In recent years, parts of the Middle East have been experiencing a food related public health crisis: an extreme rise in Type-2 Diabetes in the Arabian Peninsula region. Bahrain has the eighth highest rate of diabetes, according to the latest statistics conducted in 2015. The Kingdom is also ranked third among GCC countries after Saudi Arabia and Kuwait, pointing out that genetics and lifestyle have a big role in the occurrence of diabetes. The rate of diabetes in parts of the Arabian Peninsula is over twice the global average rate, and much higher than some other areas of the Middle East and North Africa (MENA). And cases of Type-2 Diabetes outnumber cases of Type-1 Diabetes by a ratio of 10:1.According to the International Diabetes Federation, 19.3 percent of adults aged 20 to 79 in the United Arab Emirates are diabetic. In Bahrain, the percentage rises to 19.6 and the statistic jumps to 20 percent for Kuwait, Qatar, and Saudi Arabia. These five nations all rank within the top 15 nations in the world for highest rate of diabetes per capita. The good news is that type 2 diabetes is largely preventable. About 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercise regularly and eating a healthy diet.
Types of Diabetes
Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. There is no known way to prevent type 1 diabetes.
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.
Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5–10 years. 70% of women who have had gestational diabetes will develop type 2 diabetes at some point during there lifetime.
Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases.
Pre-diabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes. Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal.
Who is at Greater Risk for Diabetes?
Type 1
- Siblings of people with type 1 diabetes
- Children of parents with type 1 diabetes
Type 2
- People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
- People over age 45
- People with a family history of diabetes
- People who are overweight
- People who do not exercise regularly
- People with low HDL cholesterol or high triglycerides, high blood pressure
- Certain racial and ethnic groups
- Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth
Signs of Diabetes
Type 1 Diabetes
- Frequent urination
- Unusual thirst
- Extreme hunger
- Unusual weight loss
- Extreme fatigue
- Irritability
Type 2 Diabetes
- Any of the type 1 symptoms
- Frequent infections
- Blurred vision
- Cuts/bruises that are slow to heal
- Tingling/numbness in the hands/feet
- Recurring skin, gum, or bladder infections
- Often people with type 2 diabetes have no symptoms
Diabetes Prevention Strategies
Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases.
Pre-diabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes. Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal.
Signs of Type 2 Diabetes:
- Any of the type 1 symptoms
- Frequent infections
- Blurred vision
- Cuts/bruises that are slow to heal
- Tingling/numbness in the hands/feet
- Recurring skin, gum, or bladder infections
- Often people with type 2 diabetes have no symptoms
Diabetes Prevention Strategies
Making a few lifestyle changes can dramatically lower the chances of developing type 2 diabetes. The same changes can also lower the chances of developing heart disease and some cancers.
Weight Reduction
Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes seven fold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight.
Losing weight can help if your weight is above the healthy weight range. Losing 7 to 10 percent of your current weight can cut your chances of developing type 2 diabetes in half.
Physical Activity
Inactivity promotes type 2 diabetes. Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin making cells.
Long hours of exercise are not necessary to gain this benefit. American Diabetes Association recommendation for adult with diabetes are advised to perform at least 150 min per week of moderate intensity aerobic activity.
Healthy Diet
Four dietary changes can have a big impact on the risk of Type 2 Diabetes.
Avoid highly processed carbohydrates, Choose whole grains and whole grain products instead:
There is convincing evidence that diets rich in whole grains protect against diabetes, whereas diets rich in refined carbohydrates leads to increased risk.
The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose. This leads to lower, slower increase in blood sugar and insulin, and a lower glycemic index. As a result, they stress the body’s insulin making machinery less, and may help prevent type 2 diabetes. Whole grains are also rich in essential vitamins, minerals, and phytochemicals that may help reduce the risk of diabetes.
In contrast, white bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what’s called a high glycemic index and glycemic load. That means they cause sustained spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk.
Avoid sugary drinks
Like refined grains, sugary beverages have a high glycemic load, and drinking more of this sugary stuff is associated with increased risk of diabetes.
Several studies show that children and adults who drink soda or other sugar sweetened beverages are more likely to gain weight and get predisposed to develop diabetes.
There is mounting evidence that sugary drinks contribute to chronic inflammation, high triglycerides, decreased “good” (HDL) cholesterol, and increased insulin resistance, all of which are risk factors for diabetes.
What to drink in place of the sugary stuff? Water is an excellent choice. Coffee and tea are also good calorie free substitutes for sugared beverages (as long as you don’t load them up with sugar and cream). And there’s convincing evidence that coffee may help protect against diabetes; emerging research suggests that tea may hold diabetes prevention benefits as well, but more research is needed.
Choose good fats instead of bad fats.
The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes. Trans fats do just the opposite. These bad fats are found in many margarines, packaged baked goods, fried foods in most fast food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label.
Eating polyunsaturated fats from fish also known as “long chain omega 3” or “marine omega 3” fats does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease. If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease.
Avoid processed meat
The evidence is growing stronger that eating red meat (beef, pork, lamb) and processed red meat (bacon, hot dogs, deli meats) increases the risk of diabetes, even among people who consume only small amounts. Studies found that eating just one daily 3 ounce serving of red meat say, a steak that’s about the size of a deck of cards increased the risk of type 2 diabetes by 20 percent. Eating even smaller amounts of processed red meat each day just two slices of bacon, one hot dog, increased the risk by 51 percent.
The good news from this study: Reducing the intake of red meat or processed red meat and increase the consumption of healthier protein source, such as nuts, low-fat dairy, poultry, or fish, or whole grains – lowered diabetes risk by up to 35 percent. Not surprisingly, the greatest reductions in risk came from avoiding processed red meat.
If You Smoke, Try to Quit
Smokers are roughly 50 percent more likely to develop diabetes than nonsmokers, and heavy smokers have an even higher risk.
The Bottom Line: Preventing Type 2 Diabetes
The key in preventing type 2 diabetes is…………”lifestyle modification”.
Dr. Syed Muneebuddin Ahmed
Internal Medicine Consultant
Bahrain Specialist Hospital
Email: syed.ahmed@bsh.com.bh