Noncommunicable diseases (NCDs) are the most common reasons for death worldwide according to world health organization statistic the deaths related to (NCDs) is equal to or more than the total number of deaths that related to other reasons, and NCD responsible for forty-one million deaths out of fifty-seven million deaths occurred worldwide, that means NCD accounts for almost 23 of all deaths globally(1). Diabetes is one of the four main NCDs and alone accounting for around 1.6 million deaths in 2016(2). Diabetes mellitus, more simply called diabetes, is a chronic condition that occurs when there are raised levels of glucose in the blood because the body cannot produce any or enough of the hormone insulin or use insulin effectively(3).
The interaction between several genetic and environmental factors Overweight and obesity are major contributors to the development of insulin resistance. When β cells have not longer able to secrete sufficient insulin to overcome insulin resistance, impaired glucose tolerance progresses to type-2 diabetes after many years of uncontrolled diabetes complication occur ether macro or microvascular which lead to blindness and renal failure and eventually death(4). The symptoms of DM include: polyphagia, polyurea, polydipsia, blurred of vision, unexplained weight loss, numbness or tingling sensation in extremity, fatigue and delayed wound healing. The symptom of DM develop slowly over the years or can develop in just a few weeks or months and can be severe depend in the Type of DM(5).
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There are three main types of diabetes, type 1 diabetes, type 2 diabetes and gestational diabetes (GDM)(6). There are also some fewer common types of diabetes which include monogenic diabetes and secondary diabetes. Monogenic diabetes is the result of a single genetic mutation in an autosomal dominant gene rather than the contributions of multiple genes and environmental factors as seen in type 1 and type 2 diabetes. Examples of monogenic diabetes include conditions like neonatal diabetes mellitus and maturity-onset diabetes of the young (MODY). Secondary diabetes arises as a complication of other diseases such as hormone disturbances (e.g., Cushing’s disease or acromegaly), diseases of the pancreas (e.g., pancreatitis) or as a result of drugs (e.g., corticosteroids)(6).
Type 1 diabetes is caused by an autoimmune reaction where the body’s immune system attacks the insulin-producing beta cells in the islets of the pancreas gland. As a result, the body produces none to very little insulin with a relative or absolute deficiency of insulin. The causes of this destructive process are not fully understood, but a combination of genetic susceptibility and environmental triggers such as viral infection, toxins or some dietary factors have been implicated(7).
Type 2 diabetes is the most common type of diabetes and is the result of inadequate production of insulin and an inability of the body to respond fully to insulin, defined as insulin resistance. During a state of insulin resistance, insulin is ineffective and therefore initially prompts an increase in insulin production to reduce rising glucose levels but over time a state of relative inadequate production of insulin can develop(8). Type 2 diabetes is most commonly seen in older adults, but it is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet(9).
GDM is a type of diabetes that affects pregnant women usually during the second and third trimesters of pregnancy though it can occur at any time during pregnancy. In some women, diabetes may be diagnosed in the first trimester of pregnancy, but in most such cases diabetes likely existed before pregnancy but was undiagnosed and usually disappears after giving birth. It occurs if your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet the extra needs in pregnancy(10).
Diabetic patients may develop complication over time if they do not stick to their treatment regimen comparing to the general population, and this complication is divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes(11).
The International Diabetes Federation (IDF) estimated the total number of adult diabetics (aged between 20 and 79 years) all over the world at around 425 million and expected to reach 629 in 2045. With the western Pacific is the highest region of the diabetic patient followed by south-east region and together they have more than half of diabetic patient, China alone has more than 100 million diabetes, and it’s the highest country in the diabetic patient. While the Africa region had the lowest prevalence in 2017.
In 2017, approximately 38.7 (27.1-51.4) million people, or 9.6% (6.7-12.7) of adults aged 20-79 years are living with diabetes in MENA. About 49.1% of these are undiagnosed. Countries with the highest age-adjusted comparative diabetes prevalence in MENA are Saudi Arabia (17.7%), Egypt (17.3%) and UAE (17.3%), The countries with the largest number of adults aged 20-79 years with diabetes are Egypt (8.2 (4.4-9.4) million), Pakistan (7.5 (5.3-10.9) million) and Iran (5.0 (3.9-6.6) million)(12)
From 1980 to 2014, worldwide age-standardized adult diabetes prevalence in men increased from 4·3% (95% CrI 2·4–7·0) to 9·0% (7·2–11·1) and crude adult prevalence increased from 3·6% (2·0–5·9) to 8·8% (7·0–10·8). In women, age-standardized adult diabetes prevalence increased from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) and crude adult prevalence increased from 4·7% (2·7–7·4) to 8·2% (6·6–9·9)(13).
In the same years. In the Middle East, adult diabetes prevalence in men increased from 5.9% to 13.7%(14). The prevalence of type 2 diabetes mellitus in the kingdom of Saudi Arabia according to the literature published increased from 3% in 1982 to 32% in 2015, The predicted prevalence will be 35.37% in 2020, 40.8% in 2025 and 45.8% in the year 2030(15).
Despite the human burden characterized by premature mortality and lower quality of life due to diabetes-related complications, diabetes also imposes a significant economic impact for countries, healthcare systems, and above all, for individuals with diabetes and their families. The healthcare expenditure on diabetes increased from 232 billion USD worldwide in 2006, to 727 billion USD in 2017 a threefold increase for those aged 20-79 years(16)
In the MENA total, the health expenditure on diabetes reached 20.5 billion USD in the region in 2017. By 2045, the total expenditure on diabetes is estimated to reach USD 37.1 billion. The largest expenditures were observed in Saudi Arabia with ID 13.1 billion, Iran ID 8.6 billion and Egypt ID 7.9 billion. The smallest expenditure was found in Armenia with 0,09 billion. The highest mean expenditure per person with diabetes was in Qatar and Saudi Arabia with ID 6,602 and ID 5,186(16).
Diagnosis of DM
diabetes was defined according to the American Diabetes Association criteria, either as fasting blood sugar level 126 mg/dL (7 mmol/L) or higher (after 8–12 hours of fasting) or random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes, or A reading of more than 200 mg/dL (11.1 mmol/L) after two hours OGTT), or Hemoglobin A1C (HA1C a plasma glucose level of 6.5 percent or higher) on two separate tests indicates diabetes(17).
Global strategy for prevention and control of DM
The Sustainable Development Goals (SDGs), adopted by the UN in September 2015, aim to achieve, through national commitments, a reduction in premature mortality from NCDs by one-third, ensure access to quality essential healthcare services and to provide safe, effective, quality and affordable essential medicines for all by 2030(18).
IDF also implement three priority objectives set out in the IDF Global Diabetes Plan 2011-2021(19):
- To improve health outcomes for people with diabetes.
- To prevent the development of type 2 diabetes.
- To prevent discrimination against people with diabetes.
National Health Program of DM in Saudi Arabia
20 Specialized Centers: the aim is kept on delivering the optimum health services for diabetics, working on enhancing the health awareness of each diabetic or anyone vulnerable to develop the disease, and providing the best health and education services.
Anti-diabetes Education National Program: It aims to have the healthcare officials participate in applying it and increasing the general awareness for all the Saudi community segments on diabetes through positive communal participation.
National Campaign for Diabetes Control: The campaign focuses on reinforcing and disseminating the general health awareness and limiting the disease spread(20).
Conclusion
Diabetes is a growing public health problem, and the number of people with diabetes has increased threefold between 2000 and 2017 mainly in developing countries. Economic development and increasing urbanization leading to more sedentary lifestyles and higher consumption of unhealthy foods linked to obesity are behind the rapid increase in diabetes prevalence. Diabetes also imposes a significant economic impact for countries, healthcare systems, and above all, for individuals with diabetes and their families.
References
- Noncommunicable diseases [Internet]. 1 June 2018. [cited 2019 Feb 5]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases
- The top 10 causes of death [Internet]. 24 May 2018. [cited 2019 Feb 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
- WHO | Diabetes mellitus. WHO [Internet]. 2010 [cited 2019 Feb 5]; Available from: https://www.who.int/mediacentre/factsheets/fs138/en/
- Skyler JS, Bakris GL, Bonifacio E, Darsow T, Eckel RH, Groop L, et al. Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis. Immunol Metab Endocrinol [Internet]. 2017 [cited 2019 Feb 5];66:10–2. Available from: http://www.diabetesjournals
- Symptoms | Basics | Diabetes | CDC [Internet]. July 25, 2017. [cited 2019 Feb 5]. Available from: https://www.cdc.gov/diabetes/basics/symptoms.html
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