One in five people in the UAE has diabetes, making it one of the most pressing healthcare challenges in the country. What’s needed to turn that statistic around, doctors agree, is education and research into the issue.
Dr Abdulkareem Sultan Al Olama, CEO of the Al Jalila Foundation, is at the forefront of efforts to invest in cutting-edge medical research and development to help combat the condition.
‘We aim to gain a better understanding about the aetiology of diabetes, how to prevent it and reverse the instances. We know that it is only through robust scientific insights that we can work towards our common goal to fighting diabetes,’ he tells Friday.
‘According to statistics, the UAE has one of the highest incidences of diabetes in the world and local research is critical to further discover the cause and prevention to reduce its prevalence in the UAE.’
Most urgent is Type 2 diabetes. ‘We welcome all types of research on diabetes, however with diabetes Type 2 being more prevalent in the UAE, and its significance to our other areas of focus such as cardiovascular disease and obesity, it currently receives the majority of support,’ he explains.
Collaboration between the likes of health authorities and governments is vital for progress to be made, he adds. ‘Today, ground-breaking, quality research can only emerge through collaboration and we work with various healthcare and educational partners, both locally and internationally, to achieve our common goals. Since 2014, we have awarded diabetes research grants to 13 scientists from medical institutions across the UAE. We look forward to when our research yields tangible results to improve the lives of people suffering from diabetes.’
Dr Hiba Kashmola, a family physician at Medcare Medical Centre in Sharjah, said with nearly one million people in the UAE diagnosed with diabetes, ‘what is more worrying is that nearly 450,000 are estimated to be undiagnosed cases’, according to findings from the International Diabetes Federation earlier this year.
Early detection and prevention are key. ‘Children as young as 13 years are getting afflicted by Type 2 diabetes. If we encourage people to go in for early screening, we can teach them to manage their condition with the right medication, lifestyle changes, good nutrition to prevent complications such as blindness, kidney disease and foot amputations in the longer term.
In Medcare group, we are doing free blood glucose tests and lipid profiles to increase the awareness to bring individuals as yet undiagnosed into the arena of knowledge. Type 2 diabetes, which is widespread, has a genetic predisposition. While we cannot control this factor, we can control other factors such as obesity, sedentary lifestyles, smoking and so on, to delay its onset and inculcate a culture of good health.’
Better education is vital, she says. Many believe people with diabetes should eat special diabetic foods, while Dr Kashmola says that in fact, ‘a healthy meal plan for people with diabetes is generally the same as healthy eating for anyone; low in saturated and trans fats, moderate in salt and sugar, with meals based on lean protein, non-starchy vegetables, whole grains, healthy fats and fruit’. She adds: ‘Diabetic foods generally offer no special benefit. Most of them still raise blood glucose levels, they are usually more expensive and can also have a laxative effect if they contain sugar alcohol.’
Dr Dima Abdelmannan, dean of Dubai Medical College, has been funded by the Al Jalila Foundation to research a new method of blood testing. The aim is to identify individuals at high future risk for Type 2 diabetes early while they still show as ‘normal’ in a glucose tolerance test.
‘The study is unique because unlike most studies, which address the disease or its complications, we are trying to look at very early prevention,’ said Dr Abdelmannan. ‘Such a simple test will provide a very useful tool to be utilised in clinical practice to identify subjects at increased risk for Type 2 and allows much earlier intervention to prevent and delay the onset of the condition.’
Dr Abdelmannan agrees that the challenges to overcoming the prevalence in the UAE are centred around education. ‘Despite all the ongoing efforts to increase awareness about the disease, there is a huge gap in education. Education about pre-diabetes and how to prevent or slow its progression, education about lifestyle interventions, and education about adherence to those and to medications when they are started,’ says Dr Abdelmannan.
There are specific traits to the disease in the UAE and Gulf region, she says, ‘lifestyle challenges as well as genetic predisposition’.
The only answer, she says, is ‘education’ and ‘awareness about early identification’. More collaboration between entities including hospitals, health authorities and researchers, she said is vital. ‘It takes collaboration between all the entities to shape the best way forward,’ she said. ‘[One] of the gaps, in my opinion, is the lack of consolidation of the efforts that are put in this field. There are many attempts that are taking place at different levels regarding awareness, diagnosis, treatment, however at the same time, we see too much fragmentation.’
Dr George Cherian, a specialist of internal medicine at Aster Clinic in Al Qusais, says the rising number of young people being diagnosed with Type 2 diabetes is a huge concern. ‘Earlier it was seen in people above the age of 50. These days there are innumerable cases of youngsters who have diabetes. Type 2 diabetes is much more common than Type 1 and typically develops in adults, although now children as young as 13 years of age develop the condition.’
The change, he says, ‘appears to be driven by genetics and unhealthy lifestyle conditions’, though genetic factors are out of an individual’s control. He says many misconceptions must be broken through better education.
‘One common misconception people have about diabetes is that it is not a dangerous disease. Diabetes is a silent killer – most people with Type 2 diabetes do not even know that they suffer from the condition because it depicts no symptoms,’ he said.
Though the prevalence of Type 2 diabetes vastly overtakes Type 1, which is believed to be around 3 to 4 per cent of all cases, its incidence is also growing, meaning more research into this area is vital, too.
Dr Cherian said: ‘Type 1 diabetes is an auto-immune disorder that usually occurs before 20 years of age. It is a serious and challenging disease and long-term management continues to evolve, allowing those with Type 1 diabetes to lead full and active lives. Though rare, when compared to Type 2 diabetes, there has been a 21 per cent increase in prevalence of Type 1 diabetes between 2001 and 2009 in the US. Hence it is important that active research in the disease keeps continuing and progressing.’
Pamela Durant would agree. Pamela took a career break as a healthcare consultant to care for her son, now nine, who suffers from Type 1 diabetes. He was diagnosed at just 20 months old.
‘I always welcome more Type 1 coverage because the number of new cases is growing, and highlighting it more just might encourage some aspiring scientist to find a cure,’ Pamela says.
The American expatriate, who has been in the UAE for 15 years, said the news of her son’s condition was ‘a shock’. ‘As we have no family history of this, to say it was a shock is an understatement,’ she said. ‘A diagnosis of Type 1 is always a shock at any age and while you are digesting the news of this diagnosis, there is a steep learning curve that you have to conquer at the same time in order to keep your child healthy and alive. Even though my husband was trained as a physician, and I worked in healthcare management, we still found it overwhelming. There is nothing that can really prepare you for this diagnosis until you have lived with it.’
Taking a career break was a necessary part of the process, she says. ‘I was working as a healthcare consultant at the time of my son’s diagnosis, and in order to care for him, I could no longer be a client-facing consultant. I needed more flexibility to be there for my son, so I took a position that did not require travel that allowed me to have the occasional flexibility to meet my son’s health needs.’
But a lack of information hampered her ability to care for him: At that time, she says, there were very few physicians in the UAE that understood Type 1. She visited a well-known diabetes centre of excellence in the US, spending a few weeks meeting physicians, diabetes nurse educators, psychologists, social workers and others who taught her how to care for my son.
‘However, when we returned to Dubai it was very difficult. I was alone in managing this, and it took us at least two years to find a doctor here who really understood the condition. Meanwhile, I tried to establish the new normal of my son’s life with diabetes as soon as I could. I knew it was imperative for him to have a normal childhood.’
Last year, she set up DiapointME to help others that have been touched by diabetes. ‘The job of a pancreas is 24/7, and it is overwhelming. When I started this journey, I was incredibly alone and no one understood what my son was going through and how that was affecting our whole family.
‘While everyone has to find his or her own way with diabetes, I thought that if I could just help flatten the mountain of a learning curve that comes with a diabetes diagnosis – even if by a small amount – then I could offer much more, and help more people, than just continue with the previous work I was doing.’
Managing diabetes, is, she says ‘incredibly demanding’. She said: ‘No two diabetics are alike, and even the same diabetic can do the exact same thing on two different days and still get different results. This is not avoidable, and can create a lot of frustration – even for the seasoned caretaker.
‘There is no break. It is a 24-hour job. Yes, parenting is a 24-hour job, but throw in Type 1 diabetes and the job is incredibly overwhelming. As a caretaker this is stressful. Many do not sleep much as they are up throughout the night checking and managing blood sugars. As Type 1 children become adults, they take on this burden of managing their own disease. It is not easy for them either.’
For children, it can be a tough time. ‘Sometimes Type 1 children are excluded from activities or parties because people assume they cannot participate because of their condition,’ she said.
‘This is far from the truth. A Type 1 child can do everything a non-diabetic child can. And, as long as they know how to count carbohydrates and dose for insulin, they can eat the same things as well. It is heartbreaking for them when they are left out or treated differently. It is a manageable condition – it takes a lot of hard work, and arming yourself with the best medical information that you can find is key. We are fortunate that now in the UAE there are many very good doctors and centres that have the ability to support a Type 1 and their family on this journey. Teaming with a doctor and diabetes medical team that is knowledgeable about Type 1 is critical to one’s success in managing this disease.’