DUBAI: Controlling the sweet tooth is not the only lifestyle choice that will determine whether or not an individual will develop diabetes in the course of their lifetime. The chronic disease, which has seen an alarming rise in cases across the world over the past decade, has been linked to sedentary lifestyles, unhealthy diets and obesity.
Inadequate knowledge about the prevention and management of the condition in many countries led the International Diabetes Federation to make “access to diabetes education” the theme of World Diabetes Day for the third consecutive year.
Every year, campaigns are launched around the world on Nov. 14 to help raise awareness about the disease, which, as of 2021, affected 537 million adults between the ages of 20 and 79 worldwide.
In recent years, cases of Type 2 diabetes have skyrocketed in specific regions, including the Middle East and North Africa — particularly in the Gulf Cooperation Council area. Countries such as Kuwait, Saudi Arabia and Bahrain now rank among the top 10 nations with the highest prevalence of Type 2 diabetes.
In the UAE, as many as one in five people have diabetes, with Type 2 being the most common form, according to Cleveland Clinic Abu Dhabi. This number is expected to double by 2040.
In response to this seemingly inexorable increase in cases, health experts are examining everything from lifestyle trends to technological advancements and healthcare systems to determine what can be done to slow the spread and identify how much is down to genetics.
According to Dr. Sara Suliman, consultant endocrinologist and diabetologist at the Imperial College London Diabetes Centre in Abu Dhabi, variables such as urbanization, changing climate, mobility and food availability influence rates of diabetes in different areas.
“The GCC, being one of the richer areas in the world, has seen far more use of cars, far more easy access to food, including high-calorie food, and is one of the leading areas in the world as far as an increase in diabetes cases is concerned,” she told Arab News.
The situation is just as worrying in other countries of the Middle East and North Africa. Data from 2021 shows that 73 million adults (aged 20-79) across the MENA region are living with diabetes — a figure that is estimated to grow to 95 million by 2030 and 136 million by 2045.
“Until very recently, we were hanging a lot of things on genes. We do know if one parent has diabetes (Type 2), then there is a 40 percent chance of an individual getting diabetes, and that if two parents have diabetes, then there is an 80 percent chance of the individual becoming affected,” said Suliman.
In fact, not only is Type 2 diabetes preventable, it can also be reversed through a complete change in lifestyle. Unfortunately, this is not the case for Type 1.
With genetics accounting for only 5-10 percent of cases, Type 1 diabetes is thought to be caused by an autoimmune reaction, which leads the body to attack itself, destroying the cells in the pancreas responsible for producing insulin.
“For Type 1 diabetes, the treatment is insulin and will always be insulin. But with Type 2, we have different options,” said Suliman.
It is no secret that excessive consumption of fizzy drinks, energy shots, sweetened juices and processed junk foods tops the list of diets that result in high blood sugar levels (or blood glucose levels).
An unhealthy diet coupled with a lack of regular exercise, fewer than seven hours of sleep per night and poor hydration significantly increases the risk of obesity as well as type 2 diabetes, said Suliman.
“Obesity is another major problem in the Gulf countries,” she said. “For example, 50 percent of children in Kuwait are at the moment either overweight or obese.”
* 537m Adults living with diabetes in 2021, predicted to rise to 643m by 2030, 783m by 2045.
* 3/4 Proportion of adults with diabetes who live in low- and middle-income countries.
* 6.7m Number of deaths caused by diabetes in 2021 — 1 every 5 seconds.
Source: International Diabetes Federation
Studies predict that at least 10 countries in the MENA region will have more than a million children suffering from obesity by 2030.
Looking at the problem through a different lens, Dr. Ihsan Al-Marzooqi, co-founder and managing director of Glucare Health, says although bad habits significantly impact rates of diabetes, there is another side to the story.
“While it is easy to blame patients for their lifestyle choices, the reason we see this growth is because, over the past 40 years, healthcare providers have not changed their model of care to tackle the root cause of the disease,” he told Arab News.
“Despite all the advances we have seen in healthcare, the system still treats patients episodically — a quick 15 minutes with your doctor every quarter — with a strong emphasis on prescription medications.”
Describing diabetes as “fundamentally a behavioral problem,” Al-Marzooqi highlighted the need for healthcare providers to focus on innovating care models that provide a more consistent follow-up approach that emphasizes changes in behavior.
To achieve this, providers need to consistently record new sets of personal data for each patient, a practice Al-Marzooqi says has not yet evolved in MENA countries.
Critiquing current care models, he says patients have little knowledge about the effect of their actions on their health, adding that this has resulted in a large number of poorly controlled diabetics in the GCC.
“We believe that most patients simply do not have agency over their own health, as in they cannot contextualize the extent of how their lifestyle choices can ultimately affect their diabetes outcome,” he said.
At the same time, “providers will always advise their patients on lifestyle modification, but none will actually track the advice they give.”
According to Al-Marzooqi, the outcome is evident in the data collected, which indicates that almost 75 percent of managed diabetics in the GCC with access to care are classified as “poorly controlled.”
Highlighting predictions of a regionwide “tsunami” of healthcare bills as a result of the situation, he says diabetes need not be a costly disease to manage.
“The complications from poorly controlled diabetes are what lead to almost a quarter of healthcare budgets being spent on diabetes,” he said.
To end this cycle, Al-Marzooqi says governments should incentivize healthcare providers by rewarding them for clinical outcomes as opposed to the current fee-for-service models.
If a value-based reimbursement model is put into practice, he argues, providers who innovate and invest in new modalities, such as digital therapeutics, will end up with a better engaged and better managed population. This, in turn, could reduce future complications, thereby reducing the overall cost.
On the upside, Gulf governments have been making efforts to raise awareness about the disease. Early education and training on managing the condition and promoting healthy lifestyles are now widespread at schools and universities in the region, says Suliman.
Some governments have got municipalities to set up public walkways and running tracks and outdoor gyms and ministries to launch nationwide fitness campaigns to encourage people to get active.
Another example of state intervention is the sugar tax in the UAE, announced in 2019, which applies a 50 percent tax on all sugar-sweetened beverages.
From a technological standpoint, treating diabetes has also come a long way, says Suliman. Historically, diabetes patients had no choice but to prick their finger several times a day to monitor their blood sugar and self-inject insulin when needed.
“We are now spoiled for choice,” she said. Significant progress has been made in the development of glucose sensors and insulin pumps. These devices allow patients to keep track of their sugar levels with live updates on their mobile phones.
Additionally, patients who are in need of insulin on a daily basis have the choice of installing a sensor and pump device that can take care of tracking and applying the right dosage needed to avoid the traditional method of injection.
“There are signs that we can at least flatten the curve,” said Suliman, who believes the younger generation is more conscious of better lifestyle choices.
“The problem is, the rise in diabetes cases has been so steep as to be scary, and if the pessimistic forecasts come true, it would be even scarier.”
She added: “We all have to move in the same direction.”
DUBAI: Iran has begun enriching uranium to 60 percent purity at its underground Fordow nuclear site, state media reported on Tuesday, a move that may annoy Western powers pushing Tehran to roll back its nuclear work by reviving a 2015 pact.
Iran is already enriching uranium to up to 60 percent purity elsewhere, well below the roughly 90 percent needed for weapons-grade material but above the 20 percent it produced before the 2015 agreement with major powers to cap enrichment at 3.67 percent.
“In a letter to the International Atomic Energy Agency (IAEA), Iran has informed the agency that it has started enriching uranium to 60 percent purity at Fordow site using IR-6 advanced centrifuges,” the semi-official ISNA news agency reported.
The IAEA’s 35-nation Board of Governors on Thursday passed a resolution ordering Iran to cooperate urgently with the agency’s investigation into uranium traces found at three undeclared sites, diplomats at the closed-door vote said.
The semi-official Fars news agency said Tehran had also started the process of “replacing the first-generation centrifuges (IR-1) with advanced IR-6 ones” at Fordow, a site buried inside a mountain.
The 2015 nuclear pact between Iran and six world powers lets Iran use only first-generation IR-1 centrifuges but, as the deal unraveled after then-President Donald Trump ditched it in 2018, Tehran installed cascades of more efficient advanced centrifuges, such as the IR-2m, IR-4 and IR-6.
In June, Reuters reported that Tehran was escalating its uranium enrichment further by preparing to use IR-6 centrifuges, which can easily switch between enrichment levels, at the Fordow site.
Iran’s SNN television network said Tehran had begun installing new cascades, or clusters, of advanced centrifuges at its Natanz and Fordow nuclear sites, adding that doing so was a “strong response” to the IAEA’s latest resolution.
“Iran has started the process of injecting gas into two cascades of IR-2m and IR-4 advanced centrifuges at the underground Natanz site,” SNN reported.
The IAEA resolution is the second this year targeting Iran over the investigation, which has become an obstacle to talks on reviving the 2015 Iran nuclear deal because Iran has demanded that the probe be ended.
Iran’s foreign ministry on Monday dismissed the resolution as “politically motivated.” Indirect talks between Tehran and US President Joe Biden’s administration to revive the 2015 accord have been at a stalemate since September, with both sides demanding more flexibility.
Iran’s crackdown on anti-government protests sparked by Mahsa Amini’s death in custody and the sale of drones to Russia have turned the United States’ focus away from reviving a nuclear deal, US special envoy for Iran Robert Malley said on Monday.
Iran denies selling drones to Russia for use in the Ukraine war.
JEDDAH: Iranian security forces on Monday were using heavy weapons to suppress protests in Kurdish-populated regions in Iran’s west, intensifying a crackdown that has killed a dozen people over the last 24 hours, rights groups said.
The Kurdish-populated provinces of western and northwestern Iran have been major hubs of protest since the onset of the movement sparked by the death in September of young Kurdish woman Mahsa Amini, who had been arrested by morality police in Tehran.
There have been particularly intense anti-regime demonstrations in several towns in the last few days, largely sparked by the funerals of people said to have been killed by the security forces in previous protests.
The Norway-based Hengaw rights group said Iranian forces had shelled the cities of Piranshahr, Marivan and Javanroud, posting videos with the thud of heavy weaponry and sound of live gunfire.
It said 13 people had been killed in the region by the security forces over the last 24 hours, including seven in Javanroud, four in Piranshahr and two more in other locations.
Among six people killed by fire from the security forces on Sunday was 16-year-old Karwan Ghader Shokri, Hengaw said.
Another man was killed when security forces fired on crowds as the teenager’s body was being brought to the mosque, it added.
The latest violence came amid continued concern over the situation in Mahabad.
Activists warn Iran was planning to use capital punishment as a means to quell the protest movement by spreading a climate of fear in the population.
Amnesty said the authorities’ pursuit of the death penalty is “designed to intimidate those participating in the popular uprising … and deter others from joining the movement.”
The strategy aims to “instill fear among the public,” it added, condemning a “chilling escalation in the use of the death penalty as a tool of political repression and the systematic violation of fair trial rights in Iran.”
Iraq condemned attacks on its northern Kurdistan region.
AL-MUKALLA, Yemen: Ninety-two children were killed and 241 injured in Yemen between the start of January and Nov. 15 despite a relative lull in hostilities under a truce brokered by the UN on April 2, according to international charitable organization Save the Children.
It said a child has been killed or injured every day this year in Yemen, as it urged armed factions in the war-torn country to protect children and refrain from attacking civilian locations and gatherings.
Children in the besieged city of Taiz told the organization that arbitrary shelling and fighting have prevented them from going to school or hospital, or even venturing out of their homes. They urged rights groups to put pressure on warring factions to protect children from mistreatment and violence, protect schools and hospitals, and push for an extension to the truce, which expired in October without a renewal agreement.
“There can never be a justification for killing or abusing children and the world must act now to stop the impunity of these crimes,”said Rama Hansraj, Save the Children’s country director for Yemen.
“Yemen’s future depends on its children, and their safety and well-being are the true indicators of peace and stability.”
A Yemeni rights organization said the Iran-backed Houthis are responsible for the deaths of thousands of Yemeni children during the war by forcing them to fight in the conflict, shelling their homes, schools and other civilian institutions, and laying thousands of landmines across the country.
The Network for Rights and Freedom said in addition to 6,728 children who died on the front lines and were formally grieved by the Houthis, the militia were responsible for the deaths of a further 3,597 children between January 2015 and July this year.
Of those 3,597, 519 were killed by Houthi snipers, 748 by shelling, and 514 died as a result of Houthi sieges of their cities and villages, including in Taiz. A further 647 youngsters lost their lives to landmines.
Houthi landmines, snipers and bombardments of residential areas injured 6,317 children during the same period, including 516 who suffered permanent disabilities or amputations.
Of all Yemeni cities, the number of child deaths and injuries was highest in Taiz, followed by western Hodeidah, Marib, Aden and Lahj.
“The Houthi militia forced hundreds of children to drop out of school and work in a perilous labor market with no legal or moral safeguards to support their families, leaving many of them vulnerable to Houthi militia recruiting gangs,” the NRF said.
Meanwhile, fighting between government troops and the Houthis broke out on Monday morning in a number of contested areas outside Taiz, according to local military officials and residents.
Yemen’s army said it pushed back a fresh Houthi assault on government-controlled areas to the west and north of Taiz, the latest in a series of attempts by the militia to seize control of new areas.
Residents said the Houthis on Sunday evening shelled residential areas near an old airfield west of Taiz, injuring a child and causing large explosions.
BEIRUT: Lebanon will on Tuesday ditch its traditional military parade for 79th Independence Day celebrations due to the continued presidential vacuum in the country.
Army chiefs said the decision had been made with the “national interest” in mind and to maintain “security and stability.”
Addressing troops on Monday, army commander, Gen. Joseph Aoun, said: “Our country is going through exceptional circumstances that require everyone, officials, and citizens, to be aware, wise, responsible, and cooperate for the sake of the supreme national interest while waiting for the political situation to be rectified and order to be restored.
“Independence is the fruit of the honorable struggle waged by the Lebanese, just as it is the fruit of the fateful challenges they faced and overcame with their unity and determination, leading to building a homeland on solid foundations, so we must preserve and protect it.”
He pointed out that the recent maritime border demarcation agreement between Lebanon and Israel had been “an important step” toward the nation’s recovery and an investment in its natural wealth.
“This achievement needs state institutions to protect and accompany it, for the benefit of the country and the Lebanese.
“Amid the presidential vacuum and the prevailing political tensions, maintaining security and stability remains our top priority. We will not allow any violation or destabilization of civil peace for certain objectives.
“Our mission was and will remain to preserve Lebanon, its people, and its land,” Aoun added.
The general praised soldiers for their discipline during the country’s ongoing economic crisis. “You have maintained your morals in dealing with all the events and incidents that our country has experienced. With your oath and vigilance, you protected Lebanon and will continue to protect it until the last drop of blood.”
He said the army would continue to coordinate with the UN Interim Force in Lebanon to maintain stability in the south.
“The confidence of the Lebanese and the international community have in you is proof of the importance of your role, so do not weaken in the face of dangers, and do not tire of campaigns of profiteering and false accusations,” he added.
In February, Aoun warned that soldiers were suffering from the same economic hardships as Lebanese civilians, and he directly criticized the political leadership for its inability to address the situation.
Arab and other countries have since donated food and medical aid for Lebanon’s military personnel.
Also addressing the military, Director General of General Security Maj. Gen. Abbas Ibrahim said Lebanon had never experienced such levels of sectarianism and regionalism, along with the ruination of state institutions.
“We need to be ready for what might happen, especially as we are responsible before the Lebanese to preserve and protect the homeland,” he added.
Ibrahim noted that states were not based on individual guarantees, but on constitutional institutions and a commitment to apply laws.
Maj. Gen. Tony Saliba, director general of State Security, told troops: “Power vacuum does not at all mean a security vacuum. Our top priority is to protect the country from the Israeli enemy, terrorism, and corruption.”
Lebanon’s Grand Mufti Sheikh Abdel Latif Derian urged MPs, “to take an initiative on the occasion of Independence Day by agreeing to elect a new president who has the characteristics that remind us of the independence leaders who fought and sacrificed for their homeland.
“The situation in Lebanon will not be corrected except by electing a president, forming a government, and restoring Lebanese-Arab relations, especially with the countries of the Gulf Cooperation Council. Otherwise, we are only wasting time.”
During the coronavirus pandemic, and following the Beirut port explosion, Lebanon stopped holding the Nov. 22 Independence Day military parade on the capital’s waterfront.
In 2021, a symbolic military parade was held at the army headquarters in the Yarzeh region, in the presence of former President Michel Aoun, Parliament Speaker Nabih Berri, and caretaker Prime Minister Najib Mikati.
The economic crisis in Lebanon has placed unprecedented pressure on the operational capabilities of the army, leaving soldiers with low morale and minimal pay, while political tensions have continued to mount, and crime and poverty rates have soared.
Ministers in the caretaker government on Monday laid wreaths on the tombs of the independence leaders.
As the Lebanese flag flew at half-mast over the presidential palace, schoolchildren also celebrated Flag Day, which falls the day before Independence Day.
CAIRO: Turkish President Recep Tayyip Erdogan met with his Egyptian counterpart Abdel Fattah El-Sisi for the first time on the sidelines of the inauguration of the 2022 World Cup in Qatar.
In what has been described as a historic moment, the two presidents shook hands with each other, with Qatar Emir Sheikh Tamim bin Hamad standing next to them.
Although neither side has commented on the meeting, the picture showing the two presidents smiling and shaking hands prior to the opening ceremony — published on the official website of the Turkish presidency — has been widely shared.
Al-Qahera News Channel reported as urgent news that a tripartite summit was held between the leaders of Qatar, Egypt and Turkiye.
Erdogan also briefly met with other leaders, including Palestinian President Mahmoud Abbas and Jordan’s King Abdullah, for a handshake and talks, according to Turkiye’s Anadolu Agency.
Turkiye has been making efforts to warm ties with Egypt since last year.
Relations between Egypt and Turkiye became strained in 2013 with the overthrow of late President Mohammed Mursi, who was supported by Erdogan’s administration at the time. Ties were further made tense as a result of the turmoil in Libya, which borders Egypt to the west.
A dispute also arose in 2019 when Turkiye and the Libyan Government of National Accord signed a memorandum of understanding in November on sovereignty over maritime areas in the Mediterranean.
Turkiye was supporting the Tripoli-based Government of National Unity, whose legitimacy was contested by the Libyan parliament.
In October, Turkish Foreign Minister Mevlut Cavusoglu announced the signing of a memorandum of understanding for oil and gas exploration in the territorial waters of Libya by joint Turkish-Libyan companies. Egypt and Greece have rejected the MoU.
Cairo and Ankara undertook two rounds of exploratory negotiations last year, led by the deputy foreign ministers of Egypt and Turkiye, in an effort to boost ties.
Egypt’s Foreign Minister Sameh Shoukry stated last month that the two exploratory meetings gave “us the chance to voice our concerns over the regional conditions.”
At the same time, Shoukry said that the course of talks with Turkiye had not resumed because there had been no change in the framework of its practices.
El-Sisi was in Doha to attend the World Cup ceremony at the request of Qatar’s emir, according to the presidency’s spokesperson.