High diabetes and obesity rates complicate GCC’s coronavirus fight

People with co-morbidities like heart disease, diabetes and obesity have a higher chance of complications with COVID-19. (Shutterstock)
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Updated 12 August 2020

High diabetes and obesity rates complicate GCC’s coronavirus fight

  • Study finds people with Type 2 diabetes twice as likely to die from COVID-19 as those without it
  • Diabetic and obese people have an immune system malfunction that particularly endangers them

DUBAI: In the ongoing havoc the coronavirus disease (COVID-19) is wreaking, a double bind has the Gulf region’s health experts worried — the rising cases of diabetes and obesity and the increased risk of mortality this population faces due to the pandemic.

According to the International Diabetic Federation (IDF), more than 39 million adults aged 20 to 79 had diabetes in the Middle East and North Africa (MENA) region last year. The figure is expected to increase to 108 million by 2045.

The IDF Atlas states that 15.4 percent of adults aged 20 to 79 in the UAE are diabetic, while in Bahrain the number is 19.6 percent. In Kuwait and Qatar, the figure jumps to 20 percent.

In Saudi Arabia, it is estimated that 15 percent of the adult population has diabetes, and many more are likely to be either undiagnosed or pre-diabetic, leaving them on the edge of the chronic disease.

These numbers are alarming by themselves, but what is more concerning is that amid the COVID-19 pandemic, some groups face a greater risk than others.

A study conducted by the Imperial College London found that people with Type 2 diabetes are twice as likely to die from COVID-19 as those without it.

The study also found that people with Type 1 diabetes were three and a half times more likely to die from a COVID-19 infection.

What causes such a lethal outcome? According to Dr. Nasr Al-Jafari of DNA Health Corporation, Dubai, the virus can be deadly because of its ability to stimulate a part of the immune system called the “inflammasome.”

“This can often cause an uncontrolled release of pro-inflammatory responses of the immune system, which leads to what has been described as a ‘cytokine storm’ (where the body starts to attack its own cells instead of fighting off the invading virus). The consequences are a potentially severe and irreversible damage to the heart and lungs,” Al-Jafari told Arab News.

“We also know that people suffering from both diabetes and obesity have a chronic activation of this same ‘inflammasome.’

“Therefore, these people are more at risk of developing the above-described inflammatory cascade of events, ultimately putting them at a higher risk of needing ventilatory support, and even a higher risk of death.”

Khadija Kapasi, a Kuwait-based clinical dietitian, says that the problem people with diabetes face is one of “worst outcomes.”

“People with co-morbidities like heart disease, diabetes and obesity have a higher chance of complications with COVID-19, and diabetics are particularly vulnerable because the virus can cause difficulties managing it,” she said.

Echoing the concerns of Al-Jafari and Kapasi, Dr. Asma Deeb, division chief of Pediatric Endocrinology at the Sheikh Shakhbout Medical City in Abu Dhabi, said that the risk of COVID-19 is expected to be high due to the wide prevalence of diabetes in the Gulf region.

“Diabetes can make COVID-19 symptoms more severe and can cause a greater likelihood of mortality,” she said, adding: “Obesity has also been identified as a risk factor.”

In addition to having diabetes, over half of diabetics in the region are reported as having at least one co-morbidity, said Kapasi. In Kuwait and Saudi Arabia, one in five are reported as having two or more co-morbidities.

“Saudi Arabia also ranks in the top 15 countries for obesity, which leads to diabetes and its complications,” Kapasi said. “The UAE, Bahrain, Saudi Arabia, Kuwait and Qatar are listed in the top 15 nations for the highest rate of diabetes per capita.”

Bassam Bin Abbas, professor and pediatric consultant of endocrinology at the King Faisal Specialist Hospital and Research Center in Riyadh, concurred, saying: “Diabetes is a risk factor for hospitalization and mortality of the COVID-19 infection.

“More than a third of the Kingdom’s adult population is obese, and obesity is also a risk factor for severe infection and diabetic complications.”

What is causing this rise in numbers? According to research from New York University Abu Dhabi, Gulf citizens may have a genetic predisposition to diabetes. But that is not the only reason.

“Experts concerned about the rapid increase in lifestyle diseases in this region have looked to history and environmental factors to identify the cause,” said Kapasi.

And the cause, according to her, is clear: “Unhealthy lifestyles and urbanization. Bahrain, Kuwait, Qatar, Saudi Arabia and the UAE are some of the wealthiest countries in the world today, and the lifestyle of the average citizen in these countries is dramatically different from that of the pre-oil era.”

Al-Jafari describes Type 2 diabetes, which accounts for over 90 per cent of the cases, as a “lifestyle disease.”

“The modernized lifestyle adopted by a large part of the population is a perfect storm for developing ‘insulin resistance’, which is at the root of this condition,” he said.

“There is an over-availability of, and dependency on, fast foods and processed foods. The lifestyle has largely become sedentary, particularly during the hotter months.”

According to all the specialists, the need of the hour is to raise awareness among people with diabetes and offer them more education and support to manage their condition during this difficult time.

Diabetics are advised to strictly monitor their blood glucose level at regular intervals to ensure that it is under control.

“They should check not only fasting but also post-meal glucose levels, which are more likely to be higher,” said Dr. Abdul Jabbar, consultant endocrinologist, Medcare Hospital, Al Safa, Dubai.

“They should strictly adhere to their medication schedule, including for control of blood pressure and lipids. Wherever possible, patients should tele-consult with doctors to reduce exposure to the virus,” he said.

Diabetes in COVID-19 patients can also be more difficult to treat due to the fluctuations of blood glucose, concomitant sepsis, and high risk of developing diabetic ketoacidosis and multi-organ failure, said Dr Vikram Hundia, consultant endocrinologist at Al-Zahra Hospital Dubai.

“Ensuring an adequate stock of regular medications, including insulin, is vital during these times when an overburdened healthcare system, shortages in supply of drugs and travel restrictions may pose a challenge,” he said.

“Employers may need to provide special working conditions to those suffering from diabetes to minimize their risk of exposure,” he told Arab News, adding that Gulf Cooperation Council states needed to put in place coordinated and effective measures for diabetic patients to prevent exposure to this infection.

“Working closely with the diabetes management team, optimizing diabetes control, practicing a healthy lifestyle, and staying safe and fit will not only protect patients with diabetes, it will also help them emerge from this pandemic stronger and healthier,” Hundia said.

Many regional governments have taken steps to combat the rise in the numbers of lifestyle diseases such as diabetes and obesity, including the Saudi government’s “Quality of Life Program,” one of the Vision Realization Programs of Saudi Arabia 2030.

“It aims to enhance the quality of life in the Kingdom through lifestyle improvement by increasing individuals’ participation in entertainment, sport and cultural activities,” Bin Abbas, of the King Faisal Specialist Hospital and Research Center, said.

“Other measures, including taxing sugary drinks, fitness initiatives and focusing on preventative care, have already been rolled out to address the rising epidemic.”

Twitter: @CalineMalek

UK MPs debate Palestinian statehood, sanctions against Israel

Updated 14 June 2021

UK MPs debate Palestinian statehood, sanctions against Israel

  • Labour’s Katherine McKinnell: Palestinians’ ‘aspiration for self-determination is one that we should wholeheartedly support’
  • MENA minister: ‘We’re firmly opposed to boycotts or sanctions against Israel’

LONDON: British MPs on Monday debated implementing two petitions that call for economic sanctions against Israel and for the UK government to recognize the state of Palestine.

The petitions garnered over 100,000 signatures each, which according to British law means they must be considered for debate in Parliament.

Politicians from both sides of the aisle urged the government to push forward the two-state solution by recognizing the state of Palestine, but the majority of MPs that took part in the debate rejected the idea of sanctions against Israel.

Chairing the debate, Labour’s Katherine McKinnell said: “I share the deeply held concerns for the plight of the Palestinian people. Colleagues who have visited the region will know that the desire of the Palestinians to live in dignity and in peace in a state of their own is unmistakable. 

“Their aspiration for self-determination is one that we should wholeheartedly support. It’s right for the Palestinian people, and it’s right for the Israeli people.”

She added: “However, I don’t believe that sweeping sanctions of the kind proposed by the second petition would bring the prospect of a two-state solution any closer.”

That petition, which currently has over 386,000 signatures, said: “The government should introduce sanctions against Israel, including blocking all trade, and in particular arms.”

It added that Israel’s “disproportionate treatment of Palestinians and settlements that are regarded by the international community as illegal are an affront to civilised society.”

James Cleverly, the UK’s minister for the Middle East and North Africa, reiterated the government’s position on economic sanctions against Israel, saying: “While we don’t hesitate to express disagreement with Israel whenever we feel it necessary, we’re firmly opposed to boycotts or sanctions against Israel.”

Cleverly also rejected the second petition’s demand — that Britain immediately recognize a sovereign Palestinian state.

“There have, of course, been many calls over the years for recognition of Palestinian statehood,” he said.

“The UK government position is clear: The UK will recognize a Palestinian state at a time when it best serves the object of peace. Bilateral recognition in itself cannot and will not end the occupation,” he added.

“The UK government continues to believe that without a negotiated peace agreement, the occupation and the problems that come with it will continue.”

Cleverly did, however, criticize Israel’s continued assaults on Palestinian homes in the occupied territories.

“The UK position on evictions, demolitions and settlements is longstanding, is public, and has been communicated directly to the government of Israel. That is: We oppose these actions,” he said.

Steve Baker, a Conservative MP, said he had made a “mistake” by deprioritizing the Israeli-Palestinian issue during a period of relative calm.

“The problem, of course, is that the conflict hadn’t gone away and has since returned with a ferocity,” he added.

Baker urged the government to actively pursue a two-state solution, a policy that he and other MPs pointed out has been endorsed by the government without ever being actively pursued. 

“I voted to recognize the state of Palestine,” he said. “I think if we’re serious about a two-state solution, it’s important that this Parliament and parliaments elsewhere, governments elsewhere, recognize the state of Palestine.”

Labour’s Naz Shah said she had a message for Israel’s new Prime Minister Naftali Bennett: “Those who support you in the Knesset (Parliament), the mood music is changing, the world is waking up to Israel’s actions, and all those who want to see lasting peace in the region know that to achieve such peace we must end the occupation, injustice and oppression. This starts with recognizing a viable Palestinian state.”

She warned Bennett: “We won’t be silent in pushing for Israel to be tried in the International Criminal Court for war crimes if any more Palestinian blood is unjustly spilled under a perverted interpretation of a right to self-defense.”

At NATO, Turkey hails its revival of dialogue with Greece

Updated 14 June 2021

At NATO, Turkey hails its revival of dialogue with Greece

  • Turkish President is holding a series of one-on-one meetings with NATO leaders, including U.S. President Joe Biden
  • Erdogan recently toned down his anti-Western rhetoric as he seeks foreign investments for his country

BRUSSELS: Turkish President Recep Tayyip Erdogan said Monday that a revival of dialogue with fellow NATO member Greece to resolve long-standing disputes will serve “stability and prosperity” in the region.
Speaking on the sidelines of a NATO summit, Erdogan also lamented what he said was a lack of support by Turkey’s NATO allies in its fight against terrorism.
It was a veiled reference to Turkey’s disappointment with US military support for Syrian Kurdish fighters, who Ankara argues are inextricably linked to a decades-long Kurdish insurgency in Turkey.
Erdogan, who is vying to mend Turkey’s battered relations with its Western partners, is holding a series of one-on-one meetings with NATO leaders, including US President Joe Biden.
The Turkish strongman has recently toned down his anti-Western rhetoric as he seeks foreign investments for his country, which has been troubled by a currency crisis and an economic downturn made worse by the coronavirus pandemic.
“Turkey is on the frontline in the fight against terrorism in all relevant international platforms, especially NATO,” Erdogan said, adding that some 4,000 Daesh group fighters were “neutralized” in Turkish cross border operations.
“Turkey is the only NATO ally which has fought face-to-face and gave its young sons as martyrs for this cause,” Erdogan said. “Unfortunately, we did not receive the support and solidarity we expected from our allies and partners in our fight against all forms of terrorism.”
Last summer, a long-standing dispute between Turkey and Greece over boundaries and rights to natural resources in the eastern Mediterranean flared anew after Ankara sent research vessels into waters where Greece asserts jurisdiction.
Diplomats from the two countries have held two rounds of talks in recent months for the first time in five years, while the foreign ministers of Greece and Turkey also held reciprocal visits.
“I believe that reviving the channels of dialogue between (Turkey) and our neighbor and ally, Greece, and the resolution of bilateral issues will ... serve the stability and prosperity of our region,” Erdogan said, in a video address to a think tank event on the sidelines of the summit.
Erdogan’s talks with Biden are expected to focus on US support for Syrian Kurdish fighters, as well as a dispute over Ankara’s acquisition of a Russian air defense system, which led to Turkey being removed from the F-35 fighter program and sanctions on defense industry officials.
Washington says the S-400 missiles, which Turkey purchased in 2019, pose a threat to NATO’s integrated air defense and has demanded that Ankara abandons the $2.5 billion system.
In April, Biden infuriated Ankara by declaring that the Ottoman-era mass killing and deportations of Armenians was “genocide.” Turkey denies that the deportations and massacres that began in 1915 and killed an estimated 1.5 million Armenians amounted to genocide.
In Brussels, Erdogan met with French President Emmanuel Macron, German Chancellor Angela Merkel, British Prime Minister Boris Johnson and Greek Prime Minister Kyriakos Mitsotakis.
After his meeting with Erdogan, Macron tweeted that he wants to “move forward” with Turkey.
It was their first meeting since a dispute between the two countries reached its peak in October, after Erdogan questioned Macron’s mental health.
Both men discussed Libya and Syria issues, the Elysee said. Macron has accused Turkey of flouting its commitments by ramping up its military presence in Libya and bringing in jihadi fighters from Syria.
During the discussion with Johnson, the two leaders agreed to “work toward the resumption of travel between the UK and Turkey,” according to a Downing Street statement. Turkey has been pushing for a relaxation of COVID-19 restrictions to allow British tourists to come to Turkey this summer.

Macron says Turkey’s Erdogan wants foreign mercenaries out of Libya

Updated 14 June 2021

Macron says Turkey’s Erdogan wants foreign mercenaries out of Libya

  • Macron was speaking after his first face-to-face with Erdogan in more than a year

PARIS: French President Emmanuel Macron on Monday said he had received assurances from Turkey’s President Tayyip Erdogan that he wanted foreign mercenaries to leave Libyan territory as soon as possible.
“We agreed to work on this withdrawal (of foreign mercenaries). It doesn’t just depend on the two of us. But I can tell you President Erdogan confirmed during our meeting his wish that the foreign mercenaries, the foreign militias, operating on Libyan soil leave as soon as possible,” Macron told a news conference at the end of a summit of NATO leaders in Brussels.
Macron was speaking after his first face-to-face with Erdogan in more than a year as tensions between the two NATO allies worsened especially over the conflict in Libya.
Turkey deployed troops to Libya under an accord on military cooperation signed with the Tripoli-based Government of National Accord (GNA), helping it repel an assault by forces from eastern Libya. It also sent thousands of Syrian fighters to Libya.

New Israeli government approves nationalist march in Jerusalem

Updated 14 June 2021

New Israeli government approves nationalist march in Jerusalem

  • Jerusalem march by Jewish nationalists poses immediate challenge to the new coalition
  • March comes just weeks after devastating Israeli bombardment of Gaza

JERUSALEM: Israel’s new government on Monday approved a Jewish nationalist march in Jerusalem, a step that risks inflaming tensions with Palestinians hours after veteran leader Benjamin Netanyahu handed over power to Prime Minister Naftali Bennett.
In the flag-waving procession, planned for Tuesday, far-right groups will march in and around East Jerusalem’s walled Old City, where tensions have remained high since 11 days of fighting between Israel and Gaza militants in May.
Palestinian factions have called for a “day of rage” against the Jerusalem march, with memories of clashes with Israeli police still fresh from last month in the contested city’s Al-Aqsa Mosque compound and in a neighborhood where Palestinians face eviction in a court dispute with Jewish settlers.
“This is a provocation of our people and an aggression against our Jerusalem and our holy sites,” Palestinian Prime Minister Mohammad Shtayyeh said of the march.
After meeting with Israel’s police chief and other security officials, newly sworn-in Internal Security Minister Omer Barlev approved the march and said police were well-prepared, according to a statement carried by Israeli media.
“(Great) efforts are being undertaken to preserve the delicate fabric of life and public security,” Barlev was quoted as saying.
It was not clear whether participants would be allowed to enter the Old City’s Muslim quarter, on a route that Israeli police had previously barred. A police spokesman did not immediately provide comment.
An original march on May 10 was re-routed at the last minute as tensions in Jerusalem led Hamas to fire rockets toward the holy city and Israel responded with air strikes on Gaza. Right-wing Israeli groups accused their government of caving into Hamas and rescheduled the march after a truce took hold.
Hamas has warned of renewed hostilities if it goes ahead, and Israeli media reported the military had made preparations for a possible escalation.
The US Embassy in Jerusalem prohibited its personnel and their families from entering the Old City on Tuesday “due to calls for a Jerusalem Flag March and possible counter-demonstrations.”
The march poses an immediate challenge for Bennett’s government, which was approved on Sunday by a 60-59 vote in parliament.
A route change or cancelation of the procession could expose the Israeli government to accusations from Netanyahu, now in the opposition, and his right-wing allies of giving Hamas veto power over events in Jerusalem.
Suggesting that a route adjustment could be in store, Yoav Segalovitz, a deputy internal security minister, said past governments had stopped nationalists visiting Muslim sites in times of tension.
“The main thing is to consider what’s the right thing to do at this time,” he told Israel’s Kan radio.
Formation of Bennett’s alliance of right-wing, centrist, left-wing and Arab parties, with little in common other than a desire to unseat Netanyahu, capped coalition-building efforts after a March 23 election, Israel’s fourth poll in two years.
Minutes after meeting Bennett, 49, on his first full day in office, Netanyahu repeated a pledge to topple his government.
“It will happen sooner than you think,” Netanyahu, 71, who spent a record 12 straight years in office, said in public remarks to legislators of his right-wing Likud party.
With any discord among its members a potential threat to its stability, Israel’s new government hopes to focus on domestic reforms and the economy and avoid hot-button issues such as policy toward the Palestinians.
Palestinians want East Jerusalem, which includes the Old City, to be the capital of a state they seek to establish in the occupied West Bank and Gaza.
Israel, which annexed East Jerusalem in a move that has not won international recognition after capturing the area in a 1967 war, regards the entire city as its capital.
A key test for the new government and its stability will be how quickly it moves to pass a budget, said Yohanan Plesner, president of the Israel Democracy Institute.
“If within 3-4 months this government will pass the 2021-22 budget then we can expect this government to serve for at least two or three years. Otherwise, the instability will continue,” he said.
Palestinians held out scant hope of a breakthrough in a peace process leading to a state of their own. Talks with Israel collapsed in 2014.
“We don’t see the new government as less bad than the previous ones,” Shtayyeh told the Palestinian cabinet.
Under the coalition deal, Bennett, an Orthodox Jew and tech multi-millionaire who advocates annexing parts of the West Bank, will be replaced as prime minister in 2023 by centrist Yair Lapid, 57, a former television host.
Lapid, widely regarded as the architect of the coalition that brought down Netanyahu, is now foreign minister.

Sudan says it is open to conditional interim deal on Ethiopia dam

Updated 14 June 2021

Sudan says it is open to conditional interim deal on Ethiopia dam

  • Ethiopia is pinning its hopes of economic development and power generation on Grand Ethiopian Renaissance Dam
  • Sudan and Egypt agreed last week to coordinate efforts to push Ethiopia to negotiate "seriously"

KHARTOUM: Sudan is open to a partial interim agreement on Ethiopia’s multi-billion-dollar dam on the Blue Nile, with specific conditions, Irrigation Minister Yasir Abbas said on Monday.
While Ethiopia is pinning its hopes of economic development and power generation on the Grand Ethiopian Renaissance Dam (GERD), Egypt fears it will imperil its water supply and Sudan is concerned about the impact on its own water flows.
Sudan and Egypt agreed last week to coordinate efforts to push Ethiopia to negotiate “seriously” on an agreement on filling and operating the GERD.
Cairo and Khartoum had been aligned on the need for any agreement to be comprehensive, but Abbas’s comments mark a potential shift in Sudan’s position.
” conditions include the signing-off of everything that has already been agreed on in negotiations, ... provisions to ensure that the talks continue even after the filling scheduled for July, and the negotiations adhering to a definite timetable,” Abbas told a news conference, citing a time crunch.
Ethiopia has said it will begin a second filling of the reservoir behind the dam during the rainy season this summer.
Talks overseen by the African Union, aimed at reaching a binding agreement, have repeatedly stalled.