An estimated one in four Saudi Arabians suffers from diabetes, but the disease wasn’t always such a burden on the Gulf state. Before the country’s transformation, starting in the 1970s, from an impoverished nomadic society into a rich oil producer, diabetes was practically unheard of. With economic prosperity, however, came rapid changes in lifestyle. And with Saudis exercising less and eating more sugar-dense and fat-laden foods, the kingdom finds itself on the brink of a health crisis.
“All of this happened very fast,” says Ali Mokdad, director of Middle Eastern Initiatives at the University of Washington’s Global Health Institute for Health Metrics and Evaluation in Seattle, US. “But,” he adds,“it’s not as gloomy as it looks.”
Prevention, treatment, and lifestyle changes are possible. The country’s health experts need to get a better scientific grip on the causes and consequences of diabetes in Saudi Arabia.
Factors affecting diabetes
Scientists across the kingdom are engaged in cutting-edge research to do just that. In Jeddah, for example, a team from the Saudi Diabetes Research Group has been systematically studying the prevalence of different types of diabetes to better understand the genetic, demographic and environmental variables that affect insulin resistance and other risk factors related to the metabolic disease.
“Jeddah’s population is of mixed ethnicity and cultural backgrounds,” explains Suhad Bahijri, a clinical biochemist at King Abdulaziz University who leads the group. “This allows us to explore different etiological hypotheses.” Last year, Bahijri and her colleagues published a study showing that age, followed by obesity, were the two strongest predictors of diabetes and pre-diabetes among Jeddah residents. Now, the researchers are digging deeper into assorted lifestyle factors, including sleep habits.
Knowing those factors should help public health officials hone their educational messages. This is especially important for younger people in Saudi Arabia, because, with increasing numbers of people in the kingdom getting diagnosed with diabetes, “the question in Saudi Arabia is not if you will develop diabetes, but when,” according to Philippe Froguel, a geneticist at Imperial College London in the UK and the Pasteur Institute in France who advises KAIMRC on its diabetes research efforts.
For Froguel, one of the big unanswered scientific questions is why Saudi Arabians tend to be diagnosed with diabetes at a younger age than people in other parts of the world. In the Arabian Peninsula, he says, “there are a lot of people who develop diabetes in their 40s, which is quite dangerous, because 15 years later the risks for stroke, cardiovascular disease and blindness are enormous, and treating these conditions can cost a fortune.” By comparison, elderly people diagnosed with diabetes often die of other causes.
A study published last year by the Saudi Diabetes Research Group suggests that new kinds of diagnostic tests could help in early detection of people at risk for some of the disease’s blood vessel-related complications. In routine practice today, patients with diabetes are only tested for their blood lipid and blood sugar levels. However, the Saudi team showed that measuring a protein marker of inflammation and an enzyme associated with oxidative stress could help stave off heart disease.
“We believe that the additional cost of these two biomarkers is justified in view of the expected benefits of avoiding, or at least controlling, vascular complications associated with diabetes,” says Anwar Borai, a pathologist at KAIMRC and King Saud bin Abdulaziz University for Health Sciences in Jeddah, who participated in the study.
Ultimately, however, controlling diabetes is a task that requires hard work, discipline and a willingness on the part of patients to get better; something Saudi Arabians are too often unwilling to make the effort for, says Bahijri.
Bahijri recently studied the effects of insulin therapy, a staple of diabetes treatment around the world. But, in Saudi Arabia, she and her colleagues found the drug didn’t work, largely because people used the medicine as an excuse to eat to excess. “They gained weight and made the situation worse,” Bahijri says. Now, to make the most of the anti-diabetic medicines that do seem to make a difference, she and the rest of the Saudi Diabetes Research Group are planning to work with a company in Canada to study drug efficacy in different ethnic populations. “This is very important to tailor management accordingly,” Bahijri says.
Some researchers are beginning to investigate the possibility of cell therapies for diabetes as well. At KAIMRC’s Stem Cells and Regenerative Medicine Department, for example, director Mohammed Abumaree and his colleagues are studying a population of stem cells isolated from human placental tissue that have a unique ability to suppress unwanted immune responses. “We are examining the ability of these cells to resolve inflammation associated with diabetes, with the specific aim of protecting endothelial cells from the oxidative stress mediators generated by the disease,” he explains. Abumaree is also looking into the effects of diabetes on fetal stem cells to better understand why babies born to diabetic mothers are more likely to develop the disease later in life.
While these research projects continue, much can be done to raise awareness of the problem and the need for healthy living. This is true year-round, but at no time more so than during the holy month of Ramadan when many people with diabetes choose to fast during the day and gorge themselves at night, creating huge swings in blood sugar levels that can cause dramatic symptoms. “Structured diabetes education is an essential, safe and effective tool in managing the disease during the fasting period and after breaking the fast during Ramadan,” Borai says.
Ali Al Qarni, a KAIMRC endocrinologist at the King Abdulaziz Hospital in Al-Ahsa, is heartened by the scientific progress being made into fighting diabetes. And while there’s still much to learn, he says,“these are opportunities for KAIMRC scientists to explore different pathways and mechanisms that could lead to the discovery of new preventive and therapeutic interventions.”