This initiative is currently on hold pending improvements of the situation in Israel and Gaza.
The goal of the program is to implement and scale a proven, culturally-competent diabetes prevention program for Arab communities in order to improve health equity in Israel and beyond.
Background
Diabetes is a global health epidemic, affecting hundreds of millions of people worldwide. The World Health Organization projects that diabetes will be the 7th leading cause of death by 2030. The disease often brings with it health complications including limb amputation, blindness, and heart disease.
The figures for diabetes in the Arab world are particularly startling as the number of people with diabetes is projected to increase by 96.2% by 2035. The unavailability of an effective program to defeat T2DM has serious consequences on the increasing rise of this disease, where available data indicates an unusually high prevalence of T2DM in Arabian children less than 18 years old.
The paramount role of intensive lifestyle intervention in preventing incident diabetes among participants and in reducing ethnic differences in diabetes incidence among Whites, Blacks, Hispanics, and Asian populations, was documented in the Diabetes Prevention Program Outcomes Study and in the Women’s Health Study
The Intervention
PACE (Promoting Activity and Changes in Eating) is a comprehensive protocol written to help medical teams guide patients during routine clinic visits, and provide consultation on lifestyle modification by increasing physical activity and adopting dietary changes. The counseling is tailored to the needs of the individual patient and his/her level of readiness for change.
Why start with Arab Israelis?
Arabs, mainly Muslim (82%), are the largest ethnic minority group in Israel, accounting for 20.7% of the total Israeli population. Most of the Arab population in Israel lives in predominantly Arab communities in close proximity to Jewish towns, with high exposure to westernized foods and eating habits, while the rest live in mixed Jewish/Arab cities. The Arab communities are still undergoing a transition from a mainly agrarian society, to a more urbanized one. On the whole, compared to the Jewish population, Arabs in Israel have lower socioeconomic status and poorer health awareness.
The accelerated urbanization has been accompanied by a nutrition transition, resulting in lower levels of physical activity, and the exchange of traditional foods high in complex carbohydrates for new foods high in refined carbohydrates. These changes explain the high prevalence of obesity among Arabs. The excess risk for diabetes among Arabs appears in all age groups and for both sexes and is only partially explained by the high prevalence of obesity. The relevance of the various social determinants of health (i.e. socioeconomic status, subjective socioeconomic status, isolation and exclusion) on modifiable causes of diabetes (i.e. BMI, physical activity, mental stress etc.).
In a population-based cross-sectional survey among 1,100 adult Jewish and Arab Israelis, the prevalence of diabetes was higher among Arab participants than among Jewish participants (21.0% vs. 11.9%), respectively. Diabetes risk calculation was based on self-reported age at diabetes diagnosis. The excess diabetes risk among Arabs was independent of body mass index [BMI], family history of diabetes, and consumption of energy-dense foods. Although prevalence data are crucial for appreciation of disease burden, they reflect both disease risk and survival. Indeed, diabetes-related mortality accounts for a significant part of the disparity in longevity among Arabs and Jews in Israel.
Why focus on women?
Diabetes was more prevalent in Arab females than in Arab males, 20% and 16.7%, respectively. No such sex difference was found among the Jews.
The mother's lifestyle impacts the family, especially children
In Arabic culture, mothers are responsible for creating and maintaining a home environment that fosters healthy eating behaviors among family members including the children. It is assumed, therefore, that mothers in Arabic culture play an essential role in preventing childhood obesity.
A comprehensive national study conducted by Rambam Health Care Campus researchers shows a worrisome increase in type 2 diabetes in children and adolescents and especially major differences between in the Jewish and Arab sectors.
Between the years 2008 and 2019, a 10-fold increase in the incidence of type 2 diabetes was observed in children and adolescents from the Arab sector (who constituted about 41% of patients, compared with 26% of the total population of children in Israel in those years), while in the Jewish sector there was a 3.5-fold rise.
