National Diabetes Guidelines

Objectives

Provide a national, evidence-based framework for preventing, diagnosing and managing diabetes in the United Arab Emirates, improving quality of life, reducing long-term complications and mortality, and supporting consistent care for UAE nationals and expatriate residents.[1][2]The framework adapts international guidance and local experience to the United Arab Emirates’ culture and lifestyle, responding to high diabetes prevalence, inadequate care and poor glycaemic control.[2][3]

• Prevent or delay type 2 diabetes by identifying and managing pre-diabetes, especially among people at elevated risk.[4]
• Promote public awareness, early diagnosis, screening and self-management education across age groups to prevent disease progression and serious complications.[1][3]
• Achieve individualised glycaemic, blood-pressure and lipid goals while avoiding severe hypoglycaemia, prolonged hyperglycaemia and diabetic ketoacidosis.[5][6]
• Reduce cardiovascular, renal, ophthalmic, neurological and foot complications through risk-factor management, screening, timely treatment and specialist referral.[7][8][9]
• Deliver safe, tailored care for pregnancy, childhood and adolescence, older people, acute illness, surgery, fasting during Ramadan, and education or day-care settings.[10][11][12][13]
• Support appropriate treatment selection, from lifestyle measures and oral medicines to insulin therapy, according to clinical need, personal preferences, lifestyle and self-management capacity.[14][15]

Diabetes is treated as a chronic metabolic condition requiring continuing medical care and patient self-management support to avert acute events and reduce microvascular and macrovascular disease.[3]Paediatric care particularly seeks the lowest sustainable glycated haemoglobin without disabling hypoglycaemia, while protecting cognition, mood and quality of life.[6]

Implementation

Implement the framework through the National Diabetes Committee, which developed the national strategy, defines relevant goals and tasks, and leads awareness and prevention activity.[1]The Diabetes Care Continuum programme is identified as the practical mechanism for executing the strategy, underpinned by research, scientific studies and evidence-based medicine.[1]Delivery draws on a multidisciplinary network spanning hospitals, primary health care, academic institutions, specialist diabetes centres, healthcare authorities and supporting companies.[16][2]

• Apply the National Diabetes Guideline across care settings for all professionals involved in diabetes management, covering classification, diagnosis, screening, treatment, complication prevention, follow-up, referral and special clinical circumstances.[2][17]
• Screen adults from age 30 years and repeat normal tests every three years, with earlier or annual testing for people with relevant risk factors; screen high-risk children from age 10 years or puberty and repeat testing every two years.[18][4]
• Provide integrated lifestyle support through education, nutrition advice, physical activity, weight management, smoking cessation and family involvement.[5][19][20]
• Use structured clinical review, self-monitoring of blood glucose, glycated-haemoglobin testing, complication screening and timely treatment intensification to guide individual care.[21][22]
• Organise multidisciplinary care around the person with diabetes and family, involving family physicians, nurse case managers, dieticians, diabetes educators and specialist referral where needed.[22]
• Establish individualised plans for schools and day-care settings, agreed by families, healthcare teams and educational personnel, covering monitoring, insulin, meals, emergency hypoglycaemia treatment and ketone testing.[23][24]
• Prepare people with diabetes before Ramadan through risk classification, assessment, education, dietary advice, glucose monitoring and individual medication adjustment, with enhanced protection for high-risk groups.[13][25][26]
• Manage acute diabetic ketoacidosis and hyperglycaemic hyperosmolar state through inpatient or intensive care where indicated, fluid and insulin treatment, correction of electrolyte abnormalities, treatment of precipitating causes and close clinical monitoring.[27][28]

Clinical monitoring includes regular glycated-haemoglobin assessment, blood-glucose testing, blood-pressure measurement, lipid assessment, renal screening, eye examinations and foot-risk review, with follow-up intervals tailored to risk and clinical status.[21][29][8][9]The available material does not specify a consolidated national reporting system, budget, financing plan, formal programme-level performance indicators or accountability arrangements beyond the National Diabetes Committee’s coordinating role and the clinical monitoring processes described.[1][30][31]

Monitoring & Evaluation

Monitoring is primarily clinical and patient-centred, combining self-monitoring of blood glucose, glycated haemoglobin (HbA1C), complication screening, acute-care observation and regular multidisciplinary review. The extracts provide limited evidence of a national programme-level evaluation, reporting or accountability framework, although the National Diabetes Committee has a coordinating role and paediatric diabetes centres are expected to compare glycaemic outcomes with local, national and international standards.[1][6]

• Monitor glycaemic control through self-monitoring of blood glucose and HbA1C. HbA1C is generally reviewed every three months for adults whose treatment is being intensified, reflects glycaemia over approximately four to twelve weeks, and should not be used as the sole measure of control.[21][6][32]
• Apply clinical targets including HbA1C below 7% for general adult diabetes management, with individualised glucose and HbA1C goals for children, older people, pregnancy and people at high risk of hypoglycaemia.[5][19][33]
• Review treatment response and intensify therapy where targets are not met, including consideration of combination treatment after three months above target and an aim to achieve the HbA1C target within six months of diagnosis.[21]
• Record monitoring results, insulin doses, hypoglycaemic episodes, relevant events and ketone results in diaries, logbooks or electronic records to support consultation, pattern recognition and treatment adjustment.[32]
• Collect glycaemic-control data from diabetes centres to support comparison of centre performance and improvement of interdisciplinary care teams; the extracts do not specify a reporting schedule, data system or responsible national body for this activity.[6][32]

Screening and follow-up requirements provide the principal measurable indicators for chronic-complication prevention. These include blood pressure measurement at every routine clinic visit, lipid assessment at least annually for most adults, annual microalbuminuria screening for specified groups, regular retinal examinations, and risk-stratified foot assessment.[7][29][8][9]

• Use blood pressure below 130/80 mmHg as a clinical target, confirm raised readings on a separate day, and monitor renal function and serum potassium when angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are used.[7]
• Assess lipids against targets of low-density lipoprotein below 100 mg/dL and triglycerides below 150 mg/dL, with sex-specific high-density lipoprotein targets.[29]
• Confirm microalbuminuria through at least two elevated results among three tests within six months, rather than relying on a single test.[29][8]
• Conduct annual eye and comprehensive foot examinations, with foot follow-up ranging from every three to six months for increased risk to every one to three months for high risk.[8][9]
• Undertake routine follow-up at every visit and at three-to-six-month and annual intervals, covering weight, blood pressure, glucose, HbA1C, cardiovascular risk, renal function, eye health, foot status, lifestyle factors and injection sites.[22]

Acute diabetes care includes intensive monitoring and escalation processes. Hypoglycaemia is to be confirmed with blood-glucose testing where possible, followed by continued observation until recovery; people treated for unconscious hypoglycaemia should be observed for 24 hours before discharge.[34]Diabetic ketoacidosis and hyperglycaemic hyperosmolar state management require repeated biochemical and clinical assessment, including serum glucose every one to two hours in diabetic ketoacidosis until stable and electrolyte, ketone and venous-pH testing every four to six hours as required.[27]

• Monitor paediatric diabetic ketoacidosis through hourly observations of pulse, respiratory rate, blood pressure, fluid balance and capillary glucose, alongside neurological observation and repeated blood-gas, electrolyte, calcium, phosphorus, anion-gap and ketone assessment.[35]
• Monitor pregnancy through frequent self-measured glucose, blood pressure, weight and HbA1C, with women who develop diabetes during pregnancy screened 45 to 60 days after delivery and advised to have annual diabetes checks if non-diabetic.[11]
• Monitor diabetes during Ramadan through multiple daily glucose tests, pre-Ramadan assessment of glycaemia, blood pressure, lipids and relevant laboratory results, and use specified glucose thresholds to end fasting.[13][25]
• Monitor school-based care through trained adults who record glucose results, act on readings outside the individual Diabetes Medical Management Plan range, test ketones when necessary and respond to results.[24]

Formal accountability mechanisms, national surveillance arrangements, audit cycles, programme indicators and mandatory reporting requirements are not specified in the available extracts beyond the cited population study, clinical testing schedules, centre-level comparison aspiration and National Diabetes Committee coordination.[1][3][6]

Costing & Financing

Costing and financing information is sparse. No overall budget, financing plan, resource-allocation formula, funding gap, resource-mobilisation strategy or economic assumption is specified for the national diabetes strategy or the clinical guidance.[1][2]

• Recognise Metformin as an inexpensive treatment option and NPH human insulin as a relatively low-cost insulin option with comparable glycated-haemoglobin reduction to long-acting insulin analogues.[14][15]
• Recognise that insulin analogues are generally substantially more expensive than human insulin, although trials cited in the guidance associate them with a modestly lower incidence of hypoglycaemia.[15]
• Recognise exenatide as a high-cost treatment option; no price, currency, procurement arrangement or affordability threshold is provided.[21]
• Provide essential operational resources including blood-glucose and ketone monitoring equipment, insulin, glucagon where indicated, hypoglycaemia treatments, suitable medicine storage and trained support in schools and day-care settings.[23][24]
• Address the potentially very high cost of blood-glucose monitoring relative to the cost of living, particularly for children and adolescents; inadequate or unavailable monitoring may contribute to acute crises, long-term complications, healthcare costs and disability.[32]

The extracts identify resource-intensive requirements such as multidisciplinary teams, specialist referral, laboratory testing, intensive care for severe diabetic ketoacidosis, regular eye and foot assessment, and paediatric monitoring equipment, but do not quantify their costs or identify funding sources.[27][9][22][35]