The Dasman Diabetes Institute seeks to improve Kuwait’s quality of life through health education and empowerment of its citizens through healthy lifestyles. Its Director-General, Dr Kazem Behbehani (OBE), discusses his institution’s advancement in providing real-world solutions to a growing problem, and goes in depth as to how diabetes prevention should be the key for its treatment.
What prompted the creation of the institute?
Dasman Diabetes Institute was established in 2006 with a mission to prevent, control and mitigate the impact of diabetes and its related conditions, through effective programs of research, training, education and health promotion, and thereby improve quality of life of the population in Kuwait. The majority of people in Kuwait suffer from type 2 diabetes, which affects mainly subjects above the age of 20. However, due to the rising prevalence of obesity in children, type 2 diabetes now occurs in the younger generation and even in the first decade of life. That is why we realized it is important to address schoolchildren by educating them about healthy eating and how to increase their physical activity.
Recently the whole world, not only Kuwait, and even countries in Africa, are facing the challenge of the rising prevalence of obesity. We are fortunate that we have institutions like ours where we have addressed the problem and stressed the importance of education to children and their teachers though school outreach programs like “Let’s get healthy today, Kuwait”.
There are 2 types of diabetes. In type 1, which mostly affects children below the age of 14 years, the pancreas cannot produce insulin, while type 2 diabetes occurs in older overweight/obese people and there is resistance to the action of insulin. Our goal in Dasman is to see that type 2 diabetes remains an adult condition and does not affect the younger generation. We are concerned about how much and what people eat and the consumption of sugar-sweetened beverages. We have to address children’s habits, parents’ habits and offer advice on healthy nutrition through education, broadcasting messages to the public and increasing awareness that proper nutrition has many advantages, and to warn people about the adverse effects of fast food. Moreover we advise them on how to improve their physical fitness.
An important aspect about type 2 diabetes is that people may not feel pain even if they are suffering from the condition. However with time it creates a serious health issue. It is similar to smoking; people enjoy smoking at early stages and do not realize how serious it is until they suffer from disease later on.
Starting from the young generations and education, there is a lot of talk about a change on the health approach, from a reactive medicine approach to a preventive medicine approach. How do you see the possibilities and the challenges today in Kuwait so that we can turn from reacting to complications and diseases to preventing them?
The only solution to the rising prevalence of obesity and type 2 diabetes as you mentioned is prevention. Prevention should start with the young people early in life and intervention programs addressed to all school children. Children should learn that eating and drinking energy-dense food and drinks is deleterious to their health. Instead they should be offered green vegetables and fruits as snacks in school. Physical exercise should be part of the school curriculum and children should be encouraged to do sport activities every day. One of the problems in Kuwait is that children are looked after by caregivers other than their mothers. Caregivers may not be aware of the concept of healthy food and offers the child sweets, which in turn lead to their weight increase. This is why school programs are important so that children themselves are educated and they in turn could educate their parents. This is crucial because these children are the future of Kuwait.
In addition to the school work, what other ideas do you think you should let them know?
Our aim is to make them understand the advantages of healthy eating and the advantages of increased physical activity have on their health, body and mind. We do not mention complications, but we do mention the positive effects it will have on their life as a whole. Our goal is to encourage and motivate them to do the right things which will give them a healthy body.
What do you do to educate the parents and explain that in the meantime?
First of all, the best would be for the parents to listen to the children when they get home and tell them what they have learnt at school. We have also several programs in Dasman and the nutrition department is very active in increasing awareness of healthy eating through education of home economic school teachers, training dieticians, and holding cooking demonstrations for the public in our “Healthy Kitchen” in Dasman, in addition to broadcasting serial talks about healthy food on television and radio channels.
We are amongst the highest countries with obesity and the whole world is calling for change, it is not only us. During the period I was working at the World Health Organization, infectious disease was more important than chronic diseases such as diabetes or cardiovascular disease. Now this has completely changed, as now non-communicable diseases have become the world at large’s primary concern.
Diabetes is a gateway chronic disease to many other health complications. We have talked about treating obesity as a main precondition for diabetes, but what can we do in terms of secondary prevention to avoid the complications once you are already diagnosed with diabetes?
Once you are diagnosed with diabetes, at the beginning you do not think about it because you are not in pain. As time passes, problems suddenly arise and your whole life becomes affected by it. For example, you realize that you cannot walk properly because your nerves have been affected. There is no cure for type 2 diabetes but with healthy eating, weight control and exercising regularly the blood sugar levels can be under control.
We have our diabetes teams in Dasman offering a high level of expertise to patients with diabetes to prevent complications that occur in the eyes, kidneys or their nerves; we have foot clinics that provides excellent care to people with foot problems and to prevent unnecessary amputations. We have multidisciplinary teams of Diabetologists, certified diabetes educators, nutritionists, eye, kidney and nerve specialists. Nowadays, average life expectancy in Kuwait is around 76 for men and 81 for women, which is quite high, and we hope that people with diabetes can also live that long without complications.
How can we educate people who are diagnosed with diabetes to live a lifestyle that will extend their quality of life and not get those complications beforehand?
You have to focus as long as possible on the younger generations, as it is the time that you learn and the way you think is different in that age group. You have the chance to choose certain things and live longer; your friends can encourage you, for example, by asking you to exercise with them. Those are the sort of things they can learn at an early stage and it will become much easier for them to move and lead a normal life.
Keeping in mind that diabetes leads to so many bad things, how do you see the shared responsibility between health institutions and society itself to promote a healthy lifestyle?
Obesity is a public health problem that has raised concern worldwide. The government and society have a role in restricting marketing and banning advertising unhealthy food. The government should regulate the prices of unhealthy food and making healthy food available and at affordable prices. They should aim at providing recreational facilities, more playgrounds for children and safe pavements for pedestrians.
In terms of Dasman, Dr. Hilal Al Sayer says that there was a before and after with Dr. Behbehani. Before you came in, there were no papers published and few specialties. Now, the amount and the reach are greater, there are new specialties and international partnerships. What would you say are the highlight of Dasman’s research?
A large part of research in Dasman is monitoring the incidence of the younger generation with type 1 diabetes, as the number of children and adolescents affected by it in Kuwait has doubled over the last 20 years. Obesity and type 2 diabetes in the young is also as a major public health concern, and an intervention school program and its advantages to their health is an important area for research. Studies that look at the inflammatory biomarkers in obesity is a rich area for research that will allow scientists to discover biomarkers as early screening tests for type 2 diabetes. We also have a well-equipped genetic department that engages in gene testing for type 1 and 2 diabetes and rare diseases in children.
How do you feel about Dasman being a flagship of Kuwait’s efforts on research?
First of all, we are not the flagship yet, as we started doing research only five years ago. However, we do have now around 86 publications in peered and refereed journals and there are new ones coming out. They are more groundbreaking compared to those of other institutions in Kuwait. We also have collaborations with international bodies such as Harvard Medical School, the University of Dundee and Forsyth Institute.
How do you face or deal with getting more people on board and funding for scholars, and what have been the strategies that Dasman has been using so far?
We are part of KFAS (Kuwait Foundation for Advancement of the Sciences), which is the main funding body. Recently there have been some budget constraints, but His Highness the Emir has provided additional funding to Dasman through the Ministry of Health. During the first year, Dasman will receive 3 million Kuwait Dinars, which may increase in the future; this will cover the cost for the education and training collaboration programs with international Universities and institutions.
The United States and Kuwait share many elements, such as the proportion of obesity in the population and their commitment to research. What do you think needs to be done to strengthen that relationship and start to do more joint research?
We have no problem with collaborating with institutions in Kuwait and abroad. We are constantly exchanging knowledge and expertise with them. Keep in mind that we belong to a different culture and have different genetic background than those of Europe or America, so we have new areas that they have never studied before.
We want to ensure that if we are to collaborate in doing research, we need everything to do it on the areas that we can join efforts together.
For the more specialized research, would you like the GCC countries to unite into Dasman’s efforts to promote more regional specific research?
Dasman Diabetes Institute has been designated as a reference center for the region by the Gulf Cooperation Council (GCC) countries. What we have established is not only this institution, but we also work closely with the Ministry of Health and Kuwait University, which offers a unique opportunity to the study of diabetes in the region.
How do you think it is best to increase the awareness and to extend the reach of Dasman’s research?
We are proud that most of the scientific studies from Dasman are published in international journals and some have received wide recognition. I am confident that this will pave the way for others to be willing to collaborate with us.
You came to the institute in 2009, now what would you like to do next and how would you like to incorporate your efforts on IT and eHealth into Dasman?
We are very fortunate in Dasman to have installed state-of-the-art information technology known as Knowledge Based Health Records (KBHR), in collaboration with Harvard. We are now paperless in the Ambulatory Clinical Services, and information is available instantly and securely to authorized users. As well as reducing prescription errors, it allows for more safety for the patients. The system has been deployed in a primary health care center, like Mishref, and we hope to see it is deployed in other healthcare facilities in Kuwait.