Amid current pace of population growth coupled with massive economic development, the need for a better and comprehensive healthcare system is essential as diabetes – often associated with obesity – as are other chronic diseases, become pandemic. In the Arab region alone, $5.5 billion are spent on diabetes healthcare every year, representing 14 percent of the total healthcare budget for the MENA region, said Dr. Wail Al-Qasim, General Manager, Saudi Arabia, Merck Sharp & Dohme (MSD). In an interview with the Saudi Gazette, he said in Saudi Arabia, more than SR12 billion are spent every year on diabetes. On the global scale, he noted that healthcare expenditure on type 2 diabetics is expected to increase from $376 billion in 2010, to $490 billion in 2030. Developed countries spend from 2.5 to 15 percent of their annual healthcare budget on diabetes. He further said families also suffer from the economic burden of diabetes as families with diabetic members spend anywhere from 15 percent to 25 percent of their monthly income on diabetes healthcare. On top of that, "we have also to take into consideration the indirect burden of diabetes, caused by lack of productivity as a result of disability or death. These expenditures and burdens are tremendously high and immeasurable," Dr. Al-Qasim pointed out. MSD has recently signed an agreement with the Saudi Society for Endocrinology and Metabolism (SSEM) to train 75 Saudi healthcare staff in diabetes care. Following are excerpts from the interview: Being at the forefront of medical research for over 70 years now, MSD has developed more than 100 new medicines and vaccines. Currently, what are MSD's priority areas? What do you think deserves extensive research work and budget allocation? At MSD we are very concerned about health issues worldwide. Health issues and challenges are countless, so we concentrate our efforts on the largest growing and most wide spread epidemics, among which is diabetes. Why diabetes? Well if we take a look at the IDF prevalent statistics, both global and regional, we will see that this disease poses an enormous challenge to both healthcare professionals and international medical companies. According to the latest IDF figures, there are already 336 million people around the world suffering from type 2 diabetes. This number represents approximately 10 percent of the world's adult population. In the MENA region, there are already more than 36 million people suffering from diabetes, with IDF expectations that in 2030 over 550 million people across the globe will suffer from the disease. If prevalence rates continue to grow at the current pace, diabetes in the MENA region will have increased by 50 percent by 2030. Equally important to our decision on the disease areas we focus on, is the complications that they can create. For example, when not properly managed diabetes can lead to a number of life threatening complications; specifically, cardiovascular disease, which can eventually lead to heart attacks, strokes and even death. MSD has explored the connection between diabetes and cardiovascular disease extensively, and the alarming link between type 2 diabetes and the increased risk of cardiovascular disease that it can lead to is one of the main factors that encouraged us to intensify research in to diabetes, in the hope of developing comprehensive medical solutions and exploring new drugs that can further address this global issue. Today, complications resulting from diabetes are the reason for 12 percent all deaths amongst diabetic patients in the MENA region, and globally more than 4.6 million diabetics die each year. On the economic level, diabetes complications create indirect financial burden on local economies and communities. Diabetes, when not properly managed can create complications that lead to disability, reducing the productivity of these citizens and amounting to huge financial losses. These losses are beside the direct expenses that the local health authorities must pay for, to ensure diabetic patients receive proper clinical and medical care. As for the criteria MSD uses to identify the disease areas we focus our research on, I would say in summary, we consider the medical risk of each disease area, taking into account the disease areas which cause the largest burden to local population. We look at prevalence rates, both globally and regionally, in addition to morbidity rates and the health complications these diseases can lead to. Of course all of these criteria are in addition to other scientific and medical criteria. MSD uses all available resources to develop the most advanced and innovative medical solutions, which will truly address global health issues and the most prevalent diseases. You will be surprised to know that the development of 1 drug may cost more than $1 billion, in addition to the tireless efforts of a dedicated research team working day and night to develop the drug which may put an end to human tragedies. What medical steps should be done in order to cure this disease? On the other hand, what preventive measures should be done to avoid such illness? Diabetes is the most prevalent disease in the MENA region. We have more than 36 million cases of diabetes in the region and according to the IDF 19 percent of these cases are attributed to Saudi adults with type 2 diabetes. Based on these figures Saudi Arabia ranks number 7th in the world in terms of diabetes prevalence and 13th in terms of morbidity caused by diabetes and its complications. Lifestyle and dietary habits as well as obesity and lack of awareness about diabetes represent the major causes of prevalence in Saudi Arabia. Medications are not the only comprehensive solution to dealing with diabetes in Saudi Arabia. I think raising awareness among medical professionals and citizens, as well as changing lifestyle and dietary habits are the most appropriate ways to address the issue. In the meantime healthy Saudi's should be educated about the risk of becoming diabetics and its direct connection to cardiovascular disease; which is more prevalent amongst diabetics with uncontrolled sugar levels, as this results in negative cholesterol streaming blood and blocking the internal of walls of heart arteries, which eventually may cause heart attacks and strokes. Additionally, sustainable medical training is of great importance to fighting diabetes. The tailor-made programs that we offer to healthcare professionals guarantees full assistance of diabetes healthcare management for healthcare professionals and creates greater awareness of diabetes and the life threatening complications it can lead to. What are your aspirtions in forging an agreement with SSEM? As you know MSD is not working alone. We cooperate with various healthcare providers and agencies to achieve our goals of better healthcare for patients and greater awareness and expertise amongst physicians and healthcare professionals. Previously, MSD has launched and executed many healthcare initiatives and programs in many countries across the MENA to educate medical professionals on the best diabetes management techniques. These programs have been highly successful on many levels. Building on this successful model MSD has signed an agreement with the SSEM to train 75 healthcare professionals on the most innovative and up to date healthcare management techniques, case management and medications for diabetes. These efforts will definitely result in a higher level of diabetics with properly managed sugar levels, ultimately eliminating the possibility of complications that come from poor disease management. The training program will take place over the course of 5 days during which time, lecturers from Leicester University and the British Medical Journal (BMJ) will share their expertise with healthcare professionals from across Saudi Arabia. Raising awareness of diabetes amongst medical professionals will eventually contribute to elevating the standard of services provided to patients, and will create an educated patient who will be able to accurately educate friends and family on the dangers of diabetes and the complications it can cause. This latest agreement with the SSEM came just in time. As you already know, despite the Ministry of Health's tireless efforts to support diabetic patients in Saudi Arabia, more needs to be done. Patients urgently need access to higher health standards and the Saudi community needs higher levels of education and awareness about diabetes. Awareness is key, to reducing the prevalence rate, particularly with 19 percent locals already suffering from the disease. Will the training course under the agreement be closely monitored and supervised to guarantee effective results? When MSD designs a training program we take into consideration all the elements needed to guarantee success. With step by step monitoring of the programs execution, we make sure all the information, tools and latest diabetes case management techniques are passed on to trainees. MSD's expertise in modeling training programs enables the trainees to share information in a very flexible manner – through lectures, interactive workshops and sessions. By using these techniques we not only guarantee trainees gain a full understanding of the content but also ensure they are able to apply what they have learned, in their day to day practices. Referred to by some as the “greatest public health epidemic of the 21st century” - and with the escalating number of diabetes cases in the Kingdom, do you think there is a need to reform or redesign the present healthcare management techniques used in the Kingdom? Is there a need to reeducate the medical practitioners? I think the healthcare systems in Saudi Arabia is one of the most sophisticated and comprehensive systems in the Arab region, therefore I don't think we need to redesign or restructure Saudi's healthcare system, to achieve healthcare objectives or ensure quality services are provided to citizens. What we need more is to be open and adapt healthcare plans and practices applied worldwide, in addition to taking whatever steps are needed to combat diseases that make our citizens suffer. On another note, training is considered as one of the most efficient ways of achieving this goal. As you know medical sciences are changing and developing very fast and we need to ensure we keep up with these developments and take advantage of them in communities we are working in. We also need to change the daily habits of Saudi citizens. What I mean here, is dietary habits. Bad diet, is one of the number one causes of the massive increase in type 2 diabetes in the Saudi community. Type 2 diabetes represents 90 percent of diabetes cases in Saudi Arabia and in most cases the disease either resulted from or was exacerbated by unhealthy dietary habits, lack of exercise and the prevalence of obesity. These key factors have resulted in diabetes becoming a silent killer. Do you see hope and more opportunities in the fight against diabetes? There is always hope. The research on diabetes carried out by MSD is continuous. After we discovered Januvia we continue to explore new and innovative solutions to alleviate the burden of diabetes and avoid complications that may cost lives. Additionally, we have to work tirelessly on awareness to better understand the disease and educate healthcare professionals and patients in order to reduce these prevalence rates and remove complications which will eventually result in reducing direct, and indirect expenditure created by diabetes. The coming years carry a lot of hope for diabetes worldwide. The clinical research in which we invest billions every year and the physicians who execute it will definitely bring new therapies and solutions to diabetics. How many R&D centers do you have globally? How much is allocated to them annually? MSD has more than 77 R&D centers worldwide with a budget of around $11 billion. Our budget represents one of the largest R&D budgets for any pharmaceutical company in the world. What are the latest findings of your research? MSD's R&D centers are working around the clock to develop new medications and vaccines, as well as new solutions to combat epidemics and life threatening diseases. Our R&D has developed a very efficient anti-diabetes drug (Januvia) specifically designed for patients with type 2 diabetes. Clinical researchers proved that Januvia has a very favorable safety profile and efficacy compared to other diabetes therapies. Therefore, Januvia tops the lists of prescribed medications for diabetics worldwide. To date, 31 million patients in US have been prescribed Januvia since its launch in 2008. Januvia has been tested for safety and efficacy through 55 clinic trials since being approved. Results from these studies showed that Jauvia is able to achieve unprecedented lower blood sugar rates amongst diabetics, through just a once a day oral dose of this medication. The mechanism of Januvia relies on the inhibiting of DDP-4 factor which causes the sugar release in blood. __
