I have spent the past 2 days here in Jeddah on a
whistle-stop trip among several centers in the Gulf. Later today, to Dubai and then to india. The welcome in Jeddah has been very warm, and the hospitality fantastic.
A thumb-nail sketch of
Jeddah: Jeddah is a city located on the coast of the Red Sea and is the major
urban center of western Saudi Arabia. It is the largest sea
port on the Red Sea, and the second largest city in Saudi Arabia (KSA) after
the capital city.
One of the issues that came up in discussion
with nephrologists here are the very high rates of diabetes and obesity. It's very relevant to Jeddah because it has the highest number of patients on dialysis in Saudi Arabia. In speaking with the nephrologists at one of their leading centers (King Abdul Aziz Univerisity or KAU), they tell me that the majority of their dialysis patients have diabetes as the cause of kidney failure. Their mission is to address the root cause of this high prevalence of kidney failure, namely the epidemic of diabetes and obesity.
As background, about 20 percent of the Saudi
population over 20 years old has type 1 or type 2 diabetes, compared to 5
percent of the global population. The average Body Mass Index (BMI) of Saudi
nationals 15 years and older is 30 kg/m2, far above the global average of 23.The
other big problem in KSA is the high rate of smoking - roughly
24 percent of all adult males smoke, and 14 percent of school children and
adolescents). Smoking is an important risk factor for the progression of diabetic nephropathy. According to news reports, KSA
has already committed billions of dollars to medical research and social programs focused on
problems relevant to the Kingdom ($400 billion on education, infrastructure and health
care by the end of 2014). Furthermore, plans are afoot for further
integration of the health system.
"Diabesity" is a new term describing
diabetes in the context of obesity (sometimes it is referred to as
obesity-dependent diabetes). I would recommend that you
read a very nicely written editorial review by Dr. Youssef Farag and Dr.
Mahmoud Gaballa published in 2010 in NDT.
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| Source: Farag et al NDT, 2010 |
Some interesting points made by Farag et al:
- The global prevalence of diabetes in 2010 was 284 million people worldwide constituting around 6.4% of the world population; the projections for 2030 show the prevalence to reach 439 million individuals comprising ~ 7.7% of the world population (1).
- The WHO reports in 2005 indicate that the global prevalence of overweight adults (age 15+) (BMI 25– 29.9 kg/m2) was ~1.6 billion and that of obese adults (BMI ≥ 30 kg/m2 ) was at least 400 million (2).
- The best way contain this epidemic is to screen for early detection, prevention and early management of obesity, especially in younger individuals, before the development of type 2 DM.
- The American Association of Clinical Endocrinologists recommend that all individuals 30 years of age or older with risk factors should be screened annually for type 2DM and obesity (3).
 |
| Source: Farag et al NDT, 2010 |
The recent commitment by KSA to increase
spending on infrastructure and health care is likely to have a major impact on
research in diabetes. The fact that Saudi
Arabia already spends 21% of the country’ s total health expenditure on
diabetes has not gone unnoticed by the leaders in the KSA.
From a country, that for many years had
been publishing around 45 papers each year on nephrology topics - mostly
clinical and mostly on dialysis and transplantation, I suspect that there will
be a marked shift in focus towards diabetes and diabetic kidney disease. Fortunately, the country has enough money to really try to address the epidemic.
References
1. Wild S, Roglic G, Green A et al.
Global prevalence of diabetes: estimates for the year 2000 and projections for
2030. Diabetes Care 2004; 27: 1047–1053
2. No. 311, W.H.O.W.F.s. Obesity and
Overweight Fact Sheets. 2006. http://www.who.int/mediacentre/factsheets/fs311/en/index.html
(September 2010, date last accessed)
3. Rodbard HW, Blonde L, Braithwaite SS
et al. American Association of Clinical Endocrinologists medical
guidelines for clinical practice for the management of diabetes
mellitus. Endocr Pract 2007; 13:1–68
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