Diabetes in Saudi Arabia is a condition that requires urgent, open, and honest discussion. Diabetes impairs the body's ability to process blood glucose, also known as blood sugar. While there are several subsets of diabetes, two broad types are classed as chronic, type 1 diabetes and type 2 diabetes. Both result in high glucose levels that cause complications to other parts of the body. For centuries diabetes was considered a death sentence (1). In recent times, modern science has developed tremendously in both prevention and management. Today, we have an abundance of new knowledge and research on the condition; however, a diabetes diagnosis still weighs heavily on those impacted by the disease and their loved ones. The Two Primary Types of Diabetes Type 1 diabetes is sometimes called insulin-dependent or juvenile diabetes. That is because it appears early in life and requires the use of insulin injections to maintain a normal blood sugar level. With this form of diabetes, the body produces little to no insulin. Insulin injections, as a solo treatment, deliver what the body needs to prevent blood glucose levels from rising above normal levels, provided a healthy diet is followed (2,3). Type 2 diabetes is the most common form of the disease and is sometimes known as adult-onset diabetes. The body either resists the effects of insulin or does not produce enough insulin to maintain normal glucose levels in the bloodstream efficiently. The strong relationship between Type 2 diabetes and obesity is of high importance. Medication should, therefore, be combined with lifestyle modifications to manage the high level of glucose in the body (3,4). Diabetes Around World Diabetes has been on the rise for decades. According to the latest information from the International Diabetes Federation (IDF), the prevalence of this disease has resulted in 463 million people living with type 2 diabetes, while 1.1 million people under the age of 20 have type 1 diabetes. The IDF data indicates that 1 in 11 adults have diabetes, yet 1 in 2 adults with diabetes are undiagnosed. The data also reveals that a staggering 10% of global health expenditure is dedicated to the treatment of diabetes. Future projections show that by 2045 it is expected that 700 million people will be diagnosed diabetic: an alarming 51% increase from today's figures (5). Diabetes in Saudi Arabia As of June 2020, the population of Saudi Arabia is slightly more than 34.8 million (6). According to the IDF, adultdiabetes prevalence in the Kingdom is currently 18.3%. The IDF also ranked Saudi Arabia as the seventh-highest country for new cases of type 1 diabetes per year (7). Although there are a variety of factors affecting the development of type 2 diabetes, lifestyle habits typically associated with urbanization are likely the most important ones. These habits include an unhealthy diet, inactive lifestyles, and sedentary behaviours (8). A major factor of concern lies in the figures highlighted by the World Health Organization (WHO). These show that 68.2% of the total Saudi population is overweight, and 33.7% of the total population are obese(9). Therefore, efforts are underway to reduce the prevalence of diabetes and improve treatment options over the next decade, with a stated goal of reducing the number of overall cases in the Kingdom. Commenting on diabetes in Saudi Arabia, Saud Alsifri, Chairman of Endocrinology & Diabetes Department, Alhada & Taif Armed Forces Hospitals, said: "Diabetes is a major public health concern, its complications represent a significant medical, social and economic problem. This disease is the main contributing factor in overall health status, morbidity, mortality and impaired quality of life. A recent survey in Saudi Arabia by the Saudi Scientific Diabetes Society showed that more than 52% of patients with type 2 diabetes die of cardiovascular causes. Other long-term complications include damage to the eyes, kidney and feet. Therefore, Saudi Arabia plans to reduce diabetes prevalence by 10% by 2030 and aspires to be on par with the average of the top five most livable countries (where diabetes prevalence ranges from 3-8%) from its current 17.9% (10). The Kingdom's efforts in introducing measures to create a healthier nation and, in turn, reduce prevalence rates - such as 'Quality of Life Program 2020', should be praised. Also, diabetes awareness programs and active promotion of public awareness, continued screening and early intervention are pivotal to boosting a positive response and helping reduce the national burden of this disease." Commenting on Lilly's initiatives in Saudi Arabia, Dimitri Livadas – Managing Director, Lilly SA said: "Diabetes is Lilly's heritage, dating back to 1922, when Lilly researchers collaborated with Frederick Banting and Charles Best on the development of the first commercially available insulin. Today, we continue our commitment to innovation in diabetes research. With many medicines currently available and others in development, our leading treatments support people with diabetes at various stages of the disease. Around the world, many patients' lives have been extended by up to 75 years or more with the help of Lilly insulin. Helping diabetic patients represents the future of Lilly – globally, as well as in Saudi Arabia. The broad availability of novel therapies such as GLP-1 Receptor Agonists transforms how diabetes is treated, while Lilly continues to invest heavily in the discovery and development of new treatment options, enabling people with diabetes to live longer, happier and healthier lives. Lilly's commitment to the Kingdom extends beyond the supply of high-quality medicines. Specifically in the field of diabetes, Lilly partners closely with the Ministry of Health on a "Diabetes Train-the-Trainer Project" that was cascaded to 1,560 physicians all across the Kingdom, as well as on a "Diabetes Patient Activation Tool" to be used in Ministry of Health Primary Healthcare Centers to improve initiation, adherence and persistence to therapy." Diabetes prevention and management Lifestyles changes can have a significant impact on preventing and managing diabetes. We should all consider the following advice to begin living healthier lives and reducing our risk of diabetes in the future. Exercise three to five days a week for a minimum 30-45 minutes; research indicates that aerobic exercise and resistance training can help control diabetes. Limit the intake of processed foods and simple carbohydrates; like processed meats, baked goods and frozen or ready meals as they can have adverse health effects. Instead, opt for foods with high nutrients and reasonable amounts of complex carbohydrates (less likely to cause blood sugar spikes). Avoid tobacco products as an essential step of any healthy lifestyle, monitor and control blood pressure levels and take the appropriate medication prescribed by your doctor (if diagnosed) (11,12). A diabetes diagnosis today is far from the death sentence it used to be. Together, we need not fear the impact on our lifestyles and quality of life. The simple changes we make today can have lasting positive consequences for our future health and wellbeing. Always follow your doctor's advice and recommendations. References: 1. Jane E.B. Reusch, 2019 Standards of Medical Care in Diabetes: What is New and Why https://professional.diabetes.org/sites/professional.diabetes.org/files/media/standardofcare2018_hawaii.pdf 2. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011 3. https://www.who.int/news-room/fact-sheets/detail/diabetes 4. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193 5. International Diabetes Federation (IDF), Ninth edition 2019, Information and projections on diabetes worldwide https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html 6. https://www.worldometers.info/world-population/saudi-arabia-population/ 7. International Diabetes Federation (IDF), Ninth edition 2019, Saudi Arabia https://www.diabetesatlas.org/upload/resources/2019/IDF_Atlas_9th_Edition_2019.pdf 8. Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249-1257. doi:10.2337/dc11-0442 https://care.diabetesjournals.org/content/34/6/1249 9. World Health Organization, Diabetes country profiles, 2016 https://www.who.int/diabetes/country-profiles/sau_en.pdf?ua=1 10. https://www.arabnews.com/node/1481756/saudi-arabia 11. https://www.who.int/news-room/fact-sheets/detail/diabetes 12. https://idf.org/aboutdiabetes/prevention.html
