Diabetes Mellitus Prevalence , consequences and management in Gaza Strip and Switzerland

Exchange scientist

• Gaza Strip, Indonesian Hospital: Abu Obaid Hassan, Master Public Health MPH

Supervisor at Swiss institution

• Lausanne University Hospital (CHUV) - UNIL: Pedro Manuel Marques-Vidal

Supervisor at MENA institution

• Najah University (Palestine), Islamic University (Palestine), and Swiss TPH (Switzerland): Mohammed Alkhaldi

Presentation of the projet

Worldwide, nearly one in 10 adults suffers from diabetes mellitus (DM). In the occupied Palestinian Territory (Gaza Strip, GS), 9.6% of adults have DM and one out of nine people die because of DM (11.2% of deaths in 2014). This high mortality is likely due to the complications of DM such as limb amputation, myocardial infarction and kidney failure, but information is lacking. In Switzerland, the frequency of DM is 6.3%, butcomplications of DM have not been studied. Our project has two steps. The first step is to describe the frequency of DM and its complications among hospitalized patients in Switzerland. Swiss hospital discharge data and clinical and administrative data from the Lausanne university hospital for the period 2008-2018 will be queried. We will assess the evolution of the frequency of DM among hospitalized patients and the association of DM with ength of stay, costs, in-hospital mortality, kidney failure, myocardial infarction, and limb amputation. This step will be conducted in Switzerland and will include the training of the PA exchange scientist regarding data collection, curation, analysis and reporting. The second step aims to run the same analyses as in the first step in the GS, using data from the diabetic clinic of the hospital of the Ministry of Health in the GS. If possible, the community care provided to patients with DM in the GS will also be queried via a cross-sectional survey among primary health care centers. Results will help in setting up and further auditing management strategies for DM in the GS based on local capacities. We expect to create a joint collaboration to optimize DM prevention and management in the GS.

Diabetes mellitus (DM) has reached pandemic proportions. Worldwide, the estimated number of peoplewith DM was 415 million in 2015, and it is expected to reach 642 million by 2040 1. In the Gaza Strip (GS) and West Bank, the prevalence of DM is estimated to be as high as 15-20% 2 and is expected to increase by 5% annually 3. This is due to the conjunction of several factors, namely aging, sedentary life and changing lifestyles, leading to increased obesity and DM. One study estimated the prevalence of DM in the GS at 9.6% 4, while another reported that the prevalence of DM rose from 6.6% in 1980 to 16.5% in 2014 5. According to the Palestinian Ministry of Health, the total number of DM cases in GS was 27’601, with an incidence rate of 15.4/1000 and representing 11.2% of all deaths in 2014 6. Overall, the evidence indicates that the prevalence of DM is rising in the GS and that current measures are insufficient to manage the disease and its effects on other organs. In Switzerland, the prevalence of reported DM increased from 3.3% in 1997 to 4.8% in 2007 7, but the prevalence of clinically assessed DM is actually higher (6.3%), as one-third of DM patients is unaware of their status.One out of six patients diagnosed with DM is not treated 8 and dietary management of DM is seldom implemented 9. Between 2003 and 2008, the number of hospital admissionsfor DM increased by 38%, and the number of DM-related amputations by 34% 10. Further, the annual costs associated with DM increased from 5500 CHF in 2006 to 5830 CHF in 2011 11. Overall, DM is increasing in both the GS and Switzerland, putting considerable pressure on the health systems. In both countries, complications of DM are poorly evaluated, management of patients with DM is suboptimal, and the reasons for the suboptimal management are mostly unknown.