Type 2 Diabetes Management in Gulf Countries

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Introduction

Diabetes mellitus (DM) is one of the most common chronic diseases in the world. The rapid spread of the incidence of diabetes mellitus (DM) has become a non-infectious epidemic. Recently, this disease has begun to be studied as a social problem that is becoming increasingly more urgent. Moreover, six of the ten countries with the highest prevalence of diabetes are located in the Middle East (Icon Group International, 2017). This determines the exceptional relevance of research on the current situation and prospects for treating diabetes in the Gulf countries. One such study is the systematic review on the quality of type 2 diabetes management in the countries of the cooperation council for the Arab states of the Gulf, prepared by Alhyas, McKay, Balasanthiran, and Majeed back in 2011, published in PlosOne.

The Philosophical Underpinnings of the Paper

Medicine, like no other discipline, needs an understanding of processes and phenomena in their integrity. This most important task can be solved only on the basis of the interpretation of medical science data from the standpoint of a systems approach. A medical specialist needs, first of all, to see the connection between various processes and phenomena during the development of the disease, that is, the true essence of the pathological process, as well as to understand the principles of choosing therapy and indicators for assessing its effectiveness. The systematic review is a well-established and widely accepted tool in the medical community for applying a systemic approach to health problems.

The Theory Used to Support the Research

Systematic reviews synthesize the results of original studies using approaches that reduce the possibility of bias and random errors. The authors of systematic reviews use the theory of evidence-based medicine and prevention, which is a policy and practice of applying the best external evidence acceptable to healthcare professionals and related industries, patients, and society as a whole. In particular, the aim of the review under consideration was to examine the current quality of management of type 2 diabetes in the member states of the GCC (Alhyas et al., 2011, p. 2). It is an important technology for maintaining and improving health.

The evidence-based approach as a technology for achieving high-quality medical care and management in health care is recognized and has been introduced over the past decades. The prerequisites for this were primarily economic: against the background of limited sectoral resources in the world, the costs of medical services and research increased significantly, which, among other reasons, was due to the predominance of chronic noncommunicable diseases in the morbidity and mortality patterns. A significant problem was also the quality of information support for management decisions in medicine and its transparency for patients and society as a whole. Accordingly, information support of medicine regarding such chronic non-communicable diseases as diabetes, especially in the regional context, is an important theoretical implication of research.

At the same time, the methodological basis of the evidence-based approach in health care clinical epidemiology provided it with the methods of medical statistics, reliability criteria, and methods of data generalization. The authors suggest clear criteria for inclusion and exclusion of publications for reviews and identified 27 published studies to include in the review. The selection of the main parameters of SD type 2 management provided the formation of a data array for further use by medical professionals and public health regulators. This data is used in medicine as a source of information for clinical decision making, planning of future research, and health policy development, thereby strengthening the link between the best research results and optimal care.

The Appropriateness of the Methodology Used

The evident proof of the appropriateness of the methodology applied by the authors is their conclusion that the quality of type 2 diabetes management in the GCC region can be characterized as poor. Based on the available data sets, the authors modeled heterogeneous groupings in accordance with the requirements of systems analysis, within the framework of the systems approach. At the same time, it should be noted that the authors do not pay enough attention to the quality of the general sample of studies for analysis they claim that there are no limitations on publication type, publication status, study design (Alhyas et al., 2011, p. 1). Dividing the sample into subsections according to research design criteria, patient samples potentially could significantly improve the quality of the results obtained.

Alternative Theory and Alternative Research Methodology That Could Have Been Used

It is known that the most general and unifying theory of the origin of diseases is the theory of diseases of civilization and social adaptation. The term adaptation as a process of overcoming inadequate conditions by the body that does not correspond to the properties of the body is no less popular than stress (Topol, 2019). Disadaptation is considered as the basis of the disease; in this regard, a determination theory of medicine was developed, the main goal of which is to unite all the basic modern knowledge accumulated in the field of biomedical research into a single system (Topol, 2019). The doctrine of adaptive response is that the determination factor is always specifically refracted through internal systems. Investigating the regional features of the incidence of type 2 diabetes, the authors should consider, in particular, some social and cultural determinants of the current situation. The determinative theory of medicine is an attempt at an integrative methodological concept that generalizes the patterns of the emergence and development of pathological conditions, processes, and patterns of the formation and maintenance of health. Its functions are the following (Topol, 2019):

Informative (obtaining information about the adaptive nature of reactions);
Systematizing (generalization of the facts of clinical and experimental medicine into a single system of adaptive response);
Predictive (anticipation of new facts, phenomena, and patterns of adaptive response);
Explaining (phenomena, facts, adaptive response).

In view of the approach to the formation of the sample presented in the considered systematic review, as well as the tasks of publication of the study set by the authors, the application of the determinative theory seems to be the most appropriate. In addition, when speaking of alternative research methodology, the application of grounded theory should be proposed. It enables in-depth analyses of empirical facts and allows the emergence of new themes, issues, and opportunities in the process of research, as well as revealing of latent interrelationships and dependencies, not evident in a standard systematic review.

Ethical Issues

In accordance with the concept of evidence-based medicine, the results of only those clinical studies that are conducted on the basis of the principles of clinical epidemiology are recognized as scientifically grounded. It makes possible minimization of both systematic and random errors (using the correct statistical analysis of the data obtained in the study). Thus, this fact determines the need for a high level of the ethical responsibility of the researcher. The authors themselves claim about the heterogeneity of studies included in the sample as a major limitation on the strength of conclusions formulated (Alhyas et al., 2011). No proper statistical analysis has been performed, but the authors argue that the level of treatment for type 2 diabetes in the Gulf countries is not satisfactory. The validity of the systematic review under consideration cannot be verified, which is somewhat of a violation of research ethics.

Conclusion

The critical analysis of the article under consideration allows concluding that systematic review represents a kind of first step in outlining the problem of type 2 diabetes management in the countries of the cooperation council for the Arab states of the Gulf. Although the overall philosophy and methodology of systematic reviews is observed, the sample is not representative, and the quality of the publications included in the review is ambiguous. However, the review has scientific and practical value in terms of evidence-based medicine in treatment of type 2 diabetes in the Gulf countries and other regions, especially for developing countries.

Reference List

Alhyas, L. et al. (2011) Quality of type 2 diabetes management in the states of the cooperation council for the Arab states of the Gulf, PlosOne, 6(8), pp. 16. Web.

Icon Group International (2017) The 2018-2023 world outlook for type 2 diabetes mellitus treatments. Author.

Topol, E. (2019) Deep medicine: How artificial intelligence can make healthcare human again. New York: Basic Books.

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