Each Country should start Diabetes Registry and screen high risk groups-Prof. Morsi Arab


 MENA Symposium during IDEC 2016

Each Country should start Diabetes Registry
and screen high risk groups-Prof. Morsi Arab

Five out of ten countries in the world with highest
prevalence of diabetes are in MENA region

Countries in the Region should have their own
National Diabetes Control Programme-Dr. Nizar

KARACHI: Dr. Nizar Albache from Syria was the first speaker in the MENA symposium organized during the International Diabetes and Endocrine Congress 2016 by Baqai Institute of Diabetes and Endocrinology (BIDE) from August 19-21st 2016. The topic of his presentation was Diabetes in MENA Region, obstacles, difficulties and Regional Plan. Dr. Nizar pointed out that MENA region has five out of the ten countries which have the highest prevalence of Diabetes and it has serious complications like kidney diseases, heart diseases, stroke and diabetic foot. Prevalence of diabetes is high because of high risk factors.

Over the years there has been an increase in income in these countries which has led to life style changes, modification in diet wherein healthy diet has been replaced with fast food, high calorie intake, high lipids, more fat, more obesity, and no exercise. We see people with more weight gain. Increase in life expectancy and increase in population have all contributed to the increase in prevalence of diabetes.  This is a very costly disease and it is difficult to have same guidelines for all the countries in the region because of different cost, culture, and life style as well as healthcare expenditures. This region has seen many conflicts. Syria has a population of twenty two million of which over five million are at present refugees. Pakistan has almost six million people who are displaced. There is war in Afghanistan and political instability in many other countries. We need Insulin, moral support and funds for the refugees. We need injectable and monitoring equipment and instruments. We need to set up clinics for children suffering from diabetes. He also laid emphasis on diabetes education and training. He also suggested to have National Diabetes Control Programme in all the countries in the region but solutions will be different for different countries, he remarked.

Dr. Mesbah Kamel

Dr. Mesbah Kamel from Egypt was the next speaker who talked about establishment of diabetic clinics in low resource situations. He gave details of a Diabetic Clinic Model in remote areas. His study assessed the feasibility and effectiveness of a structured diabetes shared care service in remote areas and also analyzed its impact on total patient care. He was of the view that they wish to follow the Ibrahim Model which has worked wonders in Bangladesh. In the MENA region, majority of the people live below the poverty line. Just about nine minutes spent by the primary care physicians with the diabetes patients was not enough. Diabetic clinic set up was extremely important. Primary care section must go to the patient and prevention of Non-Communicable Diseases should be a priority with the Governments. In Egypt we have a dense population with limited resources. We started setting up these diabetic clinics in 2006. Every patient visiting these diabetic clinics has a medical file which contained information like HbAIc, Blood Pressure, Body Mass Index, lipid profile, CVS morbidity and mortality, micro vascular complications, psychosocial measures like smoking status, treatment satisfaction at the diabetic clinic besides diabetes wellbeing scores. We arranged health education sessions for the patients, HbAIc was brought under control, Blood pressure was controlled and it was all achieved at the primary care level. We found that CVS morbidity and mortality decreased because of these interventions. We also arranged special education for Ramadan and for Hajj. Because of these measures Self Blood Glucose Monitoring also increased. About 28% of these patients were lost to follow up because of no health insurance coverage. This experiment has been a success and the diabetics have welcomed this. Apart from ease of attending these special clinics, they are glad to come into an atmosphere which is familiar and they are welcomed by the staff whom these patients know.

Dr. Adel El-Sayed also from Egypt was the next speaker who talked about Culture and Demographic aspects of Diabetes Mellitus in the MENA Region. He pointed out that the Diabetes Atlas data prepared by IDF was now being challenged by some authors particularly so for developing countries. The factors which are cited include population growth, Aging population, rapid urbanization and no exercise which are the main causes of high prevalence of Type 2 Diabetes Mellitus in these countries. In addition there has been rapid economic growth, increased reliance on mechanization, change in life style, sedentary life, and no exercise. More than 50% deaths in our region are under sixty years of age. We have some of the richest countries of the world in this Region and disaster areas in Turkey, Lebanon, Jordan, Syrian refugees, displaced persons in Pakistan. Palestine has the highest obesity and Type2 diabetes is increasing in Palestine just like an epidemic.

Dr. Nizar Albache from Syria and Dr. Adel El-Sayed from Egypt chairing one of
the scientific session during the IDEC 2016 held at Karachi recently.

Dr. Abdullah Al-Hamaq from Qatar shared the details of their National Diabetes Strategy for prevention.  At present prevalence of diabetes in Qatar he said was about  17%.The objective is to prevent diabetes and its complications, increase public awareness about this disease, screen and detect diabetes at an early stage, ensure life style advice, education and counselling. It is planned that by 2020 Qatar will have robust diabetes programme, developed infrastructure, national research agenda to promote and motivate research in diabetes. By 2022 we plan to screen the entire Qatar population, all healthcare professionals will receive continuing education in diabetes care and those screened at risk population will be offered an annual health plan.

Prof. Morsi Arab again from Egypt was the last speaker in this session whose presentation was on Diabetes and Disasters: a real critical issue in the MENA Region. He laid emphasis on mobilization of all national resources and combine them together to achieve improved level of care for the country. Patients with diabetes, NGOs working in the field of diabetes, IDF, WHO, workers, schools, medical groups, professional societies, pharmaceutical industry, Media all have some role to play in this fight against diabetes. Ministry of Health, Health Minister and Parliamentarians all needs to be educated and it is the duty of the healthcare professionals to do that. Everyone should know what to do and what not to do. We must talk but then also do something instead of spending few nights at Five Star Hotels during such conferences.

Pregnant women with diabetes need to be provided drugs, insulin availability must be ensured for them. Education is the key to diabetes management hence much emphasis needs to be on education of the patients with diabetes. We need to arrange care for the special groups like elderly, pregnant diabetics. We must promote national research. We need to check false propaganda regarding cure of diabetes, false discoveries for diabetes cure. Media in particular needs to be careful, realize their responsibilities and refrain from spreading wrong information. Pharmacists has an important role but they should not be playing the role of physicians. Schools should have facilities for blood glucose monitoring, measurement and there should be no discrimination between normal children and those with diabetes. It is also important that each country introduces a National Diabetes Registry and start screening those at high risk, Prof. Mrosi Arab remarked.