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Kuwait ranks 9th worldwide in terms of affliction rate DDI at forefront in fight against diabetes

NO gainsaying the fact that Diabetes is a colossal health issue the world over. But Kuwait, small as it is, has about 250,000 — about a quarter of the population afflicted by the disease and is currently ranked 9th worldwide in terms of affliction rate.  The Dasman Diabetes Institute (DDI) was established with a mission to prevent, control and mitigate the impact of diabetes and related conditions in the society through effective programs of research, training, education and healthy lifestyle promotion and thereby improve quality of life in the population. There’s no doubt the DDI under the directorship of Professor Kazem Behbehani, a Kuwaiti academic and scientist and a University of Liverpool- trained Tropical Medicine specialist at the PhD level whose educational exploits included stints across the US, Europe and the World Health Organization (WHO), has got its shoulders to the wheel in a fight to get the gigantic health problem under control.

In a chat with the Arab Times, Prof. Behbehani, lays out the core mission of DDI while also outlining the types, causes, effects and control of the national canker called Diabetes Mellitus.

  
Question: When and why was Dasman Diabetes Institute established?
Answer: The Dasman Diabetes Institute (DDI) was established by the vision of the late Amir of Kuwait His Highness Sheikh Jaber Al-Ahmad Al-Jaber Al-Sabah.  Recognizing that the problem of diabetes was alarmingly increasing in Kuwait, H.H. created Dasman Diabetes Institute to be an organization that would focus on tackling the disease on all its aspects. The Institute was officially inaugurated on June 6th, 2006 by the current Amir of Kuwait HH Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah. 

Q: The non-communicable disease, diabetes is highly prevalent in the Gulf region especially Kuwait.  How big really is the problem in Kuwait?
A: The prevalence rate of diabetes in Kuwait for 2013 was around 23.9% as published by the International Diabetes Federation 2013. Kuwait has the 9th highest prevalence of diabetes worldwide. The problem is certainly significant and one that necessitates immediate action and planning.

Q: What are the facts/figures of diabetics in Kuwait?
A: Kuwait is ranked 9th in the world with a prevalence rate of 23.9%.  Over 250,000 Kuwaitis have diabetes. According to the latest statistics; the incidence of type 1 diabetes is 22 among every 100,000 children in Kuwait.  Kuwaiti adolescents show the highest rate for diabetes among the Arab nations, with an obesity prevalence rate of 34.8% for males and 20.6% for females.  It is estimated that 80% of the children in Kuwait are overweight or obese.

Q: Why is it so bad? Are there any specific factors that contribute to the disease in the region?
A: In a nutshell, the main reason is our lifestyle. The increasing affluent lifestyle and fast-paced modernization since the discovery of oil have made the lifestyle of most people living in Kuwait become more sedentary. Exercising is difficult in our climate and people tend to move less at their jobs as well. Not only that, but diet is a part of lifestyle and our diets have moved away from traditional natural ingredients and nutritious diets to diets which heavily depend on junk food, processed foods and foods high in sugar and fat. People in Kuwait tend to eat out more and less at home and finding a healthy meal becomes more difficult this way.

Q:  What is Dasman Institute doing to bring this monster of a regional pandemic under control in Kuwait before it morphs into a security issue?
A: Dasman’s mission is to prevent, control and mitigate the impact of diabetes and related conditions in Kuwait. And we’d do this through effective programs of research, training, education, treatment and health promotion. So there are many prongs to our approach and our collaborations with various governmental, private and international organizations give us the expertise and strength to tackle various programs and initiatives all at once. In training and education, we offer postgraduate educational programs onsite in the field of diabetes Care and Education in collaboration with the University of Dundee. We also provide various workshops and continuous professional development programs for all healthcare professionals in the field of diabetes care.  As for treatment, we have a strong relationship with the Ministry of Health in Kuwait to attend to difficult cases of diabetes at the Institute while engaging as many of our patients as possible in our research activities. In health promotion, we have various outreach programs focusing on different aspects of diabetes prevention and care, such as our “Diabetic Ketoacidosis Awareness” campaign, our “My Life, My Medications” campaign, our “Kuwait Healthy Living” project and many others.

Q: What are the different types of diabetes?
A: There are three different types of diabetes: type 1 diabetes, type 2 Diabetes and gestational diabetes. Type-1 diabetes usually affects children or young adults and there is a need for insulin injections daily.  It also can affect older ages.  Type 2 diabetes accounts for at least 90% of all cases of diabetes and does not necessarily require insulin injections. It usually occurs in older people aged 40 and above and is associated with obesity. Recently, obese children are affected with this type of disease. Gestational diabetes is basically diabetes that occurs during pregnancy and usually disappears once the baby is born. In some cases it can continue or can appear in subsequent pregnancies.

Q:  What are some of the symptoms and treatments of Diabetes?
A: The most common symptoms of diabetes are:
* Frequent urination
* Excessive thirst
* Increased hunger
* Weight loss
* Tiredness
* Lack of interest and concentration
* Vomiting and stomach pain (often mistaken as the flu)
* A tingling sensation or numbness in the hands or feet
* Blurred vision
* Frequent infections
* Slow-healing wounds

For type 1 diabetes, the treatment is only with insulin therapy, either as injections or via an insulin pump. For type 2 diabetes, the treatment can be through oral hypoglycaemics and insulin therapy. Oral hypoglycaemics are drugs which can be taken orally that do one of the following functions: increase the amount of insulin secreted by the pancreas, or increase the sensitivity of target organs to insulin, or decrease the rate at which glucose is absorbed from the gut.

Q: Could you please elaborate more on the role, mission and activities of Dasman Diabetes Institute?
A: Dasman Diabetes Institute is the leader in establishing change in Kuwait in the fight against Diabetes. DDI was developed as a central focal point for fighting the epidemic, integrating a more holistic approach towards the disease. The idea was to build a center in which research, educational initiatives and clinical services are encompassed under one roof. From an outside perspective, the staff at Dasman range from scientists performing research on various aspects of the disease, clinicians working with patients towards methods of treatment as well as prevention, educators providing patients and healthcare professions with educational and training courses, to fitness experts working with patients towards lifestyle changes. The interdisciplinary collaborative setting developed for combating this disease provides patients, adults and adolescents with the resources to not only receive the best treatment possible, but the ability to fully understand the scope of their condition.   Dasman Diabetes Institute hosts conferences, organizes seminars, and various events such as the World Diabetes Day Walkathon, and the annual Day Open House at the Institute.  The Institute also organizes outreach campaigns in malls, universities, schools and governmental institutions to promote knowledge and awareness about diabetes among the public.

Q:  Tell us about DDI being on the world map, and the international collaborations and links the Institute has so far achieved.
A: The research endeavors present here at Dasman have provided and developed international research and educational collaborations with countries, like the United Kingdom, United States, and Canada. These collaborations have resulted in the exchange of technical expertise, as well as the ability to connect with key networks involved in working towards methods of prevention and therapy for diabetes. All of these aspects of Dasman add to the unique, competent atmosphere prepared to address the challenges of diabetes on several fronts, understanding that tackling of chronic illnesses, such as diabetes, requires the knowledge and skills of multiple areas of discipline.  In research we have many on-going research projects in collaboration with world-class academic institutions such as Harvard University, the Forsyth Institute, University College of London, Cambridge University, and the University of Dundee to name a few.

Q: Is the DDI on the social media, so people interact with the Institute?
A: Dasman Diabetes Institute is active on Instagram, Facebook, Twitter and YouTube where the useful health tips and educational information are shared on frequent basis.  The accounts are all under the name: Dasman Diabetes Institute.

Q: What can you tell us about the effects of Diabetes both individuals and the national economy?
A: There is no cure for diabetes as of yet. The main idea behind the treatment of diabetes is actually to prevent or delay the complications associated with diabetes which come from either very high or very low blood sugar levels. These complications include: heart disease which may lead to heart attacks or strokes; kidney disease which can result in total kidney failure; nerve disease especially in the legs and feet which can lead to ulcerations and amputations; and eye disease which can lead to loss of vision. The good news is that most of these complications are preventable with tight blood glucose control and proper education of patients. There are diabetics who have not only lived normal lives but have excelled in their fields. Two examples are Sir Steve Redgrave and Gary Hall Jr. who have both won Olympic gold medals while both have diabetes.
Economically, diabetes can have a huge burden on any health care systems and with the rising numbers of people with diabetes and the chronic nature of the disease means that we increasingly spend more and more on diabetes, and even more on its complications.

Q: Prevention is better than cure. How can diabetes be prevented?
A: The most common type of diabetes, type 2 diabetes, is actually preventable. The other types are not. What can be done to prevent type 2 diabetes includes: moderate-intensity physical activity for half an hour every day on most days of the week; a healthy diet avoiding foods high in sugars and fats, and eating foods with more fiber; maintaining a healthy weight and avoiding smoking.

Q: What are the latest developments when it comes to treatments for diabetes?
A: The drugs used in managing diabetes are always being developed and new ones launched. The latest developments have been in the field of peptide analogs such as the DP4 inhibitors and GLP agonists – they are both relatively new classes of drugs and patients with type 2 diabetes should ask their doctors for more information about these drugs. With regards to insulin, again new forms of insulin with newer acting ranges have been developed and may be useful for some patients.

Q: Are there any tips that you can give to our readers on lifestyle and how to avoid diabetes?
A: Choose to move rather than not when you’ve got the chance to. Practice a sport that you like or go to the gym frequently, at least every other day. Eat healthy food and cook at home instead of choosing the easier option of eating junk food or eating out. Stop smoking to better taste your food. Life is not about deprivation from luxuries and the finer things in life, but it’s about having them in moderation and with consideration. Enjoy life and stay optimistic.

Q: Are there any promising findings that the researchers and the research laboratories at DDI have reached lately?
A: The new discoveries and findings at Dasman are related to genetics and genes. Successfully, Betatrophin was identified which is a hormone that has been shown to be induced as a result of insulin resistance to increase insulin production in mice. Our research showed for the first time that level of Betatrophin in plasma is elevated in Diabetes type-2 (T2D) patients and individuals with metabolic syndrome (MetS) patients and suggests the potential use of it as a new T2D and metabolic biomarker.
Also, and for the first time, a new biomarker named DNAJB3 was recognized. It plays an important role in obesity and type-2 diabetes. This gene is reduced in obese diabetic patients and physical exercise intervention restored its normal level and potentially contributed to improving the health of the diabetic patients. Increasing the production of DNAJB3 protein represses harmful proteins linked to inflammation and increases response to insulin.

In addition, one new gene (c6orf25) was discovered as part of the rare disease research and is currently under further characterization through functional genomics experiments.
Other research works were completed on three ethnicities genomes (Arabs, Bedouins and Persian).  The Arabs and Persian genomes will be submitted shortly for publication and 196 exomes of multi ethnic samples sets for database establishment and analysis are underway.
Furthermore, the genotyping of 2000 samples were finalized for cardiometabochip GWAS analysis, which will help in the discovery of obesity, diabetes and other metabolic disorders genes and novel gene variants. Finally, and also for the first time in the region, The Genome department completed the whole transcriptome and microRNAs plasma and PBMCs samples of morbidly obese, obese, and lean sample pools with or without diabetes for transcription and epigenetic analysis using next generation sequencing approach.

biography

Kazem Behbehani is a Kuwaiti national, studied at Liverpool and London Universities and attained his MSc in Medical Parasitology in 1969, and received his PhD in 1972. He was a Post Doctoral Fellow at the London School of Hygiene and Tropical Medicine and the Mathilda and Terence Kennedy Institute of Rheumatology in London. He returned to Kuwait in 1973 and joined University of Kuwait, Medical School, where he eventually became Professor of Immunology and Medical Parasitology. At the University level he held the following posts: Vice Dean of the Faculty of Science, Vice Dean (Research) of the Faculty of Medicine, Vice President for Research and member of the university council. During these years, he also became a visiting scholar at Harvard Medical School (1979-1984). He was also Deputy Director General of Kuwait Institute for Scientific Research (KISR) and a member of the Management Board of the IBM Scientific Centre, Kuwait.

In 1990 he joined World Health Organization (WHO- Geneva). At WHO (1990-2005), he worked in the vaccine research of the Global programmes of AIDS, was the Programme Manager of Tropical Disease Research (TDR), Director of both the Division of the Control of Tropical Diseases (1994-1998) and the Eastern Mediterranean Liaison Office (1998-2003). He served as a member of the WHO Board of Appeal, Secretary of number of Intergovernmental meetings (e.g. Tobacco Convention), as well as several of the committees/subcommittees of the Executive Board and the World Health Assembly. His last position was Assistant Director-General for External Relations and Governing Bodies (2003 - 2005). In 2005, he became the WHO Health Envoy. In 2006 he was a candidate for the WHO Director-General, where he succeeded to reach the top 5 candidates in the short list. Presently he is the Director-General of the Dasman Diabetes Institute in Kuwait.

By Iddris Seidu
Arab Times Staff


By: Kazem Behbehani

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