Prevalence of Type 2 Diabetes and Its Association with Added Sugar Intake in Citizens and Refugees Aged 40 or Older in the Gaza Strip, Palestine

Abstract

Background: Little is known about the prevalence and risk factors of diabetes among Gaza Palestinians, 64% of whom are refugees with exceeded sugar intake. We aimed to estimate the prevalence of type 2 diabetes (T2D) and its association with added sugar intake among residents, with regular visits to primary healthcare centers (PHCs) across Gaza. Methods: From October to December of 2019, a cross-sectional survey was conducted among 1000 citizens and refugees in nine PHCs selected from the five governorates of the Gaza Strip. Information on dietary intake, medical history, and other risk factors was collected by trained health workers, using structured questionnaires. Anthropometry and biochemical data were extracted from the PHC medical record system. Results: Overall, the prevalence of diagnosed T2D and undiagnosed T2D were 45.2% and 16.8%, respectively, in adults aged 42 to 74 years, with the differences among citizens and refugees (diagnosed: 46.2% vs. 43.8%; undiagnosed: 15.7% vs. 18.2%). The uncontrolled glycaemic rate was 41.9% and 36.8% for diagnosed patients in citizens and refugees, respectively. Among those without a clinical diagnosis of T2D, after multivariable adjustment, daily added sugar intake was positively associated with fasting glucose and the risk of undiagnosed T2D (odds ratio, 95% CI, highest vs. lowest intake, was 2.71 (1.12–6.54) (pfor trend < 0.001). In stratified analysis, the associations between added sugar intake and the risk of undiagnosed T2D tend to be stronger among refugees or those with higher body mass index. Conclusions: Among Palestinian adults, both citizens and refugees are affected by T2D. Added sugar intake is associated with the risk of undiagnosed T2D.

The Impact of Free Sugar on Human Health—A Narrative Review

“…Many prospective and retrospective studies have been conducted with varying and inconsistent results [ 119 , 120 ]. However, the majority of research conducted has found a positive association between sugars [ 121 ], particularly fructose and SSB consumption [ 35 , 119 , 122 ], and risk for diabetes type 2 (T2DM) (see Table 2 ). Several animal and human studies have observed impaired insulin signalling and increased fasting glucose and insulin resulting from SSB consumption [ 61 , 123 , 124 ].…”

Barriers to Diabetes Care during Humanitarian Crisis during 2013–2022 in Five Arabian Countries: A Systematic Review

“…Due to a flaw in the social support system for diabetes in the Gaza Strip, adherence to non-pharmacological intervention in diabetes control was suboptimal [33]. The percentage of undiagnosed adult DM was 16.8% of the 1,000 subjects included in the cross-sectional study, which is strongly associated with sugar intake [11]. DM can be controlled with the help of social support.…”

“…Another systematic review and meta-analysis reported that about 46 million individuals now have diabetes in the Middle East, with a prevalence of 14.6% that varied among countries from 2.6% to 21.9% [8]. Although the prevalence of diabetes mellitus among refugees and internally displaced persons was not precisely estimated in each of these nations, it was found in samples of refugees who were transferred to other nations [9][10][11][12]. Due to the multifaceted crisis that the Ministry of Health in these countries is facing, there are numerous criticisms of the prevalence of diabetes in these countries, including the updated population census and the accuracy of health services in registering and monitoring diabetes patients.…”

Nutrition Programs of Higher Education in the Occupied Palestinian Territories: A Descriptive Snapshot

“…Public health nutrition-related problems in OPT highlight the need for qualified nutritionists, dietitians, and educational institutes to implement intervention plans, develop policies that help in health promotion and disease prevention to address existing and future anticipated public health nutrition problems in OPT, and improve nutritional health outcomes. The Middle East has been identified as a region with a considerable need for trained nutritionists and dietitians in order to address the escalating double burden of nutrition-related diseases, particularly for internally displaced individuals, refugees, and the vulnerable population of OPT (Damiri et al, 2018; Ghattas et al, 2020; Hwalla et al, 2016; Jebril et al, 2020; Kitamura et al, 2018; Rahim et al, 2014; Salti & Ghattas, 2016).…”