Economic burden: counting the cost of diabetes
The number of people in the UAE diagnosed with diabetes is expected to double to over 2.3 million by 2045, at a significant cost to the economy. It is estimated that the MENA region currently spends $20bn (AED 73.5bn) a year on treating diabetes and its complications, and this is forecast to increase to $37bn (AED 135.8) by 2045. But the economic burden of diabetes is far greater when you include lost working days and the cost to the community of an incapacitated breadwinner or mother as well.
There are three main diabetes variants: type 1, type 2 and gestational. The former is an auto-immune condition affecting the pancreas, which makes people unable to produce insulin – an essential hormone needed to transfer glucose to cells in the body to provide them with energy. It usually develops before adulthood and requires life-long insulin treatment.
The latter affects pregnant women, especially those who are prediabetic and overweight, or who gain more than 12kg in their first trimester of pregnancy. Hormones working against the body’s insulin production cause this variant.
The risk of developing type 2 diabetes is increased by an unhealthy lifestyle– poor diet, obesity and a lack of exercise, which over time cause the body to grow resistant to insulin.
Lifestyle-related diabetes: common causes and preventative measures
The UAE’s high rate of type 2 diabetes is concerning because it is largely preventable. The prevalence of type 2 diabetes has risen sharply in the last 30 to 40 years due to the adoption of sedentary lifestyles and the consumption of fast food. A lot of the meals consumed today are calorie-laden and of limited nutritional value. Most people work in offices with little exertion during the day, and evenings that could be spent exercising are often absorbed by television and social media.
Diabetes is a chronic disease, whereby the body is unable to maintain a healthy balance of glucose in the blood. If left untreated, it causes progressive damage to organs, leading to kidney and heart failure, blindness and limb amputation due to nerve damage. But if type 2 diabetes is caught early, it can usually be reversed through lifestyle change, which makes awareness campaigns and regular screenings so important.
Indeed, today, I see that we are witnessing a tipping point, where many UAE-based organisations and individuals are stepping out and joining in nationwide events to support a healthy lifestyle and/or specific challenges. They are also sharing stories, experiences and lifestyle tips through media, and now social media.
Why annual screening is so important
We advise annual screening for people at high risk of developing diabetes, such as those who are classified as obese, meaning a body mass index of 30 and above. Screening is especially important if a person has an immediate relative with diabetes as that makes them 80 per cent more likely to develop the disease as well. If they adopt a healthy lifestyle, the probability falls to 58 per cent. More regular screening will be recommended for people who are prediabetic or diabetic in order to measure what impact dietary and lifestyle changes are having on reducing their insulin resistance.
Eating a balanced diet, maintaining a normal weight and exercising regularly can help reverse type 2 diabetes. Weight loss makes the biggest impact. If a person has a body mass index above 40, the American Diabetes Association strongly advises bariatric surgery for 80% remission of diabetes.
Road to recovery: regular exercise and reduced sugar
It has been shown that walking briskly for 30 minutes a day five times a week can help people manage their weight and maintain a healthy waist circumference – this is important as it is the visceral fat on the organs that is especially harmful. Some 60% of our calorie expenditure comes from breathing, so if we breath faster from exercise we burn more. Physical activity also helps lower blood pressure and the risk of heart disease. To reverse type 2 diabetes, exercise needs to be combined with smart food choices. That means choosing low glycaemic index foods that are high in fibre and have low sugar content.
The Mediterranean diet is recognised as being the healthiest option for us. That does not mean pasta! It means lots of fish, tomatoes, vegetables, herbs and fresh fruit (fruit should be eaten whole, so we don’t lose the fibre that helps us digest it and prevents a spike in glucose levels).
We should avoid mass produced food. I tell my patients to always study the labels on the packaging of the food they buy and if they can’t pronounce the ingredients, they shouldn’t eat it. This is how you become more conscious of what you are putting into your body.
Fizzy drinks are especially bad for us as they contain 7-9 tablespoons of sugar and equal amounts of salt to balance the sweetness. The supposedly healthier sugar free versions are no better as the artificial sweeteners disrupt insulin production by overloading the pancreas.
Getting a good night’s sleep is another important element in a healthy lifestyle. At around 11pm, our bodies release growth hormones in our sleep, which is important for cell regeneration. If we stay up late, our glucose and insulin levels are disrupted, leading to weight gain, lethargy and irritability.
For those who do develop diabetes, eating a balanced diet, maintaining a normal weight and exercising regularly are also essential in order to effectively manage the disease in conjunction with medication (which doesn’t necessarily involve injections). This is another reason why screening is important. Diabetes is manageable. You can live a normal life with diabetes and by following your doctor’s recommendations you can avoid the complications associated with the disease.
Effective diabetes management involves three things: food; activity before/after food; and medication. It is important to pay attention to the time that meals are taken, the amount eaten and how the food mixes together. For example, if you eat again one hour after breakfast that interrupts digestion. Sleeping after a meal is also not good. Eating fruit and vegetables at the same time causes indigestion, so leave a gap of two hours. After exercise, you should wait one hour before eating or you will only burn off the food.
Multi-disciplined approach to diabetes management
At Imperial College London Diabetes Centre, we understand how hard it is to make lifestyle changes and we believe 20 minutes with a doctor is not enough. So we offer a multi-disciplined approach to diabetes management, which also includes time with an educator and a dietician. As a diabetes centre of excellence, we have cardiology, nephrology and ophthalmology departments as well.
We use technology to support our patients in their diabetes prevention and management. Our mobile application provides them with cues about their health indicators, providing encouragement and informing patients about what more they need to be doing. Technology is also used for 24-hour glucose monitoring, which helps identify patterns and reactions to different types of food and exercise.
Throughout the year, as part of Mubadala’s network of world-class healthcare providers, we also organise fitness events and diabetes awareness campaigns. Early in 2007, just months after Imperial College London Diabetes Centre opened its doors in Abu Dhabi to offer world-class treatment of diabetes and its related complications, the centre’s award-winning public health awareness campaign, Diabetes-Knowledge-Action was launched under the patronage of Her Highness Sheikha Fatima bint Mubrarak.
The campaign has directly connected to more than 200,000 people and we are hearing first-hand from participants who tell us that they now exercise regularly having taken part in campaign events. These include the Walking Challenge for corporate teams and the annual Walk for Life walkathon in November, a key pillar of the Diabetes-Knowledge-Action platform.
Thankfully, infrastructure is developing rapidly in the UAE and it is now much easier for people to exercise: there are running tracks, cycle lanes and promenades that everyone can access. I am also encouraged by the greater openness there is today about diabetes.
In the past, there was a lot of stigma surrounding diabetes, but now people are much more amenable about discussing it. This is important for raising awareness of the disease and encouraging people to get themselves tested.
As 50 per cent of cases of type 2 diabetes show no symptoms, it is very important to undergo regular screening and be aware of the risk factors, many of which are modifiable and include family history, unhealthy diet, pre-diabetes and obesity. The main symptoms are headaches, increased thirst, more frequent urination and unexplained weight loss.