The big D
Diabetes has become so prevalent you have to wonder whether it’s something that has always been as common, it’s just that now there’s a lot more people who can make money off treating it. This, however, would be an entirely pessimistic view as while there is clearly more awareness of the disease, its impact on a generation that spent a lifetime living large, and indeed their children, is undeniable.
Diabetes is now in almost every office, every school room and every town, which should be somewhat comforting to anyone with the disease because it’s not something the big drug companies or health organizations can ignore.
The situation in the Gulf is even direr than it is in most other areas on the planet. Partly due to lifestyle that includes excessive amounts of stress and fatty foods, and also because of a muted genetic predisposition, diabetes is a huge deal in this region.
Perhaps the most startling aspect of diabetes is the many ways it can be detected. It can take a year of poor health before a sufferer realises the root cause of their illness. Symptoms that include an unquenchable thirst, blurred vision and violent cravings can force sufferers to conclude they could be “allergic” to sugary foods as tame as carrots, or slipping into bouts of alcoholism, or even going prematurely blind.
Doctor Maha Taysir Barakat, who is a Consultant Endocrinologist, Medical & Research Director at the Imperial College London Diabetes centre in Abu Dhabi, said things get really “scary” when patients show no symptoms.
“There is a huge spectrum of symptoms, but what’s really scary is when people that have zero symptoms,” said Doctor Barakat. “These people are as fit as ever and then one day they just go down. “Most sufferers tend to get sick and seek help because the symptoms can range from being very thirsty and needing to pass urine all the time. Being tired is also another one, diabetes brings on inexplicable bouts of tiredness and also blurred vision.
“I’ve had patients who thought their vision was going and they have their spectacles changed three or four times over a four month period. Then they find out they have diabetes, their eyes get better and then they have to go and get them changed again because the sugar deficiency in diabetes can effect the lens in your eyes.”
Thirst is another big symptom of diabetes, which is why sufferers must be very wary of sports drinks and other drinks, like beer, that contain large amounts of sugar and other chemicals.
“Do you remember, for instance, when Lucozade came out with the advert featuring Daley Thompson? (British decathlete gold medallist) In the ads he said Lucozade was healthy because it helped quench your thirst,” said Dr Barakat.
“And that was fine as a thirst quencher for athletes and others who needed the sugar after exercise, but for someone feeling thirsty for another reason (like diabetes) if they drank a sugary drink, they could become very sick. And I’ve seen people with glucose levels as high as 900 because they’ve levels have spiked so much.”
WHAT IS DIABETES?
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
Type 1 diabetes (previously known as insulin-dependent or childhood-onset) is characterized by a lack of insulin production. Without daily administration of insulin, Type 1 diabetes is rapidly fatal. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.
Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90 percent of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.
Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring in obese children. Gestational diabetes is hyperglycaemia which is first recognized during pregnancy.
Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms. Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to Type 2 diabetes, although this is not inevitable.
WHAT ARE COMMON CONSEQUENCES OF DIABETES?
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2 per centof people become blind, and about 10 per cent develop severe visual impairment.
Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50 per cent of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.
Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation. Diabetes is also among the leading causes of kidney failure.
HOW TO MITIGATE OR AVOID IT
To help prevent type 2 diabetes and its complications, people should:
- Achieve and maintain healthy body weight.
- Be physically active - at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control.
- Early diagnosis can be accomplished through relatively inexpensive blood testing.
- Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage to blood vessels.
Tobacco cessation is also important to avoid complications.
Interventions that are both cost saving and feasible in developing countries include:
• Moderate blood glucose control. People with Type 1 diabetes require insulin; people with Type 2 diabetes can be treated with oral medication, but may also require insulin;
• Blood pressure control;
• Foot care.
Other cost saving interventions include:
• Screening for retinopathy (which causes blindness);
• Blood lipid control (to regulate cholesterol levels);
• Screening for early signs of diabetes related kidney disease.
Diabetes can be a real chore but many diabetics have attained great success. They include actors Halle Berry, George C Scott, James Cagney, Mary Tyler Moore and Mae West and writers Ernest Hemingway, HG Wells and Mario Puzo. Elvis Presley was a diabetic as was Johnny Cash. So are rockers Mick Fleetwood, Andrew Lloyd Webber and Meatloaf.
Some famous diabetics on the political scene have been Yuri Andropov, Anwar Sadat and Mikhail Gorbachev.
The most famous sportsman with diabetes was legendary “Sugar” Ray Robinson, hence the nickname. Five-time Olympic gold medallist Sir Steve Redgrave is a diabetic as are Wasim Akram, the cricketer and tennis player Bille Jean King.
Diabetes 20/20 in the Gulf
What are the statistics on how many people in UAE have diabetes/what percentage of people in UAE have diabetes?
In the UAE it is estimated that one out of five people aged 20 to 79 lives with this disease, while a similar percent of population is at risk of developing it. This year, the UAE ranked second highest worldwide for diabetes prevalence, followed by Saudi Arabia, Bahrain, and Kuwait (International Diabetes Federation (IDF) 2007)
Which group of people are most affected age/gender etc?
Most diabetes sufferers are between the ages of 40 to 59 years, with research showing a worrying rise among younger age groups. As for gender distribution, the estimates for both 2003 and 2025 showed a female predominance in the number of persons with diabetes. The female numbers were about 10 per cent higher than for males. There was also a female predominance in the number of persons with Impaired Glucose Tolerance (IGT) in the estimates for both 2003 and 2025. The female numbers were about 20 per cent higher than for males.
Polycystic ovary syndrome affects up to 5-10 per cent of females in their reproductive years and is thought to predispose their children to glucose intolerance, with studies showing up to 30-40 per cent being affected by IGT and up to 7-10 per cent with type 2 diabetes. This may explain why there are more females with type 2 diabetes amongst adolescents. (IDF 2007)
How many people are believed to have diabetes but are undiagnosed and is under-diagnosis an issue?
In a UAE Ministry of Health study conducted in 2000, approximately half of the people with diabetes in the UAE were unaware that they suffer from diabetes.
Is diabetes on the rise in UAE - and why?
Yes, diabetes is on the rise in the UAE. There seems to be a genetic predisposition to the disease among UAE Nationals and statistics show that they have a higher prevalence than other Nationalities within the UAE. However tendencies towards lifestyle, weight gain, an imbalanced diet and/or a lack of exercise seem to be major contributors. Research is ongoing with the overriding aim to help explain why diabetes occurs at such high levels in the country. This will also help instigate preventative measures.
What are some of the serious effects of diabetes you are seeing in UAE?
Diabetes brings with it several serious complications related to the heart, eyes, blood vessels, kidneys, feet and nerves. The overall risk of premature death among people with diabetes is at least double the risk of their peers without diabetes. According to statistics, mortality linked to diabetes, mellitus constitutes 75 per cent percent of the deaths among UAE nationals and 31 per cent among non-nationals.
How much do fast food outlets contribute to the obesity problem?
When eaten in excess, any type of food could contribute to the problems of diabetes and obesity. Unhealthy fast food is no exception of course, but we have to remember to distinguish between healthy and unhealthy fast food. There are now healthy fast food outlets that provide an alternative to what we conventionally know as fast food.
In my opinion, increased education on what the ingredients of unhealthy fast food can do to one’s body would be helpful and regulation of unhealthy fast food sales and marketing could also be key. Tackle the marketing of unhealthy fast food whilst simultaneously educating people about the risks of consuming such foods and I think we would see significant positive changes.
If banning smoking in restaurants, bars, can help the health-related problems with smoking, should levels of trans-fats and calorie content in fast food also be regulated in places like the UAE?
Regulation of this sort would definitely and without a doubt help, not just in the UAE but globally.
Are people in the UAE essentially just lazy?
No, I do not think it would be appropriate to generalise. People in the UAE work very hard, but today’s culture at work and in general tends to keep people tied down, to their desks or in traffic jams. This could pose a challenge for many people but, they should make time for exercise in spite of it. Studies have proven that simple exercise such as walking for half and hour, five days a week can decrease your risk of type 2 diabetes. The key to prevention of type 2 diabetes, even in those with predisposing genes is to maintain a normal body weight and to exercise regularly. The International Diabetes Federation (IDF) has stated that, up to 80 per cent of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity.
The UAE has the second-worst record for diabetes in the world, but Saudi Arabia, Qatar, Bahrain and Kuwait are also among the top five. What is it about the Gulf Region that is causing such a problem?
Estimated prevalence of diabetes according to 2007 world statistics shows the island of Nauru leading with 30.7 percent prevalence. UAE, number two at 19.5 per cent, Saudi Arabia follows with 16.7 percent prevalence. Bahrain stands fourth highest with 15.2 percent and Kuwait with 14.4 percent diabetes prevalence.
There seems to be a genetic predisposition to the disease in the Gulf region, but this risk may be mitigated if one leads a healthy lifestyle. An increased prevalence of diabetes among expatriates in the region as opposed to in their countries of origin indicate that genes are not the only factor in play and that environment (lack of exercise with high fat, high sugar diet) plays a major role as well.
Is ICLDC spreading messages about fast food causing other health problems like obesity, cardio vascular diseases etc in the awareness programmes?
Spreading healthy eating messages are the campaign’s priorities because these methods are the most effective ways to prevent, treat and or manage the disease. ICLDC’s aim is to help the population move towards healthier lifestyles and for those who have already been diagnosed with diabetes to adopt the latest evidence-based treatments. Through ‘DIABETES.KNOWLEDGE.ACTION’ we are reaching out to people across the UAE through several activities. We have rolled out I WONDER…, a public screening programme in which we screen people at high risk for diabetes.
I EAT RIGHT, an educational initiative aimed at getting children, mothers and carers to take a look at, and possibly change, what’s the children’s lunch boxes. We’re planning I PLAY SPORTS, a fun Corporate World vs. the Field Professionals football tournament with the UAE National team hopefully taking on members of the UAE’s commercial sector. I WALK to bring the community together in a walkathon to raise awareness and hopefully raise money that can be ploughed back into diabetes research public health initiatives.
We’re also working with UAE celebrity Chefs for I COOK HEALTHILY where we will be producing a recipe book and DVD to show people how they can make their own meals healthy.
What are the main causes of the incidence of diabetes in UAE i.e. the triggers/ factors contributing to diabetes?
Diabetes is a condition that is characterised by an above normal level of glucose (sugar) in the blood. This is because the pancreas does not make enough insulin or insulin becomes ineffective. Insulin, a hormone generated in the pancreas, normally controls blood sugar levels and allows the glucose to enter the cells in the body to provide energy. In people with diabetes, high levels of glucose remain in the bloodstream causing Hyperglycaemia (high blood sugar).
Those at increased risk include individuals who have a history of diabetes in their family, people over 40, those who are overweight or obese and inactive individuals.
These are just a few of the plans, you can catch up with on. Our aim is to inform people of the ways to maintain a healthy life, the risks of an unhealthy life, the complications that diabetes brings with it while making available the latest evidence-based treatments.
(all responses in this Q&A are by Doctor Barakat)
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