April 3, 2018
Road map for better diabetes care
The IDF Middle East and North America (MENA) region is a diverse and unique territory with great ethical and cultural differences and socio-economic extremes
The IDF Middle East and North America (MENA) region is a diverse and unique territory with great ethical and cultural differences and socio-economic extremes. Approximately 38.7 million adults are living with diabetes and almost half (49.1%) of them are unaware of their condition¹. The prevalence of diabetes is on rapid upsurge in the MENA region.
Several countries of this region have implemented high-impact prevention approaches to reduce diabetes and its complications. A major preventive initiative is the National Diabetes and Diabetic Foot Program in Pakistan where 115 diabetes clinics have been established and the rate of amputation has been halved (2). Similarly, Footwear for every Diabetic (FED) is another ingenuity by which ten risk assessment clinics have been established countrywide, providing low-cost footwear for people with diabetes thereby reducing ulcer rates. Recently, in Mansoura, Egypt, an IDF MENA Diabetic Foot Workshop was conducted with trainees from Afghanistan, Pakistan, Lebanon, Sudan, Jordan, and Egypt.
For the new term, the activities calendar developed in the MENA region specifically targets preventive measures including launching of diabetes mobile units by Bahrain Diabetes Society and Diabetes Palestine; and campaigns for the prevention of blindness by Sudan. Saudi Diabetes & Endocrine Association is aiming to initiate Sweet Smile Clubs for children with type 1 diabetes and mass screening campaigns as a preventive measure.
The MENA region is currently in need of a substantial number of trained healthcare providers. Pakistan has earned the recognition of nomination as an IDF Center of Education and IDF Center of Excellence in diabetes care to meet the urgent need. The network of 100 mini-clinics led by trained diabetes educators is a commendable diabetes education initiative by Sudan. Additionally, the Qatar Diabetes Association offers a structured training program for school nurses across the country along with the Al-Bawasil-camp for children with type 1 diabetes. Al-Shurooq Diabetes Camp for Children is organized by the Bahrain Diabetes Society annually. Additional activities include continuous education on healthy cooking techniques, guidelines for safe fasting during Ramadan and training programs for safe traveling, including pilgrimage, are some of the education initiatives of the region.
It is extremely worrisome that among the highest prevalent countries with diabetes worldwide, five countries belong to the IDF MENA region. There is an urgent demand for epidemiological initiatives to address such an alarming state. Recently, Pakistan has conducted the 2nd National Diabetes Survey of Pakistan (NDSP) 2016-17 which revealed that 26% of the population over the age of 20 has type 2 diabetes. Some of our member associations have already taken up the task to replicate it in their countries.
Advocacy is another prerogative aim of IDF-MENA to support people with diabetes and stop the diabetes epidemic which is strengthened through launching and implementation of effective advocacy campaigns amongst MENA countries. Furthermore, influencing international bodies, political platforms, community leaders, and national governments is required to implement practical, real time and long-term measures. Other outstanding plans for the coming term include: launching the Dia-Ambassador program in Iran; mass campaigns for safe fasting during Ramadan and decreasing the use of tobacco in Morocco and Iraq; and online education courses for people with diabetes in Sudan and Pakistan and provision of regional advocacy strategies are major goals.
More than half of the MENA region consists of resource constrained countries. The access to basic diabetes care and the crisis of insulin is a common issue. Insulin My Life (IML) project in Pakistan has already provided more than 20,000 free insulin vials to over 1,900 children with type 1 diabetes. Likewise, Diabetes Palestine has registered more 500 type 1 children and provides free services in Jerusalem and Gaza. Another major initiative is a joint project of WDF and IDF-MENA region for providing diabetes care services and free insulin to Syrian refugees in Lebanon. In the future, the Diabetes and Disaster stream for the IDF Congress would benefit by addressing strategies not only for natural calamities but also for man-made emergencies and disasters.
Continuous medical education through regular meetings and conferences is another important area which is getting recognized in the MENA region. Furthermore, Diabetes Registry of Pakistan (DRoP) is another promising initiative in collaboration with the Ministry of Health. The presentation of MENA region guidelines for the management of type 2 diabetes is another strong step toward better care. Pakistan has also developed the BRIGHT guidelines (3) to provide low cost and effective strategies for improving self-management of blood glucose.
In summary, the IDF MENA region is aiming to achieve a resilient global presence by promoting advocacy not only for people with diabetes but also for those who are at risk, emphasizing empowerment for people with diabetes and strengthening the International recognition of IDF and diabetes. We believe these measures will go a long way in achieving better diabetes care and prevention.
Abdul Basit is Chair of the IDF-MENA Region, Director of the Baqai Institute of Diabetology & Endocrinology (BIDE), Professor of Medicine at Baqai Medical University (BMU) and Joint Secretary, Diabetic Association of Pakistan (DAP).