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UAE Researchers Tackle Diabetes from the Feet Up

ABU DHABI—Researchers in different fields of medicine have teamed up to tackle one of the Gulf’s biggest health concerns: Type 2 diabetes.

They hope that their combined expertise will counteract the rapid and early onset of the disease, which is common in the Emirati population—in part due to generations of traditional marriages between cousins, which has created a concentrated gene pool prone to non-communicable diseases like diabetes.

Kinda Khalaf, a professor of biomedical engineering at Khalifa University, is looking at the patterns of how patients walk and how their weight pressure is distributed through their footprint. She is trying to see if alterations in these gait patterns can indicate if someone with Type 2 diabetes is about to see their symptoms worsen and if the disease is soon to progress.

Meanwhile, her colleague Habiba Alsafar, director of the Khalifa University Center for Biotechnology, is working on the disease from a genetic perspective. She is mapping how the Emirati genome is distinct in its vulnerability to diabetes and other non-contagious diseases.

“What makes our work unique is that for the first time, we’re doing research in depth from different angles on the Emirati population,” says Khalaf.

It’s important to study local populations because they’re often ignored in medical research, she says. “The main medication that Emiratis take is based on western research, but Emirati and Arab genes are expressed differently, so maybe we should look at different therapies and treatments.”

Alsafar agrees. “We need to study our own population. There are several genes that are novel in our own populations.”

Almost every Emirati either has Type 2 diabetes or knows someone who does. Approximately 20 percent of the population will develop the disease, and almost 20 percent of those with the condition will see it progress far enough to risk a limb amputation.

“Our population is unique because we have a lot of cousins marrying cousins and also the lifestyle is bad,” says Alsafar.

In fact, Alsafar herself is at risk of the disease. “I’ve already run my own genome, and both my parents have diabetes, so I’m predisposed to it. I decided to change my lifestyle two years ago and I lost 30 kilos.”

But it’s not just the sheer volume of diabetes patients that is a concern.

“The onset of the disease is about 10 years earlier than in other populations. Most populations start exhibiting symptoms in their 40s but here we’re finding it in late 20s and early 30s,” says Khalaf.

It’s hard to give solid estimates of the financial burden of diabetes in the region, but according to Khalaf, most estimates say it costs the Emirati economy close to $6 billion a year. The problem is mirrored in populations throughout the Gulf, in Bahrain, Qatar and Saudi Arabia.

The researchers conducted a study of 700 Emirati patients. Khalaf asked them to walk across a runway with embedded sensors. A healthy footprint would see pressure focus on the heel and ball of the foot, but she identified many people with more evenly spread pressure and a smaller than average stride.

This is a signal that the diabetes is likely to get worse.

“Since the pressure is not properly distributed it can open sores, which get infected. This isn’t just a signal of bad things to come but it also triggers bad things. The skin breaks and it gets infected,” says Khalaf. To make things worse, the patient might not feel what is happening because diabetes often causes damage to nerves in the feet.

“That’s what leads to amputation, because they don’t feel gangrene developing and it’s too late. They’re losing their feet as early as their 30s and it’s devastating and ridiculous because it’s preventable. It doesn’t have to get this bad,” says Khalaf.

Meanwhile Alsafar is cross referencing these results with her genetic analysis of the patients. She hopes to come up with a more accurate way to predict diabetes progression. At the moment scientists and medical professionals tend to compare genetics and body mass index (BMI).

“BMI is not a good tool because the fat percentage can be high with a low BMI and so you’re still at risk. You also see a lot of obese people that don’t have diabetes. Why is that?” asks Alsafar.

With gait and genetics, the pair hope they can encourage doctors to intervene in time to stop more Emiratis from enduring foot amputations and address one of the most widespread non-communicable diseases in the region.

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