have food habits that include more refined and processed foods, plus urban lifestyle plays an important part in the level of stress.”
2) Managing HbA1C levels
One of the main markers of how diabetes is being managed in an individual is the HbA1c levels. This is a measure for blood plasma glucose. The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming ‘glycated’. Measuring HbA1c gives doctors a good idea of the concentration of glucose in the blood for three months. HbA1C levels in non-diabetics are between 5 to 5.8. In diabetics, it is about 5.8 to 6.5. Dibatics with poor blood glucose control go above 7.
3) Achieving weight loss
Dr Naji Torbay, Endocrinology, Metabolism, Diabetes and Weight Care Clinic, Dubai Healthcare City, who works out tailor-made programmes for correcting blood sugar metabolism, said: “Key to a good diabetes control is weight loss. In fact, the only cure for diabetes we have so far available is bariatric surgery. It induces significant weight loss and clears the disease in some 85 per cent of cases. The same cure rate can be achieved if the patient accepts to go on a diet and increase his daily physical activity. In my experience, a low-carbohydrate diet not only improves blood sugar levels, it reduces the need for medications but induces important weight loss as well. Walking for at least half an hour 5 times a week is an easy way of increasing physical activity.”
4) Loss of resolve
Many diabetics lose their resolve on management of their disease. Taking medication or insulin injections in correct dosage and duration, avoiding direct sugar all the time, having a meal that has complex and low carbohydrates, high fibre, taking walks regularly is sometimes a tough routine for patients to follow. Dr Hassanein explained: “A chronic disease like diabetes is difficult to control. Such is its nature that people get complacent and tired of following the treatment protocol. Plus, long-term medication has side-effects. As pancreas get older and tired, the organ gets damaged. Diabetics on insulin injection suffer bouts of hyper and hypo glycaemia (High or low sugar); they gain weight and there is damage to organs as time progresses.”
The way forward
Education and awareness
‘Only 30-40% patients achieve blood sugar control’
Both Dr Hassanein and Dr Huda Ezzeddin Mustafa, Consultant and Division Chief Endocrinology and Diabetes, Shaikh Khalifa Medical City (SKMC) agree that education is the chief way of empowering a patient.
Dr Mustafa said: “Worldwide, blood sugar control is achieved in only 30-40 per cent of patients. Therefore, one needs to focus on educating the patient about the nature of the disease, its progression, the behavioural and lifestyle changes to be made.
Tailor-made programs
“Every patient requires a tailor-made [diabetes management] programme they can adhere to. In terms of medication, the patient might need insulin injections or a combination of medicines and insulin. The aim is to achieve maximum control with minimum side-effects.”
Early education
There is a need to begin education at the grass root levels from schools, from the basic unit of family, where people are motivated to exercise and eat healthy and go in for preventive screening,” said Dr Hassanain. “People with obesity and women with polycystic ovaries and gestational diabetes during pregnancy have a higher propensity of being diagnosed with Type 2 diabetes within five years. We follow a universal screening programme for all to check for pre diabetics so that the onset of the disease can either be delayed or eliminated to minimise damage. These kinds of programmes play an important step in prevention or delay of diabetes.”
Educating healthcare professionals
Educating the masses also requires trained healthcare professionals. For the first time, a training centre to augment the state of preparedness of the diabetes care professionals opened at the Dubai Health Care City in early November. The Abbot Diabetes Academy to train and equip health care professionals with new technological advancements in diabetes treatments will help in better community education and control of the disease.
Talking about the empowerment the new centre would bring, Dr Abdulrazzaq Al Madani, President of the Emirates Diabetes Society, said: “[The Academy] will equip physicians and diabetes experts to use advanced technologies to develop new and improved medical care for diabetics. It will specifically help both improve and save the lives of people affected with diabetes, filling an important gap in the region.”
New tools in diabetes management
Next generation drugs and better blood sugar monitors are now available.
Incretin medication systems
Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism. One such incretin is Glucagon Like Peptide (GLP-1), a hormone produced in the small intestine which signals the feeling of fullness to the brain. In diabetics, the production and processing of this hormone is impaired and new class of drugs available in US and Europe and to be introduced in the UAE market soon will ensure the production of GLP-1 that will inhibit the appetite of a diabetic patient and also ensure better blood glucose control.
Glucose monitoring systems
A new flash glucose monitoring system enables the diabetic to quickly and accurately check blood glucose levels without the pain of pricking. The sensor for the glucose monitoring is placed under the skin and the patient needs to hold a monitor to it and record the blood glucose levels. This means no pin pricks and accurate and readings that provide an instant scan and eight hour history of blood glucose levels. This device is available in the UAE and helps in more efficient blood sugar control.
New injectables
To help lower A1c in the bloodstream, stomach, liver, pancreas, and muscles, a new therapy for Type II has recently been introduced in the UAE. It is once-daily injectable prescription medicine that contains a combination of 2 diabetes medicines to provide a more attainable complete glycaemic solution for patients, without increasing risk of hypoglycaemia (low sugar) or weight gain compared with standard therapy. In a clinical trial of adults with type 2 diabetes, the new therapy significantly lowered A1c levels.
EVENTS IN UAE
Diabetes walkathons
The 9th edition of the Landmark Beat Diabetes walkathon will be held on November 24, 2017 from 7am at Gate No 1 Creek Park. Residents can register online for the walk until November 18, 2017. For more details log on to: beat.diabetes@landmarkgroup.com.
The Imperial College London Diabetes Centre (ICLDC), with the support of Mubadala’s network of world class healthcare facilities, Healthpoint and Cleveland Clinic Abu Dhabi, are inviting the UAE to walk together for the nation’s leading annual walkathon, WALK 2017 to be held on November 17, 2017. The walk venue is the Yas Marina Circuit, Abu Dhabi and the event begins at 2pm. For more details email to walkon@icldc.ae
Dh7,667 per year
Burden of treatment for diabetics
2.4 million
insured residents in Dubai of which 213,000 have diabetes.
Nearly 10%
Of Dubai health expenditure is on diabetes.
19.3% to 16%
National Health Agenda goal of reducing current rate of Type 2 Diabetes Mellitus by 2021.
South Asian women in UAE more prone to diabetes
A study conducted in the UAE by the Institute of Public Health and Research Centre in collaboration with Public Health Research Centre of New York University Abu Dhabi, SEHA, Emirates Diabetes Society and Dubai Health Authority, results of which were published in 2017, indicates that diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asian women. The longer length of residence in the UAE, higher the prevalence of diabetes.
The findings also revealed that the prevalence of Type 2 diabetes was significantly higher among those who had been living in the UAE for 10 years or more.
According to the atlas of the International Diabetes Federation (www.idfatlas.org), in the UAE, there are approximately one million people with Type 1 and Type 2 diabetes, with approximately 450,000 of those cases being undiagnosed, making it more of an issue now than ever before.
On World Diabetes Day (November 14), it is imperative that we review the steps being taking by health care professionals and diabetics to resolve this issue.
Unless residents set personal goals and go offensive on the diabetes prevention path, there is very little that doctors can do on their own, say endocrinologists and experts.
Gulf News looks at the challenges for diabetics and how they can be overcome.
Big obstacles
1) Poor blood sugar control
Dr Mohammad Hassanein, consultant endocrinologist of Dubai Hospital, said that poor blood sugar or glycaemic control impact the environment people live in and the lifestyle they adopt. “In a study on prevalence of diabetes on Indian people, it was found that diabetes was on the rise in the urban population and its prevalence was lower in the rural population. Similarly, diabetes was rise in Indians living in the UK and other countries. This indicates that although people may be from the same genetic pool, their environment and their lifestyle has a definite impact in the occurrence, incidence and rise of diabetes. In cities, people live more sedentary lifestyles and have food habits that include more refined and processed foods, plus urban lifestyle plays an important part in the level of stress.”
2) Managing HbA1C levels
One of the main markers of how diabetes is being managed in an individual is the HbA1c levels. This is a measure for blood plasma glucose. The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming ‘glycated’. Measuring HbA1c gives doctors a good idea of the concentration of glucose in the blood for three months. HbA1C levels in non-diabetics are between 5 to 5.8. In diabetics, it is about 5.8 to 6.5. Dibatics with poor blood glucose control go above 7.
3) Achieving weight loss
Dr Naji Torbay, Endocrinology, Metabolism, Diabetes and Weight Care Clinic, Dubai Healthcare City, who works out tailor-made programmes for correcting blood sugar metabolism, said: “Key to a good diabetes control is weight loss. In fact, the only cure for diabetes we have so far available is bariatric surgery. It induces significant weight loss and clears the disease in some 85 per cent of cases. The same cure rate can be achieved if the patient accepts to go on a diet and increase his daily physical activity. In my experience, a low-carbohydrate diet not only improves blood sugar levels, it reduces the need for medications but induces important weight loss as well. Walking for at least half an hour 5 times a week is an easy way of increasing physical activity.”
4) Loss of resolve
Many diabetics lose their resolve on management of their disease. Taking medication or insulin injections in correct dosage and duration, avoiding direct sugar all the time, having a meal that has complex and low carbohydrates, high fibre, taking walks regularly is sometimes a tough routine for patients to follow. Dr Hassanein explained: “A chronic disease like diabetes is difficult to control. Such is its nature that people get complacent and tired of following the treatment protocol. Plus, long-term medication has side-effects. As pancreas get older and tired, the organ gets damaged. Diabetics on insulin injection suffer bouts of hyper and hypo glycaemia (High or low sugar); they gain weight and there is damage to organs as time progresses.”
The way forward
Education and awareness
‘Only 30-40% patients achieve blood sugar control’
Both Dr Hassanein and Dr Huda Ezzeddin Mustafa, Consultant and Division Chief Endocrinology and Diabetes, Shaikh Khalifa Medical City (SKMC) agree that education is the chief way of empowering a patient.
Dr Mustafa said: “Worldwide, blood sugar control is achieved in only 30-40 per cent of patients. Therefore, one needs to focus on educating the patient about the nature of the disease, its progression, the behavioural and lifestyle changes to be made.
Tailor-made programs
“Every patient requires a tailor-made [diabetes management] programme they can adhere to. In terms of medication, the patient might need insulin injections or a combination of medicines and insulin. The aim is to achieve maximum control with minimum side-effects.”
Early education
There is a need to begin education at the grass root levels from schools, from the basic unit of family, where people are motivated to exercise and eat healthy and go in for preventive screening,” said Dr Hassanain. “People with obesity and women with polycystic ovaries and gestational diabetes during pregnancy have a higher propensity of being diagnosed with Type 2 diabetes within five years. We follow a universal screening programme for all to check for pre diabetics so that the onset of the disease can either be delayed or eliminated to minimise damage. These kinds of programmes play an important step in prevention or delay of diabetes.”
Educating healthcare professionals
Educating the masses also requires trained healthcare professionals. For the first time, a training centre to augment the state of preparedness of the diabetes care professionals opened at the Dubai Health Care City in early November. The Abbot Diabetes Academy to train and equip health care professionals with new technological advancements in diabetes treatments will help in better community education and control of the disease.
Talking about the empowerment the new centre would bring, Dr Abdulrazzaq Al Madani, President of the Emirates Diabetes Society, said: “[The Academy] will equip physicians and diabetes experts to use advanced technologies to develop new and improved medical care for diabetics. It will specifically help both improve and save the lives of people affected with diabetes, filling an important gap in the region.”
New tools in diabetes management
Next generation drugs and better blood sugar monitors are now available.
Incretin medication systems
Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism. One such incretin is Glucagon Like Peptide (GLP-1), a hormone produced in the small intestine which signals the feeling of fullness to the brain. In diabetics, the production and processing of this hormone is impaired and new class of drugs available in US and Europe and to be introduced in the UAE market soon will ensure the production of GLP-1 that will inhibit the appetite of a diabetic patient and also ensure better blood glucose control.
Glucose monitoring systems
A new flash glucose monitoring system enables the diabetic to quickly and accurately check blood glucose levels without the pain of pricking. The sensor for the glucose monitoring is placed under the skin and the patient needs to hold a monitor to it and record the blood glucose levels. This means no pin pricks and accurate and readings that provide an instant scan and eight hour history of blood glucose levels. This device is available in the UAE and helps in more efficient blood sugar control.
New injectables
To help lower A1c in the bloodstream, stomach, liver, pancreas, and muscles, a new therapy for Type II has recently been introduced in the UAE. It is once-daily injectable prescription medicine that contains a combination of 2 diabetes medicines to provide a more attainable complete glycaemic solution for patients, without increasing risk of hypoglycaemia (low sugar) or weight gain compared with standard therapy. In a clinical trial of adults with type 2 diabetes, the new therapy significantly lowered A1c levels.
EVENTS IN UAE
Diabetes walkathons
The 9th edition of the Landmark Beat Diabetes walkathon will be held on November 24, 2017 from 7am at Gate No 1 Creek Park. Residents can register online for the walk until November 18, 2017. For more details log on to: beat.diabetes@landmarkgroup.com.
The Imperial College London Diabetes Centre (ICLDC), with the support of Mubadala’s network of world class healthcare facilities, Healthpoint and Cleveland Clinic Abu Dhabi, are inviting the UAE to walk together for the nation’s leading annual walkathon, WALK 2017 to be held on November 17, 2017. The walk venue is the Yas Marina Circuit, Abu Dhabi and the event begins at 2pm. For more details email to walkon@icldc.ae
Dh7,667 per year
Burden of treatment for diabetics
2.4 million
insured residents in Dubai of which 213,000 have diabetes.
Nearly 10%
Of Dubai health expenditure is on diabetes.
19.3% to 16%
National Health Agenda goal of reducing current rate of Type 2 Diabetes Mellitus by 2021.
South Asian women in UAE more prone to diabetes
A study conducted in the UAE by the Institute of Public Health and Research Centre in collaboration with Public Health Research Centre of New York University Abu Dhabi, SEHA, Emirates Diabetes Society and Dubai Health Authority, results of which were published in 2017, indicates that diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asian women. The longer length of residence in the UAE, higher the prevalence of diabetes.
The findings also revealed that the prevalence of Type 2 diabetes was significantly higher among those who had been living in the UAE for 10 years or more.
Reporting by Suchitra Bajpai Chaudhary
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