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Vinolia Nyaho

Senior Practice nurse, Earlsfield Practice

Ms Vinolia Nyaho is a Senior Practice nurse, specialised in supporting patients with diabetes.


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Diabetes threatens the future stability of the UAE

  • A new NHS diabetes pathway of care could help the UAE

  • UAE has the world’s second highest incidence rate of diabetes

  • 75% of people with diabetes in the UAE do not have it under control

  • Diabetes accounts for 40% of UAE’s healthcare costs

  • Urgent need for an effective strategy to reduce UAE’s burden of diabetes


This Commentary describes how the large and escalating burden of type-2 diabetes (T2DM) in the United Arab Emirates (UAE) can be reduced by 2025.
 

Diabetes in the UAE

The UAE has the second-highest diabetes rate in the world. An estimated 25% of Emiratis, and 20% of residents suffer from the condition. Nearly 75% of people with diabetes in the UAE do not have their diabetes under control; a challenge particularly pronounced among children and young adults. It is estimated that 40 to 50% of people with diabetics in the UAE are unaware they are living with the condition. Left unchecked, the spread of diabetes portends devastating social and fiscal consequences for the UAE, including threats to its economic progress and investment stability.
 

Costs of diabetes in the UAE

Treatment costs for diabetes are estimated as 40% of the UAE’s overall healthcare expenditures. In 2011, the total cost of diabetes to the Emirates was some US$6.6bn, 1.8% of GDP. As diabetes is predicted to escalate in the region, associated costs will rise. On average, medical expenditures for those with diabetes are two to three times higher than for those without the condition. If current trends continue, by 2020, diabetes is projected to cost the UAE some US$8.5bn per year in treatment costs alone. The high level of undiagnosed and poorly controlled diabetes is an added challenge, and threatens to further increase healthcare costs, related complications, and economic development


Urgent need to prevent and manage diabetes in the UAE

These epidemiologic and economic findings suggest an urgent need to increase diabetes prevention and management efforts within the UAE. Although significant investments have been made in state-of-the-art facilities that specialise in diabetes treatment, awareness, research and training, it is generally agreed that a sustained program to further raise awareness, educate and encourage behavioural change is necessary to successfully reduce the burden of diabetes in the UAE. 
 



The UAE is a federation of seven states formed in 1971 by the then Trucial States after independence from Britain. Since then, it has grown from a quiet backwater to one of the Middle East's most important economic centers. Although each state - Abu Dhabi, Dubai, Ajman, Fujairah, Ras al Khaimah, Sharjah and Umm al Qaiwain - maintains a large degree of independence, the UAE is governed by a supreme council of rulers, which is comprised of the seven emirs, who appoint the prime minister and the cabinet.
Since the early 1960s, when Abu Dhabi became the first of the emirates to begin exporting oil, the country's society and economy have been transformed, and the UAE has achieved remarkable economic growth. Its oil industry not only created vast wealth, but also attracted a large influx of foreign workers. Today, the population of the UAE is some 9.4 million, of which over 75% are expatriates. In recent years, the UAE has tried to reduce its dependency on oil exports by diversifying its economy. Recently, annual growth has slowed due to the impact of lower oil prices: 2015 GDP is estimated to be US$644bn. 

 


 

What do people with diabetes want? 

Understanding the myths and realities about what people really want from diabetes education is vital to capturing its value. A 2014 London-based study concluded that there is a significant unmet need for premium, trusted and convenient video educational material to help people prevent and manage their diabetes remotely: see: How GPs can improve diabetes outcomes and reduce costs

A 2014 McKinsey & Co survey on patients opinions of digital healthcare services support these findings, and found that: (i) 75% of patients want quality digital healthcare services that meets their needs, (ii) people want better access and increased efficiency from healthcare systems, and (iii) the over 50s want digital healthcare services as much as younger counterparts. 
 

A faster, convenient and better pathway of care

The UAE might consider complementing its excellent diabetes care programs with a new and innovative pathway of care for diabetes pioneered by Dr Seth Rankin, co-chair of a London NHS Clinical Commissioning Group (CCG). The pathway employs behavioral techniques, which have been used successfully by the Obama Administration in the US and Prime Minister David Cameron in the UK to ‘nudge’ people to make better choices for themselves and enhance public policy. See: Behavioral Science provides the key to reducing diabetes
 

Direct and personal information 

The new pathway of diabetes care is fast, convenient and better than previous ones, and ensures that people living with diabetes are always part of a doctor-patient network, which increases the variety; velocity, volume and value of educational information patients can receive and want. At the heart of the new pathway is a content library of unique, broadcastable videos, which address patients’ FAQs about the prevention, presentation, diagnosis, and management of prediabetes and T2DM.
 
Each video is between 60 and 80 seconds in duration, which is the average attention span of people seeking video healthcare information. The pathway makes it easy for health professionals to cluster and send videos, accompanied by personal messages, directly to peoples’ mobiles. These provide Individuals with rapid and efficient answers to their questions about preventing diabetes, managing prediabetes, and T2DM. Dr Seth Rankin describes some of the thinking the pathway is predicated upon:



          
          (click on the image to play the video) 
 

The new pathway of diabetes care which we have developed could: (i) enhance the connectivity between health professionals and the citizens and residents of the UAE, (ii) increase knowledge and awareness of T2DM, and its personal, fiscal and societal effects, (iii) encourage self-management of the condition, (iv) slow the onset of complications, and (v) reduce the overall burden of diabetes in the UAE,” says Rankin. 
 

Takeaways

The UAE is ideally suited for such a pathway because with 78% smartphone penetration, UAE has one of the highest smartphone penetration rates in the Middle East and North Africa (MENA) region. In fact, 81% of mobile owners age 16-34 now own smartphones, and penetration is rising steadily among other age groups as well, which is a result of a strong economy, a growing middle class, surging consumer confidence in technology, and increasing domestic consumption.

 
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In October 2014 Harvard professor Douglas Melton announced a breakthrough in the treatment of type-1 diabetes by creating stem cells that produce insulin.

Melton demonstrated that mice treated with transplanted pancreatic cells are still producing insulin months after being injected. Testing in primates is now underway at the University of Chicago, and clinical studies in humans should begin in just a few years.

"Most patients are sick of hearing that something's just around the corner," says Melton, but he's convinced that his research represents a significant turning point in the fight against diabetes.

Type-1
Type-1 diabetes, which usually occurs in children, is an autoimmune disease in which the body attacks its own beta cells of the pancreas and destroys their ability to make insulin. It's a devastating lifelong chronic condition, which affects some three million Americans and 400,000 English people. Treatment is daily insulin doses, a healthy diet and regular physical activity.
 
Increasing incidence
For reasons not completely understood, the incidence of type-1 diabetes has been increasing throughout the world at about three to five per cent a year, and is most prevalent in Europe. This is troubling, because type-1 diabetes has the potential to disable or kill people early in their lives.

The search to discover why type-1 diabetes is increasing resembles the penultimate chapter of an Agatha Christie mystery, where there are many suspects, but no prime candidate. The last chapter to explain the increasing incidence of type-1 diabetes is yet to be written.  
 
Parents unaware of symptoms
A 2012 UK report suggests that parents are unaware of the warning signs of type-1 diabetes: thirstiness, tiredness, weight loss and frequently passing urine. As a consequence 25% of children with the condition are diagnosed once they are already seriously ill with diabetic ketoacidosis (DKA). DKA occurs because a severe lack of insulin upsets the body's normal chemical balance, and leads to the production of poisonous chemicals called ketones. This build-up can be life threatening, and needs immediate specialist treatment in hospital.
The challenge of cell production
Making industrial quantities of the insulin-producing cells of the pancreas has been a Holy Grail of diabetes research. All previous attempts have failed to achieve scalable quantities of the mature beta cells that could be of practical benefit to people living with diabetes.

Just over 20 years ago when Professor Melton's son Sam was diagnosed with type-1 diabetes Melton promised that he would find a cure. He was further inspired when his daughter at 14 was also diagnosed with type-1 diabetes.

According to Melton, it should be possible to produce 'scalable' quantities of beta pancreatic cells from stem cells in industrial-sized bioreactors, and then transplant them into a patient to protect them from immune attack. This would result in an effective cure.

"The biggest hurdle has been to get glucose-sensing, insulin-secreting beta cells, and that's what our group has done," says Melton.

In addition to offering a new form of treatment, and possibly a 'cure' for type-1 diabetes, Melton believes his discovery could also offer hope for the 10% of people living with type-2 diabetes who have to rely on regular insulin injections.

Takeaway
If Professor Melton is successful, not only will his discovery honour a promise to his children, but also it'll be a medical game-changer on a par with antibiotics and bacterial infections.
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