1. What are the statistics on how many people in UAE have diabetes/what percentage of people in UAE have diabetes?
Diabetes is currently the fastest growing debilitating disease in the world. In the UAE it is estimated that one out of five people aged 20 to 79 lives with this disease, while a similar percent of population is at risk of developing it. This year, the UAE ranked second highest worldwide for diabetes prevalence, followed by Saudi Arabia, Bahrain, and Kuwait (International Diabetes Federation (IDF) 2007)

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2. What is the age range of people affected?
There are two types of diabetes: type 1 diabetes is an auto-immune condition where the pancreas is attached by auto-antibodies causing it to fail. This necessitates treatment with insulin. type 2 diabetes on the other hand is mainly brought on by an unhealthy, inactive lifestyle and weight gain. In recent years, we have seen a (rapid) spread over all age groups. Recent studies show a rise in obesity cases among school children and young adults, which is a known cause type 2 diabetes however the 40-59 age group has the greatest number of persons for diabetes. (IDF 2007)

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3. Which group of people are most affected age/gender etc?
As mentioned earlier, most diabetes sufferers are between the ages of 40 to 59 years, with research showing a worrying rise among younger age groups. As for gender distribution, the estimates for both 2003 and 2025 showed a female predominance in the number of persons with diabetes. The female numbers were about 10% higher than for males. There was also a female predominance in the number of persons with Impaired Glucose Tolerance (IGT) in the estimates for both 2003 and 2025. The female numbers were about 20% higher than for males. Polycystic ovary syndrome affects up to 5-10% of females in their reproductive years and is thought to predispose to glucose intolerance, with studies showing up to 30-40% being affected by IGT and up to 7-10% with type 2 diabetes. It may explain why there are more females with type 2 diabetes amongst adolescents. (IDF 2007)

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4. How many people are believed to have diabetes but are undiagnosed and is under-diagnosis an issue?
In a UAE Ministry of Health study conducted in 2000, approximately half of the people with diabetes in the UAE were unaware that they suffer from diabetes.

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5. What are the main causes of the incidence of diabetes in UAE i.e. the triggers/ factors contributing to diabetes?
Diabetes is a condition that is characterised by an above normal level of glucose (sugar) in the blood. This is because the pancreas does not make enough insulin or insulin becomes ineffective. Insulin, a hormone generated in the pancreas, normally controls blood sugar levels and allows the glucose to enter the cells in the body to provide energy. In people with diabetes, high levels of glucose remain in the bloodstream causing Hyperglycaemia (high blood sugar). Those at increased risk include individuals who have a history of diabetes in their family, people over 40, those who are overweight or obese and inactive individuals.

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6. Is diabetes on the rise in UAE - and why?
Yes, diabetes is on the rise in the UAE. There seems to be a genetic predisposition to the disease among UAE Nationals and statistics show that they have a higher prevalence than other Nationalities within the UAE. However tendencies towards lifestyle, weight gain, an imbalanced diet and/or a lack of exercise seem to be major contributors. Research is ongoing with the overriding aim to help explain why diabetes occurs at such high levels in the country. This will also help instigate preventative measures.

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7. Is there much awareness of diabetes/how to prevent it amongst the UAE population? If not, why?
We believe that the UAE is taking steps in the right direction by planning various nutrition and physical activity programmes in addition to driving public awareness campaigns. Certainly, at ICLDC we have contributed with a public health thrust ‘DIABETES. KNOWLEDGE. ACTION’ and are set to continue – and grow – this campaign during 2007 and beyond.
Diabetes is now on the country’s top list of health concern and  is being tackled through awareness and lifestyle changes.  Equally important is the treatment of diabetes and its complications with the most up-to-date evidence-based medicine which is now available here in Abu Dhabi at the Imperial College London Diabetes Centre.

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8. What are some of the serious effects of diabetes you are seeing in UAE?
Diabetes brings with it several serious complications related to the heart, eyes, blood vessels, kidneys, feet and nerves. Some of the cases that we have witnessed in the UAE are: Diabetic retinopathy, a key cause of blindness and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment. Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of diabetes sufferers. Although many different complications can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation. Diabetes is among the leading causes of kidney failure where 10-20% of people with diabetes die from this complication. Diabetes increases the risk of heart disease and stroke. People with type 2 diabetes are over twice as likely to have a heart attack or stroke as people who do not have diabetes. The overall risk of premature death among people with diabetes is at least double the risk of their peers without diabetes. According to statistics, mortality linked to diabetes mellitus constitutes 75% percent of the deaths among UAE nationals and 31% among non-nationals.

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9. What has been the preliminary response to your campaign for free screening at ICLDC? What sort of responses have you seen?
The responses have exceeded our expectations, more than 10,000 people have visited the diabetes awareness booth at the Marina Mall and more than 1200 people have volunteered to be screened for diabetes so far. As part of our outreach program the awareness booth is now at the Al Jimi all in Al Ain where we aim to raise awareness, assess diabetes risk and recommend blood testing for those at defined as high risk. Risk assessment and testing people’s knowledge on diabetes through simple quizzes are some of the methods used to disaminate the information. In addition to viewing the TV ads and discussing simple changes in lifestyle that can actually provide prevention.

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10. How does ICLDC plan to spread awareness about the threat of fast food items?
‘DIABETES. KNOWLEDGE. ACTION’, is a nationwide campaign designed to draw attention to diabetes. The campaign does emphasise the need to eat a healthy and balanced diet, while avoiding unhealthy fast food. In addition, there is also strong emphasis on increased exercise, such as walking briskly for at least 30 minutes each day. Under the patronage of Her Highness Sheikha Fatima bint Mubarak, Supreme Chairperson of the Family Welfare Foundation and Chairperson of the General Women's Union ‘DIABETES.KNOWLEDGE.ACTION’ is a partnership between the Emirates Foundation and the Imperial College London Diabetes Centre (ICLDC), and endorsed by Health Authority – Abu Dhabi. ‘DIABETES.KNOWLEDGE.ACTION’ focused on disseminating knowledge surrounding diabetes prevention, symptoms and lifestyle support activities. It aims to help prevent the number of diabetes patients through education and encourage testing for diabetes on a nationwide level in order that people learn if they are affected or at risk.

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11. Is ICLDC spreading messages about fast food causing other health problems like obesity, cardio vascular diseases etc in the awareness programmes?
Spreading healthy eating messages are the campaign’s priorities since these methods are the most effective ways to prevent, treat and or manage the disease. ICLDC’s aim is to help the population move towards healthier lifestyles and for those who have already been diagnosed with diabetes to adopt the latest evidence-based treatments. Through ‘DIABETES.KNOWLEDGE.ACTION’ we are reaching out to people across the UAE through several activities. We have rolled out I WONDER…, a public screening programme in which we screen people at high risk for diabetes. I EAT RIGHT, an educational initiative aimed at getting children, mothers and carers to take a look at, and possibly change, what’s the children’s lunch boxes. We’re planning I PLAY SPORTS, a fun Corporate World vs. the Field Professionals football tournament with the UAE National team hopefully taking on members of the UAE’s commercial sector. I WALK to bring the community together in a walkathon to raise awareness and hopefully raise money that can be ploughed back into diabetes research public health initiatives. We’re also working with UAE celebrity Chefs for I COOK HEALTHILY where we will be producing a recipe book and DVD to show people how they can make their own meals healthy. These are just a few of the plans, you may visit the campaign’s website www.diabetesuaue.ae to keep informed of the latest in the campaign. Our aim is to inform people of the ways to maintain a healthy life, the risks of an unhealthy life, the complications that diabetes brings with it while making available the latest evidence-based treatments. We would like to help improve people’s quality of life by armouring them with information rather than scaremongering and promotion through negativity.

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12. We are seeing more children with Type 2, even though it normally only appears in adults over the age of 40 - why is this?
Type 2 diabetes among children is fast becoming recognized as a global public health issue with potentially serious health outcomes. Research has indicated that type 2 diabetes is mainly brought on by an unhealthy, inactive lifestyle and weight gain. In recent years, we have seen a (rapid) spread over all age groups. We at ICLDC however are hopeful that through our public health campaign ‘DIABETES.KNOWLEDGE.ACTION’ we will be able to help children and adults alike living with or at the risk of diabetes. Also through research we hope to determine why diabetes occurs at such high levels in the country and instigate further preventative measures.

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13. Do you think schools need to do more to combat the problem?
Schools can definitely help by supporting healthy eating messages. Schools should serve nutritious and balanced school meals, fruit instead of vending machines full of crisps and sweets. Sports activities should be part of the curriculum, either during school hours or after hours thus encouraging children to be physically active. With the Health Authority – Abu Dhabi (HAAD) endorsement to this campaign we believe that with the program I EAT RIGHT, an educational initiative aimed at getting children, mothers and carers to take a look at what’s in the children’s lunch boxes, it is possible to help make sure children are aware and consume healthy diets.

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14. How are ICDLC’s screening tests for diabetes different from the others?
The campaign screening done for those defined at high risk begins with a detailed questionnaire that tells us all patient details including ethnicity, medications, if any, and family history. Our medical team then measures the patient’s blood pressure, Body Mass Index (BMI), followed by drawing the blood from the arm into two different tubes. The blood is then delivered to ICLDC labs then conduct the tests:

The results are delivered to the patient along with a medical report and recommendations based on the results and the background information, written by an ICLDC diabetes specialist.

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15. How much do fast food outlets contribute to the obesity problem?
When eaten in excess, any type of food could contribute to the problems of diabetes and obesity. Unhealthy fast food is no exception of course, but we have to remember to distinguish between healthy and unhealthy fast food. There are now healthy fast food outlets that provide an alternative to what we conventionally know as fast food. In my opinion, increased education on what the ingredients of unhealthy fast food can do to one’s body would be helpful and regulation of unhealthy fast food sales and marketing could also be key. Tackle the marketing of unhealthy fast food whilst simultaneously educating people about the risks of consuming such foods and I think we would see significant positive changes.

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16. If banning smoking in restaurants, bars, can help the health-related problems with smoking, should levels of trans-fats and calorie content in fast food also be regulated in places like the UAE?
Regulation of this sort would definitely and without a doubt help, not just in the UAE but globally. As mentioned earlier, regulation and increased public awareness need to go hand in hand. With this aim, ‘DIABETES. KNOWLEDGE. ACTION.’ hopes to draw nationwide attention to diabetes. It is a partnership between the Imperial College London Diabetes Centre (ICLDC) in Abu Dhabi and the Emirates Foundation and has the patronage of Her Highness Sheikha Fatima bint Mubarak, Supreme Chairperson of the Family Welfare Foundation and Chairperson of the General Women's Union with the endorsement of the Health Authority – Abu Dhabi (HAAD). The campaign focuses on disseminating knowledge surrounding diabetes prevention, symptoms and lifestyle support activities. It aims to help prevent the number of diabetes patients through education and encourage testing for diabetes on a nationwide level in order that people learn if they are affected or at risk.

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17. Are people in the UAE essentially just lazy?
No, I do not think it would be appropriate to generalise. People in the UAE work very hard and today’s culture at work and in general tends to keep people tied down, to their desks or in traffic jams. This could pose a challenge for many people but, they should make time for exercise in spite of it. Studies have proven that simple exercise such as walking for half and hour, five days a week can decrease your risk of type 2 diabetes. The key to prevention of type 2 diabetes, even in those with predisposing genes is to maintain a normal body weight and to exercise regularly. The International Diabetes Federation (IDF) has stated that, up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity.

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18. To what extent are longer working hours and increasing numbers of working women contributing to a shift from the traditional home-cooked meals to fast/convenience food?
I cannot comment accurately on whether long work hours or more working women contribute to current food choices. Convenience, however, might be the key word here and with healthy convenience food rare, people tend to settle for what is available. We hope we can set an example for office cafeterias and other outlets through our very own café at ICLDC. We offer healthy food options where all ingredients are monitored by our nutritionists from time to time. Whole grain products, vegetables and fruits and other healthy ingredients form a major part of our menu thus benefiting patients, visitors and staff alike.

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19. What are the other contributing factors towards the obesity problem in the UAE?
In the UAE and the world over, poor, unbalanced and unhealthy diet coupled with a sedentary lifestyle are large contributors to obesity and diabetes. A genetic predisposition too might contribute in some cases therefore when screening for diabetes we always look at family history.

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20. The UAE has the second-worst record for diabetes in the world, but Saudi Arabia, Qatar, Bahrain and Kuwait are also among the top five. What is it about the Gulf Region that is causing such a problem?
Estimated prevalence of diabetes according to 2007 world statistics shows the island of Nauru leading with 30.7 percent prevalence. UAE, number two at 19.5 per cent, Saudi Arabia follows with 16.7 percent prevalence. Bahrain stands fourth highest with 15.2 percent and Kuwait with 14.4 percent diabetes prevalence. There seems to be a genetic predisposition to the disease in the Gulf region, but this risk may be mitigated if one leads a healthy lifestyle. An increased prevalence of diabetes among expatriates in the region as opposed to in their countries of origin indicate that genes are not the only factor in play and that environment (lack of exercise with high fat, high sugar diet) plays a major role as well.

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