Johnson’s Journal: Kuwait City 2014

In October, I had the privilege to teach the American Pharmacists Association(APhA)  “Pharmacist & Patient Centered Care” to 22 pharmacists in Kuwait City, Kuwait with Dr. Staci Marie Norman, a pharmacist from Indiana that is also a national faculty member for this program.  One of the reasons for having a male and female team is that when we get to the part of the program where we teach the pharmacist to conduct blood pressure, blood sugar, insulin injection and foot exams, it is not culturally appropriate for the men and women to be in the same room. Kuwait has seen an explosion in the number of cases of diabetes and they brought us over to teach this class and provide clinical pearls that may be helpful to them as pharmacists in providing counseling and diabetes management for the patients they encounter. Amir Sheikh Jaber had a vision to build a center that not only treated diabetes but also offered research and development. The Dasman Diabetes Institute is a beautiful 4 story building that is across the street from the Bay of Kuwait. It is a one stop diabetes shop that includes primary care, nutrition education, pharmacist clinical services, ophthalmology and an indoor fitness center and swimming pool. Research labs and offices are also located at the center. Dr. Mohammad Waheedi, a Consultant Pharmacotherapist, served as our host for Dr. Norman and me, taking us on a tour of Kuwait City after the day and a half training. Dr. Waheddi allowed us to sample native teas of cardamom and saffron and see a traditional market.

According to the International Diabetes Federation, there were 407,530 cases of diabetes in Kuwait in 2013. Dr Faisal Al Refaei, Director of Clinical Services at Dasman Diabetes Institute, said that in terms of prevalence and incidence of diabetes, Kuwait is one of the top ten countries in the world. All six Gulf countries are all part of the top ten countries in the world as far as diabetes rates. In 1998, the incidence of diabetes in Kuwait was 15 percent and today it is around 25 percent, meaning that one in four Kuwaitis will be diagnosed with diabetes. Patients being diagnosed with type 2 diabetes are younger in Kuwait compared to the rest of the world. In the US type 2 diabetes presents in patients around age 14 or 15, while type 2 diabetes in Kuwait occurs in children younger than  10 years old on average. Dr. Refaei thinks that the reason is two-fold. One is genetic and one is environmental. He thinks that genes are playing a role. At the Dasman Diabetes Institute they have their own genetic center and conduct research. He thinks the biggest component is actually environment. Lifestyle and behavior including nutrition and lack of exercise. Dr. Refaei says that their lifestyle is sedentary, partly due to the weather conditions, and that people are comfortable sitting at home and relaxing. He says that exercise is the last thing on your mind, and you don’t actually want to move around much. He said that Kuwait is a society that has transformed from a less affluent and traditional nature to a very rich and modern one in less than sixty years. With affluence comes being able to hire people to do jobs, including yardwork that many people used to do themselves. The types of jobs most people in Kuwait perform has changed. Jobs don’t involve much physical labor, and with the advent of technology, less and less physical work is done. Most of their jobs involves sitting comfortable in our seats staring into computers.

He said “with so many fast food chains and other eateries and processed food, our diet has undergone a massive change. We consume very low amounts of food prepared using natural produce. Our diets are very unhealthy. The food we eat is a major factor in diabetes in two ways. One is we eat more of carbohydrates and glucose rich diet, which has a direct bearing on diabetes, and then of course there is obesity which kicks in with overeating.”

At the Dasman Diabetes Institute, one of their objectives is instilling that education in the public. Education on lifestyle, behavior modification and nutrition is key to prevent and delay diabetes rather than managing it. Managing diabetes is costly, especially in cases where the patient has had diabetes for 15, 20 years, and suffers complications, which by the way are many. So, prevention is the best bet and changing lifestyle is essential for that.

Dr. Refaei says that here are several ways they are going to fight diabetes. Research, patient education, professional diabetes management training for their pharmacists, nurses and physicians, They look at bringing national and international training programs such as the APhA “Pharmacist & Patient Centered Care” to the Dasman Diabetes Institute to train professional teams that work in the public sector. They are currently setting up an information center for patients to be able to call in and ask questions about diabetes, which may be staffed by the pharmacists that we trained.

This is the second international training that I have been able to conduct with Dr. Norman with the 1^st training being conducted in Abu Dhabi, UAE for 60 pharmacists in April 2011. Both have been a great personal and professional experience.

– Written by Dr. Tommy Johnson, PharmD, RPh, BC-ADM, CDE, FAAPE, who is a Professor Department of Pharmacy Practice at the Presbyterian College School of Pharmacy