The Curse of Wealth – Middle Eastern Countries Need to Address the Rapidly Rising Burden of Diabetes

Document Type: Perspective


1 Pardee RAND Graduate School, Santa Monica, CA, USA

2 Diabetes Strategy - Emerging Markets at Eli Lilly and Company

3 RAND Health Advisory Services, RAND Corporation, Boston, MA, USA


The energy boom of the last decade has led to rapidly increasing wealth in the Middle East, particularly in the oil and gas-rich Gulf Cooperation Council (GCC) countries. This exceptional growth in prosperity has brought with it rapid changes in lifestyles that have resulted in a significant rise in chronic disease. In particular the number of people diagnosed with diabetes has increased dramatically and health system capacity has not kept pace. In this article, we summarize the current literature to illustrate the magnitude of the problem, its causes and its impact on health and point to options how to address it.


Main Subjects

1.  U.S. Energy Information Administration (EIA). Top World Oil Net Exporters, 2012 (Thousand Barrels per Day) [internet]. 2013 [updated 2013 August 16]. Available from:
2.  U.S. Energy Information Administration (EIA). Annual Energy Review 2011.Washington, DC: EIA; 2012.
3.  Ng SW, Zaghloul S, Ali HI, Harrison G, Popkin BM. The prevalence and trends of overweight, obesity and nutrition-related noncommunicable diseases in the Arabian Gulf States. Obes Rev 2011; 12: 1–13. doi: 10.1111/j.1467-789X.2010.00750.x
4.  Al-Nesf Y, Kamel M, El-Shazly MK, Makboul GM, Sadek AA, ElSayed AM, et al.Kuwait STEPS 2006. Kuwait Ministry of Health, A‑liated hospitals for tertiary care Patient Primary care Specialist care Lifestyle coaching Equipment for diagnostics and treatment Selfmanagement education Medication management Figure 5.Integrated diabetes care model for free-standing centers GCC, WHO; 2006.
5.  Bener A, Al-Suwaidi J, Al-Jaber K, Al-Marri S, Dagash MH, Elbagi IE. The prevalence of hypertension and its associated risk factors in a newly developed country. Saudi Med J2004; 25: 918–22.
6.  Kuwait Ministry of Health (MoH). Kuwait Nutrition Surveillance (2001–2004). Food and Nutrition Administration (ed.). Kuwait: Ministry of Health: 2004.
7.  Al-Sendi AM, Shetty P, Musaiger AO. Prevalence of overweight and obesity among Bahraini adolescents: a comparison between three different sets of criteria. Eur J Clin Nutr2003; 57: 471–4. doi:10.1038/sj.ejcn.1601560
8.  World Health Organization (WHO). The World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: WHO; 2002.
9.  International Diabetes Foundation (IDF). Diabetes Atlas. 5th edition (updated) [internet]. 2012. Available From:
10.  International Diabetes Federation (IDF). Diabetes Atlas. 6th edition [internet]. 2013. Available from:
11.  Habibzadeh F. Diabetes in the Middle East. Lancet2012; 380: 1.12.  van Dieren S, Beulens JW, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil2010; 17: S3–8.
13.  Badran M, Laher I. Type II Diabetes Mellitus in Arabic-Speaking Countries. Int J Endocrinol2012; 2012: 902873. doi:
14.  World Health Organization (WHO).Global status report on noncommunicable diseases 2010. Geneva: WHO; 2011.
15.  National Commercial Bank (NCB) Capital. GCC Agriculture: Bridging the food gap. Economic Research [internet]. March 2010.  Available from:
16.  Yosef AR. Health Beliefs, Practice, and Priorities for Health Care of Arab Muslims in the United States Implications for Nursing Care. J Transcult Nurs 2008; 19: 284–91. doi: 10.1177/1043659608317450
17.  Alzaid A. Diabetes: A tale of two cultures. Br J Diabetes Vasc Dis 2012; 12: 57. doi: 10.1177/1474651412444143
18.  Babineaux S, Miller L, Courtinard C, Toaima D, Tahbaz A, Zagar A, et al. An Epidemiological Study of the Lifestyle and Treatment Changes in Patients With Diabetes Before Initiation of Ramadan Fasting Period. International Diabetes Federation (IDF) 21st World Diabetes Congress; December 4–8, 2011; Dubai, UAE.
19.  Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al.EPIDIAR study group A population-based study of diabetes and its characteristics during the fasting month of  Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care2004; 27: 2306–11. doi: 10.2337/diacare.27.10.2306
20.  Benjamin K, Donnelly TT. Barriers and facilitators influencing the physical activity of Arabic adults: A literature review. Avicenna 2013; 8: 1–16. doi: 10.5339/avi.2013.8
21.  Meyer BF, Alsmadi O, Wakil S, Al-Rubeaan K. Genetics of type 2 diabetes in Arabs: What we know to date. Int J Diabetes Mellit 2009; 1: 32–4. doi:
22.  Ahlqvist E, Ahluwalia TS, Groop L. Genetics of type 2 diabetes. Clin Chem 2011;  57:  241–54. doi: 10.1373/clinchem.2010.157016
23.  World Health Organization (WHO). Diabetes: the cost of diabetes [internet]. Undated. Available from:
24.  Williams R, Van Gaal L, Lucioni C. Assessing the impact of complications on the costs of Type II diabetes. Diabetologia2002; 45: S13–7.
25.  Health Authority – Abu Dhabi (HAAD). Weqaya [internet]. 2011. Available from:
26.  Al-Maskari F, El-Sadig M, Nagelkerke N. Assessment of the direct medical costs of diabetes mellitus and its complications in the United Arab Emirates. BMC Public Health2010: 10: 679. doi:10.1186/1471-2458-10-679
27.  Kronfol NM. Delivery of health services in Arab countries: a review. East Mediterr Health J2012; 18: 1229–38.
28.  Makhoul J, El-Barbir F. Obstacles to health in the Arab world. BMJ 2006; 333: 859. doi:
29.  Akala FA, El-Saharty S. Public-health challenges in the Middle East and North Africa. Lancet2006; 367: 961–4. doi: 10.1016/S0140-6736(06)68402-X
30.  Ghannem H. The need for capacity building to prevent chronic diseases in North Africa and the Middle East. East Mediterr Health J2011; 17: 630–2.
31.  American College of Physicians [homepage on the Internet]. [updated 2013 December 16]. Available from:
32.  The World Bank. World Development Indicators [homepage on the Internet]. [updated 2013 December 18]. Available from:
33.  Informa. Healthcare in the GCC: A Snapshot. Hospital Build & Infrastructure Magazine [serial on the Internet]. 2012. Available from:
34.  Al-Ahmadi H, Roland M. Quality of primary health care in Saudi Arabia: a comprehensive review. Int J Qual Health Care2006; 17: 331–46. doi: 10.1093/intqhc/mzi046
35.  Alhyas L, McKay A, Balasanthiran A, Majeed A. Quality of type 2 diabetes management in the states of the Co-operation Council for the Arab States of the Gulf: a systematic review. PLoS One2011; 6: e22186. doi: 10.1371/journal.pone.0022186
36.  Mourshed M, Hediger V, Lambert T. Gulf Cooperation Council Health Care: Challenges and Opportunities [internet]. 2008. Available from:
37.  World Health Organization (WHO). Global Strategy on Diet, Physical Activity and Health. Geneva: WHO; 2004.
38.  World Health Organization (WHO). European Action Plan for Food and Nutrition Policy 2007–2012. Geneva: WHO; 2008.
39.  World Health Organization (WHO). World Health Assembly endorsed the Global NCD Action Plan 2013-2020. Geneva: WHO; 2013.
40.  Saad B, Azaizeh H, Said O. Tradition and perspectives of arab herbal medicine: a review. Evid Based Complement Alternat Med 2005; 2: 475–9. doi: