On World Diabetes Day, the head of medical core facilities and research platforms at the King Abdullah International Medical Research Center in Saudi Arabia Mohamed Boudjelal writes to Nature Middle East’s House of Wisdom about the region’s type 2 diabetes nightmare, and what could be done, on the individual level, to prevent or at least ease the blow of the yet incurable disease.
Diabetes is a global issue that strains both the societies it’s rampant within, and the economies that these societies rely on. This is especially true in developing regions like the Middle East and North Africa (MENA).
According to popular projections, the number of diseased persons worldwide may reach 200 million by 2020. The International Diabetes Federation estimates that by 2035, the MENA region alone will be home to 68 million diabetes cases. As it stands, nearly 35 million are already suffering from the disease across MENA and millions remain undiagnosed.
There are two type of diabetes: type 1 which results from the insufficient secretion of insulin in the body and type 2 diabetes which occurs due to some bodies’ insensitivity towards insulin. Type 2 is more widespread, and is intimately linked to changes in our modern lifestyles.
What causes type 2 diabetes?
Obesity, defined by having a body mass index of 30 kg/cm2 or higher, predisposes to type 2 diabetes , which is mainly characterized by the resistance of the body to burn excess energy and instead gain weight in the form of fat.
Obese people usually carry the excess weight unevenly throughout the body; usually they have central adiposity in the abdomen. Estimates in the Arab world show that over 30% of the population are obese, measured by waist-hip ratio, and females in particular show a significantly higher prevalence of central obesity than males.
This rampant weight gain in the Arab population is, in some instances, culturally desired. But lately it is more likely to be a direct consequence of unhealthy lifestyle changes that eventually lead to dysfunction and more lethargy. In my opinion, the recent spread of this pandemic was aggravated by the abandonment of a traditional lifestyle – one that used to encourage activity and healthy eating.
In the last few decades, nighttime entertainment changed the way our societies eat and sleep – essentially messing up the body’s biological clock which governs most of its physiological processes. The molecular clock is composed of central and peripheral clocks; the central clock, found in the brain, gets synchronised, sensing the day and night via light captured through the retina. As a consequence, the brain would send signals; channeling melatonin or cortisol to the peripheral organs, to tell them if it is day or night, and in turn the organs would switch on or off their biological processes depending on these signals. Some processes are supposed to function only during the day or during the night.
This cycle regulates the timing of hormone secretion, heart rate, blood pressure, cell cycle, metabolism, and energy burning. For example, DNA repair usually happens during the night while cell division occurs during the day; inflammatory factors are secreted in early morning as the cortisol level in the body is at its lowest. That is why asthmatic and rheumatoid patients suffer more in the early morning.
The continuous perturbation, however, of the body’s biological clock leads to diseases and/or worsen their condition – and it is one of the causes of obesity, since it is why people start eating more during the night when the metabolism is low. On top of that, fast food lovers consume a lot of fat and artificial ingredients leading to obesity and higher levels of insulin secretion.
The cure? It’s partly personal!
Diabetes is not yet curable but could be preventable, and preventing obesity is the first step.
Resisting the side effects of urbanization and avoiding a fast food lifestyle (and what it entails) should be the focus of individuals.
Policymakers should also lend a hand by regulating the life of Arab world populations to a degree: for instance, shops should not stay open late unless there is a necessity to encourage early sleep. Such a small step may on the long run help protect our biological clocks.
Education and the media should play a significant role in raising awareness about healthy eating and sports. Small tips, like teaching people to eat and stop when they are no longer hungry as opposed to when they’re stomach-full, can make a difference. Such campaigns should target schools, mosques, colleges and places frequented by young adults.
In sum the solution is not only in the hands of governments, but every single one of us. So there is an urgent need for each and every one to review their lifestyle choices, and determine how to make positive changes.
Mohamed Boudjelal is the head of Medical Research Core Facility and Platforms King Abdullah International Medical Research Center, National Guard Health Affairs. Email: firstname.lastname@example.org