The health status of an individual or a group of people is influenced by several factors that are collectively known as determinants of health. These factors may be social, personal, economic, political or environmental (Krumeich & Meershoek, 2014). The purpose of this paper is to explore the available literature on type 2 diabetes and establish its prevalence and its specific determinants in Middle East countries. The paper seeks to evaluate how these determinants can help prevent type 2 diabetes and hence promote the overall health of people residing in the Middle East countries. According to the World Health Organization (WHO), Non-Communicable Diseases (NCDs) claim over 41 million lives annually. The blow of these diseases is specifically high is low and middle income countries where approximately 32 million deaths occur as a result of NCDs (Lee, 2014). According to Malikhao (2016), Diabetes Mellitus is a major NCD, and statistics from WHO further establish that over 1.6 million lives are lost annually due to diabetes. NCDs are mostly affected by factors such as lifestyle and genetics. Lifestyle is however the major risk factor to major NCDs such as diabetes (Yang, 2016).
Diabetes Type 2: Its Nature, Prevalence and Significance
In the past, Diabetes Mellitus (DM) was considered a minor illness with little health significance. However, this assumption has been long forgotten and currently the disease is considered a major threat to global health. It was estimated that by 2030, the number of people expected to be living with the disease would be 366 million (Tsehay Biru, 2017). However, a shocking fact is that, according to the International Diabetes Federation (IDF), the 366 million threshold was reached in 2011, and current projections are that by 2030, 530 million people will be suffering from diabetes (Yahia, 2014). A type of DM, that is extremely common is type 2 diabetes and nearly 96% of diabetes patients have this form of the disease. According to WHO, diabetes is a chronic disorder of metabolism characterized by hyperglycaemia, which result from defective processes of insulin secretion and action. These defects consequently lead to disturbances of fat, protein and carbohydrate metabolism (Kharroubi, 2015). The condition has multiple etiologies. Those suffering type 2 diabetes are able to produce insulin; but in small amounts that are insufficient ("Health Promotion Behavior among Patients with Type 2 Diabetes Mellitus? A Cross Sectional Survey," 2017). Some of the ultimate effects of diabetes are reduced life expectancy, reduced quality of life and increased complications of diseases of macro vascular origin (Dagogo-Jack, 2016). In 2011, type 2 diabetes was estimated to claim over 4.5 million lives of people aged between 20-79 years, with its estimated death rate being one person in every seven seconds (Yahia, 2014). A study conducted in Saudi Arabia estimated that by 2014 the prevalence of the disease was at 25.4%. Moreover, about 6% of deaths that occur in Saudi Arabia are due to type 2 diabetes (Abuyassin & Laher, 2016). Type 2 diabetes has therefore over the years become an issue of global concern, due to the fact that it currently claims more lives than those claimed by infectious diseases such as HIV/AIDS, tuberculosis and malaria, which currently are the top priorities of public health (De Maio, 2014). The above stated statistics therefore indicate that type 2 diabetes is a global threat to public health and hence the need to reduce its prevalence at all costs. A particular issue of concern is the high number of people who suffer from this disease in Middle East countries (Yahia, 2014).
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Risk Factors Associated With Type 2 Diabetes
According to Tsehay Biru (2017), there are two main categories of risk factors that are associated with type 2 diabetes; modifiable risk factors and non-modifiable risk factors. The non-modifiable factors include: age, ethnicity, and presence of the illness during a previous pregnancy, as well as family history of diabetes. Individuals who are more than 44 years old are at a higher risk of showing symptoms for type 2 diabetes. The modifiable risk factors include; inadequate physical activity, unhealthy eating habits, hypertension, impaired glucose tolerance and elevated plasma triglycerides. A woman who had gestational diabetes during a previous pregnancy has a higher chance of developing the disease as so is the risk for overweight individuals or those who engage in minimal or no physical exercise. In addition, belonging to certain ethnicities such as Hispanic, African-American, Native American and Asian American further increases the risk (De Maio, 2014).
Upstream Determinants of Type 2 Diabetes
Social, political, environmental and economic determinants are some of the important factors that play a crucial role in occurrence of the disease (Krumeich & Meershoek, 2014). For instance, the rapid economic development that has taken place over the last three decades has brought about great changes that have led to improvement in amenities such as infrastructure. Improved infrastructure has consequently led to reduced physical activities due to increased reliance on mechanization (Sherif, 2015). Moreover, westernization has led to proliferation of fast foods which contain excess fats and simple carbohydrates that are not only harmful and unhealthy, but also of no nutritional value. Economic growth, which is usually associated with urbanization, has been shown to be a major contributor of increased prevalence of the disease in Middle East countries (Yahia, 2014). For instance, earlier studies in Saudi Arabia found the prevalence of type 2 diabetes in urban areas to be more that it prevalence in rural areas by two-fold. In Oman, urban areas had a prevalence of more than 17%, while rural areas had a prevalence of less than 11% (Sherif, 2015). A study conducted in 2017 in the United Arab Emirates (UAE) established that the associated countries have a high prevalence of type 2 diabetes, with the major determinants being sedentary lifestyles, poor diet and lack of physical activity (Razzak, Harbi, Shelpai, & Qawas, 2017). In Dubai for instance, statistics show that the prevalence of type 2 diabetes is approximately 19%. A survey conducted by the IDF in UAE placed the prevalence of type 2 diabetes at 17.4%, with more than a million people living with diabetes. Additional studies indicate that the disease is on the rise in UAE, with the prevalence increasing at a faster rate than the rest of the world. It is expected that by 2040 more than two million people in UAE will be suffering from diabetes (Imperial College London Diabetes Center, 2018). In addition to this, the 21 st century is characterized by cheap immigrant labor which leads to sedentary lifestyles with no physical activities especially by the young people. It’s important to note that sedentary lifestyle has been named as one of the most significant risk factor associated with type 2 diabetes. The above mentioned factors have led to increased prevalence of obesity in Middle East countries; which is directly associated with type 2 diabetes (De Maio, 2014). Obesity is considered the primary risk factor for type 2 diabetes. Studies conducted in Kuwait for instance found out that at least 77% of obese females were diabetic as so were 48% of obese males. In other studies conducted in Qatar and Oman, it was indicated that more than 55% obese patients in Qatar and 50% obese patients in Oman were diabetic (Abuyassin & Laher, 2016). Other environmental factors such as scorching high temperatures discourage people from Middle East countries from engaging in outdoor activities which encourage physical activity. In addition, the cultural heritage of Middle Eastern people encourage women to have multiple pregnancies and to stay indoors both of which are risk factors for type 2 diabetes. Political instability is another factor that has tremendous influence on the health of people. It results to difficulty of accessing quality and affordable health services (Sherif, 2015).
Application of Upstream Determinants to Reduce Prevalence of Type 2 Diabetes
The high prevalence of diabetes in Middle East countries can be attributed to the fact that prevention strategies are minimal. Not enough is being done in these countries to address the upstream determinants that are associated with type 2 diabetes (De Maio, 2014). Knowledge of the determinants of diabetes as well as risk factors can be effective in ensuring that the prevalence of the disease is reduced (Dagogo-Jack, 2016). For instance, use of available data from research studies with regards to obesity, ethnicity and genetics can help in assessing the appropriateness of a community setting for physical activity and hence help create awareness with regards to the health risks associated with diabetes. Consequently this can lead to improved health status of the public. Awareness of these determinants can also encourage the already affected individuals seek medical services and hence improve their quality of life (Abuyassin & Laher, 2016). For example, addressing the political instability in these regions can help in formulation of health policies that can improve the health status of affected individuals and those at risk.
Benefits of Addressing Upstream Determinants
In addition to preventive measures, appropriate screening tools can help create an actual picture of the disease prevalence Social community supports such as education programs can also be effective in managing the situation. Economic policies, such as taxation of sugary food and drinks can reduce the overall production and hence consumption of these foods, which increases the risk of acquiring the disease (McKenzie & Pinger, 2014). To sum this up, addressing all the above listed determinants will not only improve the quality of life of people residing in Middle East countries, but will also reduce the economic and health costs associated with diabetes (Sherif, 2015).
Conclusion
The review has established that there is a surprisingly high prevalence of type to diabetes in these countries; most especially within the last two decades. This has been documented to have tremendous health and economic costs. Economic development together with an proliferation of the western lifestyle are the two major factors that have fueled the high prevalence of the disease. This is due to the fact that the two factors have consequently led to reduced manual jobs and increased number of low physically demanding jobs, which encourage people to live sedentary lifestyles void of physical activity. While these countries are continuously faced with political instability, more needs to be done. Introduction of new health policies that can produce health benefits and increase the quality of life while reducing the economic costs associated with the disease would be a starting point (Dagogo-Jack, 2016).
Despite the high prevalence of this disease in Middle East, the current existing research with regards to the disease in Middle East is not extensive enough to match the level of health risks associated with the disease. This was a major setback during the compilation of this review. Lack of prediction of the burden that type 2 diabetes is expected to incur in the next few years has made it difficult for policy makers to put strategic prevention plans in place. Due to this, little is being done with regards to control of the disease these regions. However, studies show that predictive data is only available for Saudi Arabia where prevalence is expected to be at 44.1% by 2022. A change in the current economic, health and political policies in Middle East will ensure a reduced prevalence of type 2 diabetes and an over improvement in the health of the population (Sherif, 2015).
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