ueda2011 diabetes in arb-d.nabil

1. 1
Diabetes in the
Nabil Isseh MD
Kalamoon University
Syria
middle east

2. THANK YOU

4. Thank you
Thank you

5. Thank you

6. conflict of Interest Declaration
No other conflicts to report
UEDA Luxor 2011 conference
and I dislike pharaohsI like Tahreer Square

7. What is the
middle east
?

8. East from where?
Middle of what?

9. East from where?
Middle of what?
middle east

10. The Middle East 1850

11. The Middle East 1930

14. The Arab World

15. Diabetes was
a rare disease

16. “I, too, have not seen it in the West,
nor did any of my teachers under
whom I studied mention that they had
seen diabetes. However, here in
Egypt, in the course of approximately
ten years, I have seen more than
twenty people who suffer from this
illness.”
“Diabetes mellitus was seldom seen
in “cold” Europe, whereas it was
frequently encountered in “warm”
Africa.”
(1135-1204AD)
Diabetes was a rare disease
MAIMONIDES

17. Diabetes is the epidemic of the new
century

18. PROJECTIONS FOR THE NUMBER OF PEOPLE WITH DIABETES
(20-79 AGE GROUP), EASTERN MEDITERRANEAN AND
MIDDLE EAST REGION, 2007-2025 (MILLIONS)

19. Eben Kholdoon:
Recognized this
problem when he
talked about Urban
and rural medicine

20. But what is the
cause of this
epidemic
?

21. The new century
Epidemic

22. The new century
Epidemic

23. The rates of
diabetes and
obesity are
rising in the
Arab world

24. The Prevalence of diabetes and other
chronic diseases in Arab Countries
0 5 10 15 20 25 30
Epilepsy
Tberculosis
Hepatitis
Doudenal ulcer
Asthma
Hpertension
Hyperlipidiaedemia
Diabetes
Prevalence %
Prevalence %
WHO, 2000

25. Prevalence of Diabetes (20-79 age group)
2007-2025
2007 2025
• Nauru 30.7% 32.3%
• United Arab Emirates 19.5% 21.9%
• Saudi Arabia 16.7% 18.4%
• Bahrein 15.2% 17.0%
• Kuwait 14.4% 16.4%
• Oman 13.1% 14.7%
• Tonga 12.9% 15.2%
• Mauritius 11.1% 13.4%
• Egypt 11.0% 13.4%
• Mexico 10.6% 11.4%
IDF Diabetes Atlas 2006
Top 10

26. Prevalence of overweight and obesity among some
countries of the Eastern Mediterranean Region
Country Overweight / obesity (%)
Male
Overweight / obesity (%)
Females
Bahrain 56.4 79.0
Egypt 43.8 41.0
Islamic Republic of Iran 57.0 67.7
Jordan 46.0 43.7
Lebanon 60.0 53.0
Libya Arab Jamahiriya 42.5 74.9
Morocco 37.2 21.7
Oman 40.5 43.5
Pakistan 10.5 34.6
Saudi Arabia 64.0 70.0
Tunisia 13.1 41.9
United Arab Emirates 25.5 39.9
Eastern Mediterranean Health Journal - 2004

27. Why are the rates
of diabetes and
obesity rising in the
Arab world
?

28. What’s Unique
about the Arab
world?

29. The Arab World
1. The site of ancient civilizations
2. The birthplace of three of the world’s major
religions
3. Strategic location
4. Oil
5. Conflict and war
6. Occupation

35. 7
Moroco
2003
8
Algeria
2001
4
Tunisia
1988
3
Mauritania 1998
1
4
Libya
2001
13
Egypt
1997
7
Yemen
2002
24
Saudi Arabia 2004
26
UAE
2006
15
Qatar
19
Bahrain
16
Jordan
2004
9
Syria
1999
1
3
Lebanon
1997
3
Sudan
1996
5
Iraq 1979 1
6
Oman 200
<10%
10-20%
>20%

36. Cummunicablediseases
Trachoma
Malaria
Schistosomiasis
Smallpox
Trachoma
Diseases pattern in the kingdom of
Saudi Arabia over 100 years

37. Non-comunicable diseases
DiabetesMellitus
Obesity
Hypertension
Hyperlipidemia
Diseases pattern in the kingdom of
Saudi Arabia over 100 years

38. 0
5
10
15
20
25
1970 1975 1980 1985 1990 1995 2000 2005 2010
PrevalenceRate
Years
Diabetes Prevalence in Saudi Arabia
From 1975 to 2004
Al-Nuaim
Fatani et al
Anokute et al
 El-Hazmi et al
 El-Hazmi et al
Al-Nozha
Bacchus et al4
Abu-Aisha abst*.

39. Millions of years 50 years
Thrifty genes
‫البخيلة‬ ‫المقتصدة‬ ‫الجينات‬

44. ‫السـفربرلك‬ ‫مجاعة‬

45. 1915

48. November 4, 2009

51. 51

52. November 4, 2009

55. 55
172 million in 1981
331 million in 2007
385 million in 2015
Arab Population

57. 80

58. 34M31 M

59. 34

60. Diet change in SAUDI ARABIA:
There has been an increase in the total calorie in-take from
1900 to 3000 cal.
This increase is associated with low fiber diet.
1900
3000
3600
0
1000
2000
3000
4000
1970 1990 USA
33
123
0
40
80
120
160
1970 1990
Total fat intake
Dietary change

63. Diabetes and Poverty
Diabetes and Poverty …
Which one will kill the patient first ?

64. Mortality andPoverty
Mortality Adult Below National Diabetes Country
before literacy poverty poverty Prevalence
40 years rate line line Rate
% of cohort % of >15 yrs 2 US$/day (%)
Bahrain 4.7 12.4 - - 10*
Djibouti 42.3 35.4 - 45.1 -
Egypt 10.3 44.7 52.7 22.9 9.3*
Iran 9.3 23.7 - - 8*
Jordan 7.9 10.3 7.4 11.7 14.0*
Kuwait 3.0 18.0 - - -
Lebanon 5.0 14.0 - - -
Oman 6.8 28.3 - - 10.0*
Pakistan 20.1 56.8 84.6 34.0 14.0*
Qatar 4.8 18.8 - - -
Saudi Arabia 6.4 23.7 - - 24.3*
Sudan 27.3 42.2 - - 3.4*
Tunisia 7.8 29.1 10.0 14.1 3.8*
UAE 5.4 23.7 - - -
Yemen 20.0 53.7 45.2 19.1 -
UNDP, Human development report 2002
*The Epidemiology of Diabetes Mellitus, Ekoe2001

65. Occupation and War

68. 1798

70. The British Army stationed in Damascus
after the fall of the Ottoman Empire in
October 1918 .

71. the 2003invasion of Iraq

72. The new England journal
of medicine
special article
Violence-Related Mortality in Iraq
from 2002 to 2006
Iraq Family Health Survey Study Group*
January 31, 2008

73. The NEW ENGLAND JOURNAL
of MEDICINE
The Weapons That Kill Civilians — Deaths of
Children and Noncombatants
in Iraq, 2003–2008
April 16, 2009

74. Two bloody decades
conflicts in the Arab world since 1990
Conflict Arab deaths
Invasion of Iraq (since 2003) 110,000
War of Kuwait (1990-1991) 30,000
Second Palestinian Intifada (2000-2005) 5,500
Gaza war (2009) 1,400
Lebanon war (2006) 1,200

75. The Human Cost
of the War in Iraq
A Mortality Study, 2002-2006
A new household survey of Iraq has found
that approximately 600,000 people have
been killed in the violence of the war that began
with the U.S. invasion in March 2003.
Bloomberg School of Public Health
Johns Hopkins University
Baltimore, Maryland
School of Medicine
Al Mustansiriya University
Baghdad, Iraq
in cooperation with the
Center for International Studies
Massachusetts Institute of Technology
Cambridge, Massachusetts

76. Mortality after
the 2003 invasion ofIraq
Published online October 11, 2006

82. Restrictions on the movement of
Palestinians, curfews and frequent
shutdowns have had a devastating effect on
health services in general

83. Economic and social repercussions of the Israeli occupation
on the living conditions of the Palestinian people in the
Occupied Palestinian Territory, including Jerusalem, and of
the Arab population in the occupied Syrian Golan

84. The Israeli closure system remains a primary
cause of poverty and humanitarian crisis in
the occupied Palestinian territory, and
restricts Palestinian access to natural
resources.

87. The Wall
• West Bank’s wall:
to be at least 650
KM long
Hight:8 Meters
• Berlin Wall: 155
KM long
Average Hight:3.6
Meters
Berlin Wall

88. THANK YOU FOR TRYING TO STAY
AWAKE

91. 1945

93. Type 2 diabetes in Arab
Countries
1. Prevalence is relatively high ( 13-25 % in subjects > 30 y)
2. Prevalence is rising steadily
3. In many surveys, proportion of patients with previously
undiagnosed DM was relatively high
4. Many patients present with co-morbidities and
complications
5. The role of obesity is consistently clear

94. Cultural Aspects of Diabetes Care
in the Arab Population
1- Body image
2- Diet
3- Hospitality and social etiquette
4- Hijab
5- Alcohol
6- Contraception
7- Fasting Ramadan
8- Hajj to Mecca
Diabetes in the Arab world Lakhdar A, Gill G
2005:

95. Fatness is good for
you
Let me have men about me that
are fat;
Yond Cassius has a lean and
hungry look;
He thinks too much: such men
are dangerous.
W. Shakespear; Julius Ceaser

96. ‫مرافقها‬ ‫درم‬ ‫فنق‬ ‫هركولة‬
‫الوحل‬ ‫الوجي‬ ‫يمشي‬ ‫كما‬ ‫الهوينى‬ ‫تمشي‬
‫األعشى‬(‫م‬-‫م‬)‫العرب‬ ‫صناجة‬

97. Why do Arabs have
high prevalence of
type 2 Diabetes?

99. Prevalence of Obesity vs Diabetes
in Europe: selected countries
0
5
10
15
20
25
UK Gr Hu Sp Ge Fi Tu Sw Fr No
BMI>30
Diabetes
Obesity: NationMaster.com: Diabetes: IDF

100. Diabetes in Syria
1- Random sample of 1168 subject > 25 years
2- Prevalence of Diabetes was 15.6 %
3- Impaired fasting glucose was 8.6 %
4- Many people with Diabetes are unaware
5- The majority had A1c > 7 %
Aleppo study of prevalence of DM and CV Risk Factors. Diabetes
Research Unit, Aleppo University 2006. Submitted data

101. PREVALENCE OF DM ON EGYPT
DM type2 in Egypt
4.30%
9.30%
10.20%
0%
2%
4%
6%
8%
10%
12%
Arab / 1992 Herman / 1995 (>20) Herman / 2000 (>20)

102. Diabetes Mellitus in Saudi Arabia
A survey of 17,232 Saudi subjects aged 30-70 y
RESULTS:
Age-adjusted prevalence: 21.9 %
In urban areas: 25.5 %
rural areas: 19.5 %
Percentage of previously undiagnosed diabetics: 27.9 %
Al-Nozha M et al, Saudi Med J 2004; 25: 1603-10

103. What is the
Most Common
Cause of Death
in People with
Diabetes
?

104. Dyslipidemia is
common in the
Arab world

105. Population attributable risks associated with
smoking, hypertension, diabetes, abdominal
obesity and lipids by geographic region
Region risk factors
Smoking % Hypertension % Diabetes% Abdominal
obesity%
Lipids%
Western
Europe
29.3 21.9 15.0 63.4 44.6
Middle East 45.5 9.2 15.5 25.9 70.5
Southeast
Asia and
Japan
36.2 38.4 21.0 58.0 67.7
North
America
26.1 19.0 8.0 59.5 50.5
Yusuf S et al. Lancet. 2004;364:937-52.
INTERHEART

106. Smoking is a
common and
accepted way
of daily life
1997 11 : 14Nutr Health
20 – 50 %

109. THANK YOU
FOR TRYING
TO STAY
AWAKE

110. THANK YOU