Almost one in five people in the UAE has diabetes, making it one of the country’s biggest health concerns, but a major research project brings hope of improvements.
The UAE Healthy Future study aims to analyse, over the long term, the health of 20,000 Emiratis with the aim of highlighting risk factors for Type 2 diabetes and heart disease.
The importance of the study, which began in 2016, is undeniable: data released in 2015 indicates that 19.3 per cent of the country’s population has diabetes, a condition that can cause multiple serious health problems including heart disease, and damage to organs including the eyes and the kidneys.
Those organising this longitudinal study – meaning that it will follow individuals over time – hope to identify the specific way risk factors affect the Emirati population.
This is important because factors identified as contributing to diabetes in other parts of the world may have more or less influence here.
For example, obesity rates in the UAE are approximately the same as those in the US, yet diabetes is twice as common in the Emirates as in America, said one of the researchers co-ordinating the study, Dr Raghib Ali, director of New York University Abu Dhabi’s Public Health Research Centre. This disparity between different parts of the world indicates the complex nature of the causes of diabetes, with genetic and epigenetic factors (the latter concern the way genes are expressed) among the many variables affecting risk.
The prevalence of consanguineous marriages, in which the husband and wife are related to one another, may explain some of the increased genetic risk.
Dr Ali said there was evidence from elsewhere that historical food scarcity could increase rates of diabetes in children and grandchildren of those affected – an epigenetic effect. He noted that, in the UAE a couple of generations ago, there was relative food scarcity.
“The main purpose is to understand what the importance of the many risk factors is and, on the basis of that, to intervene to prevent these diseases in the future,” said Dr Ali.
“We cannot change people’s genes or the way people’s genes have been expressed, so the focus will be on addressing modifiable risk factors, like physical activity or diet or Vitamin D [deficiency] or use of antibiotics or early life experiences like breastfeeding.”
Just as researchers in the UAE are hoping to identify how diabetes rates can be reduced, recent studies in the US have highlighted the value of community-level interventions in reducing diabetes’ effects. One researcher says the work could have great relevance for the UAE.
Dr Ithar Hassaballa, an assistant professor of psychology at The American University in Cairo, has been working in North Carolina and Boston, focusing on African-American women. She has looked at the effectiveness of interventions such as visits to the doctor every three months, healthy eating promotion, and community discussions where patients talk about their diabetes with others with the condition.
A risk algorithm has been used so that interventions can be tailored according to whether individuals are of low, medium or high risk for diabetes.
One project working with 200 high-risk individuals in Durham County, North Carolina, resulted in a 34 per cent reduction in emergency department visits and a 40 per cent cut in hospital visits.
“It’s saving a lot of money health-wise and reducing the financial burden and economic burden related to diabetes. I was very excited to see these numbers,” said Dr Hassaballa.
She is “very optimistic” that similar results could be achieved in the UAE, although it is vital that measures are tailored to local conditions.
“Countries like the UAE can benefit from looking at the risk algorithm, perhaps using it with patients. I know the UAE is progressive in addressing diabetes,” said Dr Hassaballa.
“We have a suite of interventions. The most important aspect is to run them first by leading diabetes experts in the UAE and run it by Emirati citizens.”
Among the community interventions Dr Hassaballa says are worth considering in the UAE are walking groups.
For all such initiatives, issues that may prevent individuals from participating should be considered. The need to look after children may make it harder for some women, in particular, to take part in some activities. Dr Hassaballa found that, in the US, it could be helpful to arrange for certain activities to take place in the home.
In the UAE, considerable efforts are being made to improve diabetes treatment, with the Dubai Health Authority having brought in unified protocols so that patients get a consistent standard of treatment between centres.
Meanwhile, recruitment of participants for the UAE Healthy Future Study is continuing apace, with the 20,000 target due to be reached in 2020.
The importance of longitudinal studies such as this is shown by a well-known long-term study of the cardiovascular health of residents of Framingham in Massachusetts, US. Launched in 1948, this has involved repeated analysis over time of individuals, and it has gone on to analyse even the grandchildren of the original participants. The study has been credited with identifying a number of heart disease risk factors.
Another researcher involved in the UAE Healthy Future Study, Professor Ravichandran Ramasamy, a professor at New York University Abu Dhabi’s Department of Medicine and Department of Biochemistry and Molecular Pharmacology, said the hope is that the current research will highlight biomarkers that help to predict a person’s susceptibility to obesity, Type 2 diabetes and cardio-vascular disease.
“We hope to be able to identify them when we look at these 20,000 subjects,” he said.
Using mice, Professor Ramasamy and his colleagues have pinpointed glucose metabolism biomarkers associated with diabetes complications. He said it was “very, very exciting” to now be looking at how such knowledge could be applied to humans.
Many UAE institutions and researchers are collaborating in the UAE Healthy Future study and the aim is to cast the net as wide as possible when it comes to recruiting participants, who will be aged 18 to 40.
“We have not explored, for example, some of the Bedouin communities. It’s our hope to approach them and get samples from them,” said Professor Ramasamy.