by Zlatko Nikoloski
It is estimated that 415 million people are living with diabetes in the world, which is thought to be 1 in 11 of the globe’s adult population. The figure is expected to rise to 642 million people living with diabetes worldwide by 2040. More importantly, 46% of people with diabetes are undiagnosed. The prevalence of diabetes mellitus is also high in the Middle East and North Africa (MENA) region, amounting to 12.8% in 2019. Fifty-five million adults aged 20 to 79 were living with diabetes in the MENA region in 2019 and it is estimated that this figure will increase to 108 million by 2045.
Within the MENA region, countries in the Gulf Cooperation Council (GCC – Kuwait, Bahrain, Oman, Saudi Arabia, the United Arab Emirates and Qatar) have the highest prevalence rate of diabetes. According to World Development Indicators, diabetes prevalence in the GCC countries ranges from 14.8% in Oman to 20% in Saudi Arabia. Diabetes, therefore, places a significant burden on the GCC healthcare systems.
Diabetes prevalence is notable in Kuwait. In 2015, the International Diabetes Federation (IDF) reported that one in seven adults in the country had been diagnosed with diabetes. The same information source estimated the total unadjusted- and age-adjusted diabetes prevalence rate for those aged 20-79 years amounted to 14.3% and 20% respectively. These rates suggest that roughly 400,000 people (approximately 10.3% of the population in Kuwait) suffer from diabetes. Moreover, these figures do not include those who were undiagnosed, which, according to the IDF, is roughly a third of the overall population with diabetes.
Against this background, over the last year, LSE Health has joined forces with Dasman Institute (the leading research institute on diabetes in Kuwait) in order to study the overall burden of diabetes in Kuwait. The project had the following research objectives: (i) to shed more light on the main correlates associated with having diabetes; (ii) based on (i), to analyse the link between diabetes and healthcare utilisation (both outpatient and inpatient); (iii) based on survey and administrative data, to determine the total direct cost of diabetes in Kuwait by providing a static measure of the cost of diabetes and (iv) to critically evaluate the existing preventive measures (by also doing a comparative analysis with the rest of the Gulf region) aiming to reduce the overall economic burden of diabetes in Kuwait.
In this analysis, we have relied on the World Health Survey (2013) for Kuwait. Diabetes within the survey was captured using both a subjective and objective measure. The former relied upon binary responses from participants who answered the question regarding whether they had been diagnosed with diabetes or not. The objective measure, on the other hand, utilised fasting blood sugar levels with those who recorded readings greater than 7.0 mmol/ol considered diabetic. Objective measures of diabetes are preferable, however, given the paucity of data collected using this measure, we relied upon self-assessed diabetes for our analysis. Using this measure of diabetes, data from the World Health Survey suggests 13.42% of Kuwaiti nationals are diabetic. These results closely mirrored objective prevalence rates recorded within the 2006 Kuwait STEPS survey (i.e. 12.4%).
Further analysis of the subjectively reported measure of diabetes suggested that females, the elderly and those with lower levels of educational attainment were more likely to have been diagnosed with diabetes. Regarding key risk factors, obese, hypertensive and insufficiently active respondents were more likely to be diabetic. Finally, when examining the prevalence of multiple chronic conditions, our results showed that diabetic patients were more likely to have been diagnosed with two or more chronic conditions compared to non-diabetics.
Diabetes (Type 2) is a non-communicable disease (NCD) that may be avoided by leading a healthy lifestyle. For this reason, our project explored a range of risk factors associated with the disease. Our results found that, in general, Kuwaiti nationals do not lead healthy lifestyles with 32.01% and 49.52% of adults considered obese or overweight, respectively. Furthermore, only 32.09% of respondents are sufficiently active. When broken down by gender, it is clear that women are at greater risk of developing NCDs as a higher share of women are overweight, obese and insufficiently active. The causes of leading risk factors in Kuwait have been widely explored and include: increasing availability of fast food restaurants, cars, cheap labour; social stigma associated with walking outdoors; high temperatures; inadequately designed pedestrian walkways and bicycle routes; social norms to spend time with family and extended networks (which were usually inactive and include meals); as well as sedentary work and school environments. Despite a clear understanding of risk factors, the majority (85%) of public healthcare expenditure in Kuwait is allocated to curative (rather than preventative) services.
Understanding the risk factors as well as the consequences of diabetes is not only an interesting research question but it also has relevance to national health policy. Indeed, diabetes creates significant costs both for affected individuals as well as to the healthcare system more broadly. The costs associated with diabetes could be both direct (e.g. medical costs associated with the use of inpatient and outpatient services) as well as indirect (e.g. inability to work, lower productivity etc). Based on the provided survey and administrative data, we estimate a total direct cost of 84.8 million Kuwaiti Dinars (or roughly 0.17% of GDP).
Findings from our project, which predict rising costs caused by preventable diseases, indicate that policy-makers should focus their attention (and subsequent spending) on preventative healthcare services, while also paying attention to careful management of the disease for those already living with diabetes. For example, through education and awareness campaigns to get people moving, as well as improving people’s knowledge of the nutritional value of the foods they are eating. With regard to diabetes specifically, a national diabetes strategy endorsed by all key public and private stakeholders would help streamline efforts to reduce the prevalence of the disease (e.g. promotion of regular testing for pre-diabetic cases).