Prevalence And Pathophysiology Of Diabetes Type 2 In Arab Nations

Background information

Background information

The diabetes type 2 is more common than type 1 in that it exists in about 90% of all people suffering from the ailment. This fact means that 1 person in a group of 10 Arabians suffers from the ailment (Zayed, 2016). There are many risk factors of developing type 2 diabetes including aging, obesity, poor life style, and excess belly fat. In such a case, the glucose in the body becomes saturated while the pancreas produces more of the insulin. As seen earlier, the type 2 diabetes, occurs when the body fails to respond to the increased glucose levels even though it is producing the insulin.  

Objectives

The main purpose of this essay is to describe how the type 2 diabetes has found its way into the 22 Arabic nations. Since it is more common than type 1 diabetes, we are sure that the Arabians suffer from its wrath.

Methods

The research conducted here is quantitatively based and has focused on some of the countries that have the highest diabetes type 2 in the Arabic world. Of the discussed countries, the ones with the highest prevalence are Kuwait, Saudi Arabia, Bahrain, U.A.E., and Oman. Their prevalence rates include 25.4%, 31.6%, 25.0%, 25.0%, and 29% respectively. Other countries such as Somalia (3.9%) and Mauritania (4.7%) had lower prevalence rates.

Introduction

Over the past, we have had different people suffering from diverse ailments. Among these illnesses include diabetes. Diabetes is a condition in the human body where the body fails to control the metabolism action of glucose in the blood. In general, the ailment exists in two forms that are the diabetes type 1 and diabetes type 2.

Pathophysiology of diabetes

In diabetes type 1, the infected person fails to completely produce the relevant insulin. In type 2, the persons in question produce the insulin, some in low quantities that fail to act accordingly to the metabolism of glucose in the blood. As a result, the infected person may always observe a number of symptoms such as hunger, fatigue, consistent urination, blurry vision, and wounds that take long to heal.

Prevalence of diabetes globally

As we had seen earlier, diabetes occurs in two types, the type 1 and type 2. The type 2 is most common in the globe as many people tend to produce the insulin that is non-reactive to the glucose metabolism. According to the World Health Organization (WHO), the number of the people suffering from the diabetes ailment rose from 108 million in 1980 to 422 million in 2014. This increase represented the shift in percentage from 4.7% to 8.5% specifically on the adults considered to be over 18-years of age (Nisa, et al., 2014). Diabetes is linked to be more devastating to the nations with low income earning when compared to those with higher per capita income. In the countries that have been infected, the side effects of the ailment included heart attacks, failure in kidney normal operation, and blindness in people. In addition, the stroke and amputation of the lower limb have been associated with this ailment (World Health Organization, 2017).
In another record by the WHO in 2015, it was noted that diabetes resulted in the deaths of more than 1.6 million people worldwide. This fact was a shift in the records even though 2.2 million people, back in the year 2012, were linked to deaths resulting from high glucose levels in their blood. To conclude, WHO indicates that diabetes will be the seventh deadliest disease by 2030 as the current data indicates that people suffering from this ailment die before they attain their 70-years of age (World Health Organization, 2017).

Objectives

The genotype-phenotype correlation

The distinguishing of the diabetes types that may be affecting a particular patient may be difficult. Some patients do not display their condition as they did not have a correlation between the phenotype and the genotype. Of the research that I conducted, it was evident that those patients that had HNF1B syndrome and complications in diabetes have a higher prevalence. The HNF1B is the molecular alterations of the hepatocyte nuclear factor 1B (Cuilin, et al., 2013). The human leukocyte antigens (HLA) for the diabetes type 2, especially the HLA-DR4, can be transmitted to a child from a parent. The child results in suffering from type 1 diabetes. This fact is evidenced as most people are suffering from the type 2 diabetes in the Arabic world (Rich, et al., 2010). Just the same as HLA-DRB1, most people in the Arabic nations have this type of proteins (Nomura, et al., 2006).

Methods

The study that I have conducted is solely on the diabetes type 2 affecting the Arabic people in their 22 countries. In my research, I have used the scholarly publications from PubMed, Web of Science, and Science Direct among others in the attainment of the results. Below is a detailed description of the ailment in 5 Arabic countries.

1) Egypt

People in this country are suffering from the ailment where 15.6% of all adults between 20 to 79-years of age are sick. The country is in the ninth position globally with patients suffering from the condition. The impacts of the ailment in this country have been linked to the defects in the mortality, morbidity, and scarcity in patient care resources (Hegazi, et al., 2015).

2) Oman

This country has been in the burden of the ailment and it’s the record has shifted from just 8.3% in 1991 to 11.6% in the year 2000. The ailment tends to affect people who are aged 20-years or older. According to the WHO, these people suffering from the diabetes disease are estimated to increase in number by 190% from 75000 to 217000 by the year 2025 (Al-Shookri, et al., 2011). Currently, it stands at 29%.

3) Saudi Arabia

According to the data given by the WHO, Saudi Arabia is the second country in the Middle East to have the highest records of diabetes infection but seventh globally with a prevalence of 31.6%. In the country, more than 7 million people are living with the ailment while other 3 million having a pre-diabetic condition. This fact is even worse as the administration in the country has already spent over180 billion Saudi Riyal in caring for the patients that suffer from the diabetes type 2 condition. As a matter of fact, diabetes alone consumes 13.9% of the total healthcare expenditure in the country (Robert, et al., 2017).

Methods

4) United Arab Emirates (U.A.E.)

According to the information broadcasted by the Emirates 24/7 channel, people in the U.A.E. are suffering from the adverse effects of diabetes type 2. In the news, it was openly declared that every one person out of a group of 5 was suffering from this condition. Of the total people suffering from this condition, they make up a total of 25% of the overall population in the country (Emirates 24/7, 2014).

5) Kuwait

The prevalence of diabetes type 2 in Kuwait differs from other nations. In this country, those people suffering from the ailment accounted to 15.35% for those who were between the age of 20 to 39-years of age. However, the rate rose to 26.25% for those people who are between the age of 40 to 59-years. In conclusion, 63% of the people suffering from the condition had a link of hereditary ailment transfer in their blood line (Abdella, et al., 2018).

Results

From the research that I conducted, it is very clear that most of the Arabic countries are suffering from this ailment. In addition, a detailed research that I did and not included in the methods section has been included in the tables below.

	Country	Age	M/F	Study period	Incident/prevalence	Reference
01	Egypt	20 – 79	Both	2015	15.6%	(Hegazi, et al., 2015)
02	Oman	20 – years and above	Both	2011	11.6%	(Al-Shookri, et al., 2011)
03	Saudi Arabia	30 – 70	Both	2013	23.9%	(Naeem, 2015)
04	U.A.E.	20 – 79	Both	2017	17.3%	(Imperial College London Diabetes Center, 2017)
05	Kuwait	30 – 70	Both	2013	23.1%	(Naeem, 2015)

Table 1: The summary of the results

Gene	Mutation	Kind of mutation	Arab country	Clinical phenotype	Other ethnic group	Clinical phenotype	Reference
HNF1B	Renal cysts, diabetes and noninsulin-dependent diabetes.	Protein	Egypt, Oman, Saudi Arabia, UAE, Kuwait	Liver, kidney, intestine, urogenital, and pancreas.	Whites, Africans, Indians.	Liver, kidney, intestine, urogenital, and pancreas.	(Clissold, et al., 2016) (Alvelos, et al., 2015)

Table 2: Gene mutation

Discussion

1) Phenotype of the HNF1B mutation

The HNF1B gene mutation is linked to the causing of the diabetes in the Arabic nations. Not only has it affected the Arabs alone but also the Whites, Africans, and Indians as well.

However, its mutation happens mostly in the Arabs in the urban areas when compared to those in the rural areas. A fact to this reason is that people in the urban centers perform less physical work as well as less exercise.

This gene happens to occur in bloodline transmission as a child is sure to be infected once he or she attains the adult age. This kind of transmission has been discussed earlier and occurs at a rate of 73%.

2) Spread of the gene

Most races, including Africans, Whites, Indians, and the Arabs share this gene and are mostly affected by its advances as they grow old (Clissold, et al., 2015). However, its prevalence in the Arabic nations is much more adverse when compared to other ethnic groups.

The common fact about this gene is that it binds itself to the DNA of the different races in two types as either heterodimer or homodimer. In addition, the binding must be related to the protein hepatocyte (Faguer, et al., 2014) which nuclear factor 1-alpha.

Pathophysiology of diabetes

Another common fact about this gene is that, once it has found its way to the body of the host, it tends to limit the development of the embryonic pancreas. This action happens when it functions in the nephron development (Clissold, et al., 2015).

3) The genotype-phenotype correlation

As we have discussed in the sections above, the Arabs have been of the spot light of the ailment when compared to other nations. This gene has also been linked to the persons who are obese and combined Juvenile Polyposis (Sulaiman, et al., 2018).

In the Arabic nations, the HNF1B gene has been found to be the most common gene that has been responsible for the spread of the ailment across the Arabic countries. This is because it encodes a pore-forming subunit of the inwardly remedying ATP-sensitive K+ channel (Siddiqui & Tyagi, 2015). As a result, the insulin secretion is altered resulting to the rise in the ATP that causes the diabetic condition to thrive (Babiker, et al., 2017).

The flow chart below shows how the diabetes type 2 can be diagnosed and the help that the Arabic nations need in order to be free from this ailment.

References

Abdella, N., Khogali, M., Bajaj, J., & Saad, A.-A. (2018). Known type 2 diabetes mellitus among the Kuwaiti population. A prevalence study. Retrieved 2018, from ResearchGate: https://www.researchgate.net/publication/14335618_Known_type_2_diabetes_mellitus_among_the_Kuwaiti_population_A_prevalence_study

Al-Shookri, A., Khor, G., Chan, Y., Loke, S., & Al-Maskari, M. (2011, April 17). Type 2 diabetes in the sultanate of Oman. Retrieved 2018, from National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pubmed/22135872

Alvelos, M. I., Rodrigues, M., Lobo, L., Medeira, A., Sousa, A. B., Simao, C., et al. (2015). A novel mutation of the HNF1B gene associated with hypoplastic glomerulocystic kidney disease and neonatal renal failure: a case report and mutation update. Medicine, 94(7).

Babiker, R., Elmusharaf, K., Keogh, M. B., Banaga, A. S., & Saeed, A. M. (2017). Metabolic effect of gum Arabic (Acacia Senegal) in patients with type 2 diabetes mellitus (T2DM): randomized, placebo controlled double blind trial. Functional Foods in Health and Disease, 7(3), 222-234.

Clissold, R. L., Hamilton, A. J., Hattersley, A. T., Ellard, S., & Bingham, C. (2015). HNF1B-associated renal and extra-renal disease—an expanding clinical spectrum. Nature Reviews Nephrology, 11(2), 102.

Clissold, R. L., Oygar, D. D., Gale, D. P., Bingham, C., & Neild, G. H. (2016). HNF1B Genetic Testing In a Turkish Cypriot Population with a High Incidence of Familial Kidney Disease. Journal of Nephrology & Therapeutics.

Prevalence of diabetes globally

Clissold, R., Shields, B., Ellard, S., Hattersley, A., & Bingham, C. (2015). Assessment of the HNF1B score as a tool to select patients for HNF1B genetic testing. Nephron, 130(2), 134-140.

Cuilin, Z., Wei, B., Ying, R., Huixia, Y., B, K., Edwina, Y., et al. (2013, May 19). Genetic variants and the risk of gestational diabetes mellitus: a systematic review. Retrieved 2018, from National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682671/

Emirates 24/7. (2014, November 15). One in 5 people in UAE is diabetic. Retrieved 2018, from Emirates 24/7: https://www.emirates247.com/news/one-in-5-people-in-uae-is-diabetic-2014-11-15-1.570097

Faguer, S., Chassaing, N., Bandin, F., Prouheze, C., Garnier, A., Casemayou, A., et al. (2014). The HNF1B score is a simple tool to select patients for HNF1B gene analysis. Kidney international, 86(5), 1007-1015.

Hegazi, R., El-Gamal, M., Abdel-Hady, N., & Hamdy, O. (2015). Epidemiology of and Risk Factors for Type 2 Diabetes in Egypt. National Center for Biotechnology Information (NCBI), 01.

Imperial College London Diabetes Center. (2017). UAE Diabetes Trends. Retrieved 2018, from Imperial College London Diabetes Center: https://www.icldc.ae/about-us/p/UAE-Diabetes-Trends

Naeem, Z. (2015, July 09). Burden of Diabetes Mellitus in Saudi Arabia. Retrieved 2018, from National Center of Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633187/

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Sulaiman, N., Mahmoud, I., Hussein, A., Elbadawi, S., Abusnana, S., Zimmet, P., et al. (2018). Diabetes risk score in the United Arab Emirates: a screening tool for the early detection of type 2 diabetes mellitus. BMJ Open Diabetes Research and Care, 6(1), e000489.

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