IDF Diabetes Atlas
Diabetes in the Middle-East and North Africa: An update

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Abstract

In recent decades, the prevalence of diabetes has risen dramatically in many countries of the International Diabetes Federation's (IDF) Middle-East and North Africa (MENA) Region. This increase has been driven by a range of factors that include rapid economic development and urbanisation; changes in lifestyle that have led to reduced levels of physical activity, increased intake of refined carbohydrates, and a rise in obesity. These changes have resulted in the countries of MENA Region now having among the highest rates of diabetes prevalence in the world. The current prevalence of diabetes in adults in the Region is estimated to be around 9.2%. Of the 34 million people affected by diabetes, nearly 17 million were undiagnosed and therefore at considerable risk of diabetes complications and poor health outcomes. Enhanced research on the epidemiology of diabetes in the MENA Region needs to be combined with more effective primary prevention of diabetes; and early detection and improved management of patients with established diabetes, including an increased focus on self-management and management in primary care and community settings.

Introduction

Over the last few decades, the prevalence of diabetes has risen dramatically in many countries in the International Diabetes Federation's (IDF) Middle-East and North Africa (MENA) Region [1]. The countries of MENA Region now have amongst the highest rates of diabetes in the world. This increase has been driven by a range of factors that include rapid economic development and urbanisation; changes in lifestyle that have led to reduced levels of physical activity, increased intake of refined carbohydrates, and a rise in obesity; and the ageing of their populations [2]. These factors have led to an increase in risk factors for type 2 diabetes and a rapid increase in its prevalence. Consequently, diabetes has become a major public health problem in the Region and imposes a considerable strain on individuals, family members and carers; as well as on health systems and economies in the Region [3]. In this paper, we discuss the epidemiology of diabetes in the MENA Region and its impact on individuals and societies, as well as discussing likely future trends in diabetes prevalence.

Section snippets

Methods

The full description of the methods and global estimates of diabetes prevalence for the International Diabetes Federation (IDF) Diabetes Atlas data is described in detail elsewhere [4]. A list of the countries included in MENA Region is also given in this paper. Briefly, a literature search for studies of diabetes prevalence was conducted and a modelling approach applied to derive the prevalence of diabetes in adults 20–79 years of age in countries and the Region for the years 2013 and 2035.

Epidemiology of diabetes in MENA

There is a high burden of diabetes in the MENA Region, and type 2 diabetes predominates; other forms of diabetes such as type 1 diabetes and gestational diabetes, while increasing, are less common, as are cases of diabetes secondary to conditions such as pancreatic disease.

The adult population (aged 20–79 years) in the MENA region was around 374 million in 2013 (Table 1). The current crude prevalence of diabetes in this age group was estimated to be around 9.2% in the same year and equivalent

Type 1 diabetes

In total, 10,700 new cases of type 1 diabetes were diagnosed in 0–14 year olds throughout the MENA Region in 2013. There are currently 64,000 children with diabetes in this age group; a prevalence of 0.03%. Study data was available and selected for 12 out of the 21 countries in the IDF MENA Region, the newest of which comes from Habeb et al. [5], based on an urban population in Saudi Arabia, a country which is estimated to have the fourth highest incidence rates of type 1 diabetes in the world.

Undiagnosed diabetes

The estimates for undiagnosed diabetes are derived from population-based studies using either fasting blood glucose or oral glucose tolerance test to produce a figure of the proportion of people identified at the time of the cross-sectional survey who were not previously aware of their condition. The MENA Region has a considerable number of population-based studies from which to draw these estimates. Of the 34.5 million cases of diabetes in the MENA Region, nearly 17 million were unaware of

Health system spending on diabetes

In 2013, health expenditure on diabetes was estimated at around USD13 billion [13]. Future predictions of health expenditure on diabetes are difficult to make but it is likely to increase dramatically, driven both by the increased number of people who are predicted to have diabetes; and the progressive ageing of the diabetes population, which will lead to an increase in the number of people with diabetes complications and therefore requiring more expensive medical care. Costs to health systems

Risk factors for diabetes and its complications

Key risk factors for diabetes onset, and poor clinical outcomes for diabetes after its onset, include genetic predisposition, family history, overweight, obesity, hyperglycaemia, hypertension, dyslipidaemia, physical inactivity, ethnicity, and environmental factors. A systematic review published in 2011 examined the prevalence of some of these risk factors in a subset of the MENA states [2] The review reported very high prevalences of overweight and obesity in prior studies in adults (25–50%

Quality of management of diabetes

Many countries in the MENA Region have responded to their rising prevalence of diabetes by implementing national diabetes programmes. However, there is limited information on both the extent of implementation and efficacy of these diabetes management programmes. A systematic review of a subset of countries in the MENA Region that summarised the findings of 27 studies reported on the management of type 2 diabetes in three key areas: glycaemic control, hypertension and dyslipidaemia [19]. The

Health system organisation

Primary care is now seen as having a key role in the prevention, early detection and management of long-term conditions such as diabetes; and in providing whole-person care that can address the multi-morbidity that is present in many people with diabetes [20]. Traditionally, diabetes in the MENA Region has been managed in specialist centres but this is now gradually changing with the emergence – albeit slowly in some countries – of stronger primary care delivery systems. However, many patients

Interventional and research strategies

Interventional preventive strategies are need to address the rising personal and health system costs of diabetes in the MENA Region. These include encouraging more healthy diets and lifestyles that promote physical activity and a reduction in obesity, the main modifiable risk factors for type 2 diabetes. Prevention strategies need to be combined with improved research on the epidemiology, management and prevention of diabetes. Currently, healthcare research is not seen as a priority in many

Conclusions

The MENA Region faces major challenges from tackling the rising prevalence of diabetes and the associated disease burden. We recommend an increase in the number of higher-quality studies using more standardised methods that would allow comparison of diabetes prevalence over time, between countries and among population sub-groups. Enhanced research on the epidemiology of diabetes needs to be combined with more effective primary prevention of diabetes (particularly in areas such as diet, exercise

Conflicts of interest

The authors have no conflicts to disclose.

Acknowledgements

The 6th edition of the IDF Diabetes Atlas was supported by the following sponsors: Lilly Diabetes, Merck and Co, Inc., Novo Nordisk A/S supported through an unrestricted grant by the Novo Nordisk Changing Diabetes® initiative, Pfizer, Inc., and Sanofi Diabetes.

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