According to the World Health Organization (WHO), diabetes currently affects more than 25.5 percent of the Bahraini population while 40 percent of the population is at risk of developing the disease. This is one of the highest population percentages with diabetes in the world. (See sidebar: separate document for additional background on diabetes in Bahrain.)
"The Middle East is facing a health crisis as a substantial percentage of its population either has diabetes or is at risk of developing diabetes," said C. Ronald Kahn, M.D., President and Director, Joslin Diabetes Center, and the Mary K. Iacocca Professor of Medicine at Harvard Medical School. "This Affiliate relationship allows the expertise of Joslin to be transmitted to an outstanding team of Bahraini medical professionals and enables Joslin's proven approach to diabetes treatment to be brought to bear on this epidemic."
The agreement brings to Bahrain Joslin Diabetes Center's respected disease management programs designed to help prevent complications. The Joslin Diabetes Center Affiliate – Bahrain will leverage telemedicine technology that enables Joslin specialists in Boston to assess images of the retina using the Joslin Vision Network, a digital retinal evaluation tool that enables the early diagnosis and treatment of diabetic retinopathy.
In addition, the Bahrain center will have access to and regular consultation from Joslin's experts in clinical, educational and operational issues. These experts from Joslin Diabetes Center in Boston will train Bahraini medical professionals on the latest Joslin clinical guidelines and help them implement these techniques and processes. The Bahrain Center also will have access to Joslin's wide range of program manuals and patient education materials for the care and education of people with diabetes as well as their families.
Joslin Overseer Khalid M. Kanoo, Managing Director of the Yusuf bin Ahmed Kanoo Group of Companies and Chairman of the Bahrain Chamber of Commerce and Industry, initiated the alliance. Working with Alan Jacobson, M.D., Senior Vice President of Joslin's Strategic Initiatives Division, and Antoine Kaldany, M.D., Director of International Programs at Joslin, Mr. Kanoo helped develop the plans for the Joslin Diabetes Center Affiliate – Bahrain, and worked to secure the land, the funding and the Bahraini government approval for the project.
"Since the early 1990s, the Bahrain Ministry of Health's strategic plan has included a focus on diabetes treatment," said Mr. Kanoo. "This center will help Bahrain raise diabetes awareness and introduce cost-effective treatment strategies to prevent and treat this devastating chronic disease."
The Gulf Diabetes Specialist Center is an outpatient medical center specifically designed to provide diabetes prevention programs as well as multidisciplinary education and treatment for people with diabetes and their families.
Joslin has affiliated programs at more than 20 locations across the U.S. "As part of our mission of global education, Joslin has assisted organizations in the development of diabetes programs in other countries, such as Japan, Brazil and India," said Dr. Jacobson. "However, this is our first formal international affiliate. Our hope is that this is the first of many that will make a positive impact on populations across the globe."
Joslin Diabetes Center Affiliate Services in Bahrain
Joslin Diabetes Center Affiliate – Bahrain will offer processes and tools to clinicians and diabetes patients that decrease variability in practice; reduce short- and long-term complications; and improve quality of life.
Evidence-based clinical guidelines provide a basis for diabetes treatment and intervention strategies. Joslin's Clinical Guideline for Adults with Diabetes outlines the screening frequency, goals, and treatment recommendations for lab evaluations and physical examinations for diabetes and associated conditions. Recommendations for evaluation and management of A1C, micro/macroproteinuria, lipids and cholesterol, peripheral vascular, blood pressure, cardiovascular health, smoking cessation, retinopathy and eye health, immunizations, women's health, men's health, and visit frequency are all incorporated into the Guideline.
About the Bahrain Ministry of Health
The Government of Bahrain places a high priority on access to comprehensive health care for its citizens. Treatment by the Kingdom medical services is available to citizens and residents free, or at a nominal cost. The Bahrain Ministry of Health, with coordination of other Ministries, the private sector and the community, provides integrated preventive and curative health services through a network of primary, secondary and tertiary health care facilities. The Minister of Health, Dr. Khalil Hassan, is a member of the Council of Ministers chaired by the Prime Minister of the State, H.H. Sheikh Khalifa Bin Salman Al Khalifa. For more information visit www.moh.gov.bh.
About Joslin Diabetes Center
Joslin Diabetes Center, affiliated with Harvard Medical School, is the global leader in diabetes research, care and education and is uniquely qualified to lead the battle against diabetes in the 21st century. Joslin Research is a team of over 300 people at the forefront of discovery aimed at preventing and curing diabetes. Joslin Clinic, affiliated with Beth Israel Deaconess Medical Center, the nationwide network of Joslin Affiliated Programs, and the hundreds of Joslin educational programs offered each year for clinicians, researchers and patients enable Joslin to develop, implement and share innovations that immeasurably improve the lives of people with diabetes. As a non-profit institution, Joslin relies upon the generosity of donations to support its programs. For more information on Joslin, call 1-800-JOSLIN-1 or visit www.joslin.org.
Sidebar: Bahrain Faces Growing Diabetes Epidemic
[Boston, December 11, 2003] -- In the midst of what the World Health Organization (WHO) calls a "global diabetes epidemic, affecting developing countries in particular," Bahrain stands out.
Diabetes already affects 25.5 percent of the Bahraini population, according to a WHO study. By comparison, just 6.2 percent of the United States population has diabetes.
Even more troubling is that 40 percent of the Bahraini population is at risk of developing the disease, WHO reports.
"That gives Bahrain one of the highest population percentages in the world," said C. Ronald Kahn, M.D., Joslin President and Director, and the Mary K. Iacocca Professor of Medicine at Harvard Medical School. "That is why the opening of the Joslin Diabetes Center Affiliate – Bahrain is an important step in the country's fight against diabetes. We will partner with Gulf Diabetes Specialists Center to not only improve treatment, but also to prevent the many complications of the disease."
Bahrain has seen some very positive medical trends – such as a decrease in infant mortality and an increase in life expectancy – as a result of the socioeconomic growth that began in the 1970s, according to Farouq I. Al Zurba, M.D., and Ahmad Al Garf, M.D., the authors of a 1996 WHO study on the prevalence of diabetes among Bahrainis.
However, ironically, some positive changes to the Bahraini economy have resulted in the increase in diabetes. Increased affluence, bringing cars and air conditioning and unhealthy high-fat diets, has led to a more sedentary life and an increase in obesity – a key risk factor for diabetes.
"Diabetes tends to run in families, so Bahrain's high percentage of intermarriage greatly increases the risk of diabetes on top of the usual factors," said Antoine Kaldany, M.D., Director of International Programs, Joslin Diabetes Center. "Another factor may be the so-called 'thrifty genome-type' theory. Bahrainis typically had slow metabolisms because food was not plentiful. Now that they can afford to eat more, they are penalized because their metabolism is still slow."
Those most at risk for developing diabetes are people who:
- are 45 or older
- are overweight
- are habitually physically inactive
- have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
- have a family history of diabetes
- are members of certain ethnic groups (including Asian American, African American, Hispanic American, and Native American)
- have had gestational diabetes or have given birth to a child weighing more than 9 pounds
- have elevated blood pressure
- have an HDL cholesterol level (the "good" cholesterol) of 35 mg/dl or lower and/or a triglyceride level of 250 mg/dl or higher
- have polycystic ovary syndrome
- have a history of vascular disease
Diabetes-related Costs
Because it is a chronic disease, diabetes management can have an emotional and economic toll on people with diabetes, their families and their health systems.
Emotional
Diabetes is a complex disease and can lead to a variety of adjustment issues for people with the disease and their families. People with diabetes must often change their lifestyle (nutrition and physical activity), monitor blood glucose levels daily and take medication that can range from pills to insulin injections. Living well with diabetes requires the development of a balanced lifestyle that is in tune with both the physical and the mental challenges of the disease.
Economic Impact on Individuals
Economic costs of diabetes can include higher insurance rates, medication and monitoring costs, more frequent healthcare visits and, in some cases, lowered work productivity. In some countries, insurance does not pay for all costs associated with diabetes management and education. WHO estimates that a low-income Indian family may have to allocate 25 percent of its income for the treatment of an adult with diabetes.
Economic Impact on Societies
For a country like Bahrain, with a policy that "all residents in the country enjoy the right to access comprehensive health care," the direct economic impact of diabetes can be considerable. Diabetes and its complications cost an estimated $132 billion annually in the U.S. alone in healthcare costs and lost productivity. According to WHO, diabetes impact can range from 2.5 to 15 percent of a country's annual healthcare budget. Two major factors in this are the prevalence of diabetes and the sophistication of available treatment.
"Better care and treatment can improve quality of life while dramatically reducing the costs of diabetes," said Alan Jacobson, M.D., Senior Vice President of Joslin's Strategic Initiatives Division. "Joslin programs have been shown to cut average per patient costs by 20 percent in the first two years and cut overall costs for diabetes patients to 50 percent of the U.S. national average while reducing hospitalizations and patients' lost time from work and school. Our procedures will help Bahrain contain the disease and improve patients lives, and reduce the burden on the overall health system.
About Diabetes
According to WHO, diabetes is a growing public health threat, affecting an estimated 177 million people worldwide in 2000, up from an estimated 30 million in 1985. Type 2 diabetes, formerly considered a disease of older adults and largely thought due to obesity and sedentary lifestyle, has grown at epidemic rates in recent years and is occurring increasingly among young adults and even children.
Diabetes is a leading cause of end-stage kidney disease, heart attacks, strokes, eye disease and blindness, and other costly complications. Research has clearly demonstrated that expert diabetes care that keeps blood glucose near normal can reduce the risks of developing complications, and can markedly slow the rate at which complications progress. Studies at Joslin and elsewhere in the U.S. have shown that people at risk for diabetes can reduce their risk of developing diabetes by over 50 percent by losing modest amounts of weight and exercising regularly.
Successful diabetes management, such as that practiced at Joslin, relies heavily on the patient, primary care physician and specialized diabetes healthcare team – including physicians, nurses, dietitians, educators and exercise physiologists – working together to coordinate medication (insulin and other drugs that help the body produce and use insulin) with meal planning, exercise and regular blood glucose monitoring to achieve good diabetes control and a healthy lifestyle.
Contact:
Marjorie Dwyer
Joslin Diabetes Center
617-732-2415
Marjorie.dwyer@joslin.harvard.edu
Tarek Abdulla
Joslin Diabetes Center Affiliate - Bahrain
+973-239239
Tarek.abdulla@joslinbahrain.com