Dr Emran Khan, an endocrinologist at King’s College Hospital Dubai, provides an overview of the prevalence of diabetes in the UAE after studies revealed that around 17 percent of the population suffers from the disease. Moreover, Dr Khan analyzes the country’s efforts to combat the disease and the role that the pharmaceutical industry can play going forward.
About 38.7 million adults between the ages of 20 to 79 [in the MENA region] are currently diabetic, which means that, by 2040, about 82 million people in the region could become diabetic
As an expert in the field, can you provide an overview of the main trends that are affecting UAE and GCC countries in terms of diabetes?
The UAE ranks third in terms of diabetes prevalence in the Middle East and North Africa (MENA) region. According to a survey from the International Diabetic Federation (IDF), about 38.7 million adults between the ages of 20 to 79 are currently diabetic, which means that, by 2040, about 82 million people in the region could become diabetic. Moreover, it is a fact that 17.3 percent of the UAE population is diabetic but keep in mind that almost half of diabetics remain undiagnosed.
There was a recent cross-sectional study at the University of Sharjah, conducted by Dr Nabil Sulaiman, entitled “UAE Diabetic Lifestyle Survey”, which was conducted over a period of five years and studied 4,200 adults. It concluded that 21.3 percent of adult Emiratis are diabetic, as well as 19.1 percent of expatriates. All studies on type 2 diabetes, which affects 90 percent of diabetic patients, has indicated that lifestyle habits are the main contributors to the disease. The incidence of type 2 diabetes is determined by a complex interplay between multiple genetic, epigenetic and environmental factors. Some of them include genetics and high levels of triglycerides, obesity, physical inactivity due to urbanisation and use of technologies like mobile phones, hypertension, smoking, irregular sleep patterns and consanguinity in Arab nations.
These observations emphasize the necessity of considering diabetes as one of the main priorities of the Ministry of Health (MoH) in the UAE. In fact, the MoH has formulated an independent local body of scientists and health experts to formulate strategies and national programs to increase public know-ho, public awareness and educate the people on steps to identify and control the disease.
How has the prevalence been evolving over the past few years and how do you explain this continuous growth?
The cases of type 2 diabetes outnumber type 1 by a ratio of 10 to 1. While in the UAE over 17 percent of the population is diabetic, on Bahrain the percentage rises to 19.6 percent and in Kuwait, Qatar and Saudi Arabia it jumps up to 20 percent. These five nations rank within the top 15 nations of the world for the highest rate of diabetes per capita. Kuwait and Bahrain and Saudi Arabia and the UAE also rank number 15 for the top countries for obesity. Qatar actually ranking highest for obesity at number six.
There is also a high rate of smoking in all these countries which leads to increased rates of heart disease and high blood pressure. In a survey in Bahrain last year, 50 percent of men over the age of 15 used tobacco products.
Unhealthy diets and a sedentary lifestyle are on the rise. And there has been a massive shift in social behaviours towards those often seen in developed countries. A sedentary lifestyle and endless fast food options have replaced the more traditional modes of work, travel and cuisine.
Research from the New York University Abu Dhabi (NYUAD) shows that the Emiratis also have a genetic predisposition to diabetes. There is a hypothesis that there is a link between genetics and the rapidly changing environment.
Although there are efforts to fight it, I feel the diagnosis of diabetes does not appear to be taken as seriously. People are not as devastated when they are told that they have such a life-threatening and life shortening disease with some serious consequences. I also feel that, amongst many other things we have spoken about regarding lifestyle, food and education, another factor might be the local attire. This has not been much looked into and it would be interesting to do a study. My own thought is that the western dress highlights the increase in weight and the potential obesity issue at a very early stage. And people who are conscious of the fact realize that they have to make certain changes in their lifestyle to remain the same clothes size/waist size.
What do you believe that the government, industry and health professionals should do in order to revert the situation, and advance towards a better level of care in this therapeutic area?
As this is such a herculean task, I really do not think that it is possible for one institution to deal with this immense problem alone. The epidemic of “Diabesity” has taken on the world but has particularly affected the oil-rich countries. We have exposed, the local Arab genes to the Western lifestyle with fast food and sedentary lifestyle.
As far as doctors and hospitals are concerned, I feel that they are doing an immensely great job and are essential in this firefight. There has been a tremendous amount of investment in this part of the world, with amazing infrastructure education and medical advancements. Where they have made the impossible… possible. We need interventions and necessary measures to stop the disease from occurring in the first place, which means focusing on prevention.
The government alone cannot deal with this big task and they have to seek help and partnership from everyone. We also need to take assistance from the pharmaceutical industry. This is an equally big challenge for them in helping us in stopping and preventing complications with their contribution.
We need educational programs, particularly in the shopping malls and pharmacies and supermarkets. We need our food industries to help to promote healthier food options. This includes food available in the supermarkets and in restaurants.
What are your expectations from the pharmaceutical companies?
No one can address the issue of diabetes alone. It has to be a collaboration of the government with the pharmaceutical companies. In 2015 Johnson & Johnson launched an initiative called ‘step up for life.’ There is also Johnson & Johnson Diabetes Institute which is coming up with innovative solutions to encourage patients to regularly check their blood sugar levels. That is a good place to start. Diabetes is a lifelong medical condition, but not a life sentence. With proper care, it would be possible to have a normal productive life.
Last year, the MoH launched a new app called Actiste, a device for remote management of diabetes. It is the world’s first service for remote treatment and management of diabetes. It is used to measure blood glucose, administer insulin and take notes and reminders at the same time. It automatically logs all treatment data so it can be shared via a mobile device with primary caregivers and family.
How do you access the level of education of the endocrinologists in the UAE?
I came to Dubai after practising for over 25 years in the UK and I am extremely impressed with the level of knowledge, experience and dedication that endocrinologists have here. They work to help the local community and thus to contribute towards reducing the misery of diabetes. I can see that there are a lot of educational events that are being held all over the UAE and there is ample opportunity for physicians to learn, network and share their experiences.
There is a lot of good research being done locally, but we need to realize that, although research appears to be expensive to begin with, it does bring a lot of benefit in the long run. We need to figure out better ways to tailor services to the local needs. I also feel that patients should be guided to the right specialists who have the expertise and knowledge at an early stage in order to prevent complications that present later on. We need to somehow get our insurance services to understand the importance of prevention, as in the long run, it would be cost-effective for their insurance business.
One of the biggest and desirable contributions I would like to make would be changing the food labelling in order to allow the general public to understand what they buy. Years ago, I conducted a study where we changed the food labelling to show the number of minutes required to burn those calories by walking instead of just the number of calories. As an example, if an adult man of average weight walks at a normal pace, it will burn 100 calories per 20 minutes. A can of soft drink would have a label suggesting it will take 30 minutes of walk to burn off that drink. So, in addition to reading and understanding calories, one would be able to also understand the time it would take to burn off that particular item
I feel that this will increase the knowledge about the food of the average person which we know from numerous studies is very limited.
What is your final message to our global audience?
I feel very strongly that the diabetes epidemic is a huge burden, particularly in the UAE. It has a huge negative impact on society. The effects of the disease are devastating when you think about it at a personal level. I also feel that this also presents a great opportunity for the pharmaceutical industry to be able to rise to the challenge.
This situation puts them in a position where they can help the UAE and the government by contributing to providing knowledge and resources. It will help in raising the stature of the pharmaceutical industry, being considered as part of the solution and not only as a for-profit business.