Diabetes is rising in the International Diabetes Federation (IDF) Middle East and North Africa (MENA) region. Despite advancements in diabetes care, access to healthcare in MENA remains limited, particularly in rural areas where specialised diabetes care facilities are often needed.
For example, fewer than 1 in 10 people with type 2 diabetes in low- and middle-income countries, including those in MENA, receive comprehensive guideline-based treatment. Not only do disparities in the standard of care between rural and urban areas exist within a country, but disparities also exist between MENA countries.
Over the past decades, many MENA countries have experienced rapid economic growth and urbanisation, which have affected lifestyle factors and diabetes prevalence. Estimates released by the IDF in 2021 reported that the MENA region had the highest regional diabetes prevalence, 12.2%, with projections indicating an 86% increase by 2045. Qatar, one of the fastest-growing economies in the region, has the second highest prevalence of type 2 diabetes among MENA countries, with obesity being the primary risk factor.
Limited public awareness about diabetes symptoms and risk factors results in many people with diabetes being diagnosed only when complications arise. The number of people living with undiagnosed diabetes in the MENA region was estimated at 44.7% in 2019. In some countries, late diagnosis happens due to a shortage of endocrinologists and diabetes education.
As with disparities in access to healthcare, rates of undiagnosed people vary by country, ranging from 17.4% in Jordan to over 35% in some areas of Egypt. Older populations generally tend to experience higher rates of undiagnosed diabetes, indicating a need for better screening programmes for this age group.
However, diagnosis does not guarantee access to quality and affordable care and treatment due to the cost of insulin, medicines, and supplies. Overall, there is a need for cost-effective solutions and better resource allocation in the region. The economic constraints in many MENA countries further exacerbate these challenges, with health expenditures on diabetes remaining critically insufficient.
Diagnosis does not guarantee access to quality and affordable care and treatment due to the cost of insulin, medicines, and supplies.
Along with barriers to treatment, cultural outlooks, such as traditional diets and lifestyle habits, can also hinder effective diabetes management. Furthermore, in some areas, cultural stigmas and a lack of diabetes awareness can prevent people from seeking timely care and adhering to treatment plans. This complex landscape underscores the need for targeted diabetes awareness-raising campaigns in the region.
Women in the MENA region face several diabetes risk factors, including obesity and low physical activity. Obesity, a major contributor to insulin resistance, is particularly prevalent in this region with 26.9% of men and 43.5% of women living with obesity. Pregnant women in the MENA region are at greater risk of hyperglycaemia during pregnancy and developing gestational diabetes mellitus (GDM), which can lead to long-term issues with blood sugar levels. This risk is particularly high in Gulf Cooperation Council countries – Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates – and North African countries. Currently, 1 in 7 live births is impacted by gestational diabetes, increasing the risk of both the mother and baby developing diabetes later in life.
Cultural considerations, such as Ramadan fasting, also play a significant role in diabetes management Middle East. Estimates suggest that there are over 150 million Muslims with diabetes worldwide. Therefore, Ramadan has a major impact on the management of diabetes in the Muslim population. Due to the metabolic nature of the condition, people with diabetes are at particular risk of complications from marked changes in food and liquid intake. Before the start of Ramadan, healthcare providers need to work with their patients to determine if it is safe to fast and develop a diabetes management plan.
Healthcare providers can be overwhelmed by their caseload or need more in-depth training on diabetes management. This gap can translate to a limited understanding of diabetes self-management among people with the condition. To address disparities in diabetes care and improve access to diabetes care through policy initiatives, a clear view of the diabetes situation in the MENA region is needed. However, national diabetes registries that enable data collection for screening and diagnosing are sometimes scarce or non-existent, hampering policymaking and resource allocations.
Not all countries in the region have operational national strategies or diabetes prevention strategies for non-communicable diseases, including diabetes. Even if diabetes policy Middle East initiatives exist, they are not always implemented, again due to insufficient resources. There is often a gap between policy formulation and real-world implementation, particularly in addressing issues like diabetes specialist availability and healthcare infrastructure.
Some countries, such as Iran, Bahrain, Qatar, Kuwait and UAE, have implemented action plans for obesity, diabetes, and physical activity. Furthermore, national registries for diabetes and surveys for identifying risk factors exist in several countries, including Bahrain, Qatar, Iran, Jordan and Kuwait.
Even if policy initiatives exist, they are not always implemented, again due to insufficient resources.
As in many regions, the MENA region is subject to natural and human-made crises that often share commonalities and affect people with diabetes similarly. Libya, Syria and Yemen are examples of countries that have witnessed conflict, political instability and sanctions that have disrupted healthcare and put pressure on already strained healthcare systems. These conflicts also lead to displacement and migration, creating barriers to diabetes treatment and care for refugees and internally displaced people living with diabetes. Resources are often diverted to emergency care, leaving conditions like diabetes underfunded and poorly managed.
Successful disaster response requires the collaboration of multiple stakeholders, including government agencies, international organisations, non-governmental organisations (NGOs), and local diabetes communities. Diabetes associations and advocates in IDF regional groups are also a source of aid and assistance in a disaster scenario within a geographical region. In 2023, the Disaster Committee of the IDF MENA region joined Direct Relief and its local partners to address the urgent need for essential diabetes medicines and supplies for people living with diabetes in Sudan and Sudanese refugees in neighbouring countries. MENA medical associations also collaborate with Direct Relief to source and deliver insulin through the Egyptian Red Crescent to people with diabetes in Gaza.
Minimal awareness, economic constraints and disparate policy initiatives collectively hinder effective diabetes management in the MENA region, leading to higher rates of complications and mortality. Addressing these issues requires coordinated efforts to stabilise healthcare systems, ensure the availability of medications and support vulnerable populations.
Governments in the MENA region can reach these objectives by improving access to education for healthcare providers and the public, raising public awareness and implementing comprehensive national strategies that will set the stage to combat this growing health crisis. As the region continues to develop, bridging these gaps in treatment and diagnosis is needed to improve the lives of millions affected by diabetes.
