13. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimate for the year 2000 and projections for 2030. Diabetes Care 2004; 127 ( 5 ):1047-1053 .10.2337/diacare.27.5.1047 [PubMed ] [Cross Ref ] 28. Kahn CR. Banting Lecture. Insulin action, diabetogenes, and the cause of type II diabetes. Diabetes 1994. Aug; 43 ( 8 ):1066-1084 [PubMed ] 39. Collier CA, Bruce CR, Smith AC, Lopaschuk G, Dyck DJ. Metformin counters the insulin-induced suppression of fatty acid oxidation and stimulation of triacyglycerol storage in rodents skeletal muscle. Am J Physiol Endocrinol Metab 2006; 219 ( 1 ):182-189 .10.1152/ajpendo.00272.2005 [PubMed ] [Cross Ref ] Type 2 diabetes mellitus (DM) is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world. As a result of this trend, it is fast becoming an epidemic in some countries of the world with the number of people affected expected to double in the next decade due to increase in ageing population, thereby adding to the already existing burden for healthcare providers, especially in poorly developed countries. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include type 2 diabetes mellitus, prevalence, current diagnosis, and current treatment. Only articles in English were included. Screening and diagnosis is still based on World Health Organization (WHO) and American Diabetes Association (ADA) criteria which include both clinical and laboratory parameters. No cure has yet been found for the disease; however, treatment modalities include lifestyle modifications, treatment of obesity, oral hypoglycemic agents, and insulin sensitizers like metformin, a biguanide that reduces insulin resistance, is still the recommended first line medication especially for obese patients. Other effective medications include non-sulfonylurea secretagogues, thiazolidinediones argumentative essays, alpha glucosidase inhibitors, and insulin. Recent research into the pathophysiology of type 2 DM has led to the introduction of new medications like glucagon-like peptide 1 analogoues: dipeptidyl peptidase-IV inhibitors, inhibitors of the sodium-glucose cotransporter 2 and 11ß-hydroxysteroid dehydrogenase 1, insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, metabolic inhibitors of hepatic glucose output and quick-release bromocriptine. Inhaled insulin was licensed for use in 2006 but has been withdrawn from the market because of low patronage. 21. McCarthy MI. Genomics, type 2 diabetes, and obesity. N Engl J Med 2010. Dec; 363 ( 24 ):2339-2350 10.1056/NEJMra0906948 [PubMed ] [Cross Ref ] 7. Azevedo M, Alla S. Diabetes in sub-saharan Africa: kenya, mali, mozambique, Nigeria, South Africa and zambia. Int J Diabetes Dev Ctries 2008. Oct; 28 ( 4 ):101-108 10.4103/0973-3930.45268 [PMC free article ] [PubMed ] [Cross Ref ] 36. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, et al. Epidemic obesity and type 2 diabetes in Asia. Lancet 2006. Nov; 368 ( 9548 ):1681-1688 10.1016/S0140-6736(06)69703-1 [PubMed ] [Cross Ref ] 22. Walley AJ, Blakemore AI, Froguel P. Genetics of obesity and the prediction of risk for health. Hum Mol Genet 2006. Oct; 15 ( Spec No 2 ):R124-R130 10.1093/hmg/ddl215 [PubMed ] [Cross Ref ] 50. Pratley RE, Salsali A. Inhibition of DPP-4: a new therapeutic approach for the treatment of type 2 diabetes. Curr Med Res Opin 2007. Apr; 23 ( 4 ):919-931 10.1185/030079906X162746 [PubMed ] [Cross Ref ] Acarbose, Voglibose and Miglitol have not widely been used to treat type 2 DM individuals but are likely to be safe and effective. These agents are most effective for postprandial hyperglycemia and should be avoided in patients with significant renal impairment. Their use is usually limited due to high rates of side-effects such as diarrhoea and flatulence.38 Voglibose, which is the newest of the drugs, has been shown in a study to significantly improve glucose tolerance, in terms of delayed disease progression and in the number of patients who achieved normoglycemia.48 These generally well tolerated but because they stimulate endogenous insulin secretion, they carry a risk of hypoglycemia.38 Elderly patients, with DM who are treated with sulfonylureas have a 36% increased risk of hypoglycemia compared to younger patients.41 Glyburide is associated with higher rates of hypoglycemia compared to glipizide.42 Some of the risk factors for hypoglycemia are age-related impaired renal function, simultaneous use of insulin or insulin sensitizers, age greater than 60 years, recent hospital discharge, alcohol abuse, caloric restriction, multiple medications or medications that potentiate sulfonylurea actions.43 Use of long acting sulfonylurea such as glyburide should be avoided in elderly patients with DM and use of short-acting glipizide should be preferred.38 20. Rother KI. Diabetes treatment–bridging the divide. N Engl J Med 2007. Apr; 356 ( 15 ):1499-1501 10.1056/NEJMp078030 [PMC free article ] [PubMed ] [Cross Ref ] 48. Kawamori R, Tajima N, Iwamoto Y, Kashiwagi A, Shimamoto K, Kaku K, Voglibose Ph-3 Study Group Voglibose for prevention of type 2 diabetes mellitus: a randomised, double-blind trial in Japanese individuals with impaired glucose tolerance. Lancet 2009. May; 373 ( 9675 ):1607-1614 10.1016/S0140-6736(09)60222-1 [PubMed ] [Cross Ref ] 35. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2007. Dec; 298 ( 22 ):2654-2664 10.1001/jama.298.22.2654 [PubMed ] [Cross Ref ] Type 2 DM is due primarily to lifestyle factors and genetics.15 A number of lifestyle factors are known to be important to the development of type 2 DM. These are physical inactivity, sedentary lifestyle, cigarette smoking and generous consumption of alcohol.16 Obesity has been found to contribute to approximately 55% of cases of type 2 DM.17 The increased rate of childhood obesity between the 1960s and 2000s is believed to have led to the increase in type 2 DM in children and adolescents.18 Environmental toxins may contribute to the recent increases in the rate of type 2 DM. A weak positive correlation has been found between the concentration in the urine of bisphenol A, a constituent of some plastics, and the incidence of type 2 DM.19 10. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001. Dec; 414 ( 6865 ):782-787 10.1038/414782a [PubMed ] [Cross Ref ] 57. Inhaled insulin and diabetes. Diabetes monitor. Information, education, and support for people with diabetes. Available at: www.diabetesmonitor.com/inhaled.htm (Accessed 21st December 2011). 4. Maitra A, Abbas AK. Endocrine system. In: Kumar V, Fausto N, Abbas AK (eds). Robbins and Cotran Pathologic basis of disease (7th ed) 2005. Philadelphia, Saunders; 1156-1226. Thiazolidinedione is an insulin sensitizer, selective ligands transcription factor peroxisomes proliferator-activated gamma. They are the first drugs to address the basic problem of insulin resistance in type 2 DM patients,46 whose class now includes mainly pioglitazone after the restricted use of rosiglitazone recommended by Food and Drug Administration (FDA) recently due to increased cardiovascular events reported with rosiglitazone.36 Pioglitazone use is not associated with hypoglycemia and can be used in cases of renal impairment and thus well tolerated in older adults. On the other hand, due to concerns regarding peripheral edema, fluid retention and fracture risk in women, its use can be limited in older adults with DM. Pioglitazone should be avoided in elderly patients with congestive heart failure and is contraindicated in patients with class III-IV heart failure.47 Biguanides, of which metformin is the most commonly used in overweight and obese patients, suppresses hepatic glucose production, increases insulin sensitivity examples of a annotated bibliography, enhances glucose uptake by phosphorylating GLUT-enhancer factor, increases fatty acid oxidation, and decreases the absorption of glucose from the gastrointestinal tract.39 Research published in 2008 shows further mechanism of action of metformin as activation of AMP-activated protein kinase, an enzyme that plays a role in the expression of hepatic gluconeogenic genes.40 Due to the concern of development of lactic acidosis introductions for persuasive essays, metformin should be used with caution in elderly diabetic individuals with renal impairment. It has a low incidence of hypoglycemia compared to sulfonylureas.39 6. Genetic basis of type 1 and type2 diabetes, obesity, and their complications. Advances and emerging opportunities in diabetes research: a Strategic Planning report of the DMICC. www2.niddk.nih.gov/NR (Accessed 22nd December 2011). 1 Division of Gastroenterology, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria. 49. Stonehouse AH, Darsow T, Maggs DG. Incretin-based therapies. J Diabetes 2011. (published online ahead of print). 41. van Staa T, Abenhaim L, Monette J. Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 1997. Jun; 50 ( 6 ):735-741 10.1016/S0895-4356(97)00024-3 [PubMed ] [Cross Ref ] Received 2012 Mar 10; Accepted 2012 May 8. * Address correspondence and reprints request to: Abdulfatai B. Olokoba, Division of Gastroenterology, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria. E-mail: moc.oohay@abokolobard 5. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus: present and future perspectives. Nature reviews endocrinology. Available at: www.nature.com/uidfinder (Accessed 22nd December 2011) 55. Rosenstock J, Lorber DL compose thesis, Gnudi L, Howard CP, Bilheimer DW, Chang PC, et al. Prandial inhaled insulin plus basal insulin glargine versus twice daily biaspart insulin for type 2 diabetes: a multicentre randomised trial. Lancet 2010. Jun; 375 ( 9733 ):2244-2253 10.1016/S0140-6736(10)60632-0 [PubMed ] [Cross Ref ] The 1997 ADA recommendations for diagnosis of DM focus on the FPG, while WHO focuses on the OGTT.32 The glycated hemoglobin (HbA1c) and fructosamine is also still useful for determining blood sugar control over time. However, practicing physicians frequently employ other measures in addition to those recommended. In July 2009, the International Expert Committee (IEC) recommended the additional diagnostic criteria of an HbA1c result ³6.5% for DM. This committee suggested that the use of the term pre-diabetes may be phased out but identified the range of HbA1c levels ³6.0% and <6.5% to identify those at high risk of developing DM.34 37. Boffetta P, Mclerran D, Chan Y, Manami I, Sinha R, Gupta PC, et al. Body mass index and diabetes mellitus in Asia. A cross sectional pooled analysis of 900,000 individuals in the Asia cohort consortium 2011. Available at www.plosoni.org/article/info (Accessed December 2011). [PMC free article ] [PubMed ] 25. Powers AC. Diabetes mellitus. In: Fauci AS, Braunwauld E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J (eds). Harrison’s Principles of Internal Medicine.17th ed, New York, McGraw-Hill; 2008: 2275-2304. There is a strong inheritable genetic connection in type 2 DM, having relatives (especially first degree) with type 2 DM increases the risks of developing type 2 DM substantially. Concordance among monozygotic twins is close to 100%, and about 25% of those with the disease have a family history of DM.20 Recently, genes discovered to be significantly associated with developing type 2 DM, include TCF7L2. PPARG. FTO. KCNJ11. NOTCH2. WFS1. CDKAL1. IGF2BP2. SLC30A8. JAZF1. and HHEX. KCNJ11 (potassium inwardly rectifying channel, subfamily J, member 11), encodes the islet ATP-sensitive potassium channel Kir6.2, and TCF7L2 (transcription factor 7-like 2) regulates proglucagon gene expression and thus the production of glucagon-like peptide-1.21 Moreover, obesity (which is an independent risk factor for type 2 DM) is strongly inherited.22 Monogenic forms like Maturity-onset diabetes of the young (MODY), constitutes up to 5% of cases.23 There are many medical conditions which can potentially give rise to, or exacerbate type 2 DM. These include obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed metabolic syndrome (it is also known as Syndrome X thesis statements on climate change, Reaven's syndrome).24 Other causes include acromegaly, Cushing's syndrome book report writing ideas, thyrotoxicosis, pheochromocytoma, chronic pancreatitis, cancer, and drugs.25 Additional factors found to increase the risk of type 2 DM include aging,26 high-fat diets, and a less active lifestyle.27 Objectives: To reconsider the aims of screening for undiagnosed diabetes, and whether screening should be for other abnormalities of glucose metabolism such as impaired glucose tolerance (IGT), or the ‘metabolic syndrome’. Also to update the previous review for the National Screening Committee (NSC) on screening for diabetes, including reviewing choice of screening test; to consider what measures would be taken if IGT and impaired fasting glucose (IFG) were identified by screening, and in particular to examine evidence on treatment to prevent progression to diabetes in these groups; to examine the cost-effectiveness of screening; and to consider groups at higher risk at which screening might be targeted. P- Reviewer: Pezzilli R, Tomkin GH S- Editor: Ji FF L- Editor: Roemmele A E- Editor: Lu YJ 5. Sellayah D, Cagampang FR, Cox RD. On the evolutionary origins of obesity: a new hypothesis. Endocrinology. 2014; 155 :1573–1588. [PubMed ] Article in press: December 1, 2014 11. Na’amnih W, Muhsen K, Tarabeia J, Saabneh A, Green MS. Trends in the gap in life expectancy between Arabs and Jews in Israel between 1975 and 2004. Int J Epidemiol. 2010; 39 :1324–1332. [PubMed ] 46. Chorny A, Lifshits T, Kratz A, Levy J, Golfarb D, Zlotnik A, Knyazer B. [Prevalence and risk factors for diabetic retinopathy in type 2 diabetes patients in Jewish and Bedouin populations in southern Israel] Harefuah. 2011; 150 :906–910, 935. [PubMed ] According the Central Bureau of Statistics, the State of Israel had a population of 8102000 in March 2013, with close to 75% Jews, about 21% Arabs and about 4% others[6 ]. The Bedouins in the Negev are at the bottom of the socioeconomic scale in Israel[8 ]. Phenomena such as polygamy, in-marriage (marriage within one’s own tribe or group as required by custom or law) and high birth rates (in 2009 the average Bedouin family numbered 6.8 children) are common in Bedouin society[7 ]. 34. Fraser D, Bilenko N, Vardy H, Abu-Saad K, Shai I, Abu-Shareb H, Shahar DR. Differences in food intake and disparity in obesity rates between adult Jews and Bedouins in southern Israel. Ethn Dis. 2008; 18 :13–18. [PubMed ] 13. Shalata A, Jazmawi W, Aslan O, Badarni K, Dabbah K, Sawaed S, Cohen Castel O, Borochowitz ZU, Karkabi K, Defronzo R, et al. Early metabolic defects in Arab subjects with strong family history of Type 2 diabetes. J Endocrinol Invest. 2013; 36 :417–421. [PubMed ] These differences should be addressed when develo-ping stroke and coronary artery disease preventative strategies, planning healthcare services and designing culturally relevant public education programs. 23. Khatib M, Efrat S, Deeb D. Knowledge, beliefs, and economic barriers to healthcare: a survey of diabetic patients in an Arab-Israeli town. J Ambul Care Manage. 2007; 30 :79–85. [PubMed ] 43. Tamir O, Peleg R, Dreiher J, Abu-Hammad T, Rabia YA, Rashid MA, Eisenberg A, Sibersky D, Kazanovich A, Khalil E, et al. Cardiovascular risk factors in the Bedouin population: management and compliance. Isr Med Assoc J. 2007; 9 :652–655. [PubMed ] An epidemiological survey conducted among Bedouins about half a century ago reported that only a few patients had hypertension and diabetes and none had ischemic heart disease[38 ,39 ]. Later, evidence accumulated that cardiovascular risk factors among the Bedouins were on the rise and that this increase was more pronounced among Bedouin living in settled settings compared to the traditional tribal groups. A study performed in 1990 demonstrated that among Bedouins who lived in permanent towns, 15% were obese and 23% were overweight compared to Bedouins who did not live in permanent towns, where there were no obese individuals and 23% were overweight. This difference was particularly apparent in the younger age group. No difference was found between the groups regarding fasting blood glucose[40 ]. A study from 2005 found a difference in diabetes prevalence in urban compared to rural settlements (5.5% vs 3.9%, respectively, P < 0.001). In this study writing a informative essay, diabetes control was less successful among Bedouin diabetes patients. Only 29.3% had their diabetes under control compared to 46.7% among non-Bedouin diabetes patients[41 ]. A study at the largest urban Bedouin outpatient clinic in 2002 revealed that the prevalence of diabetes was 7.3% among men and 9.9% among women. Women had significantly higher BMI levels than men but lower levels of HbA1c and microalbuminuria[42 ]. Prescribed oral medicines were purchased by 69% of the women compared to 76% of the men. Insulin was purchased by 19% of the women compared to 15% of the men[42 ]. The study from 2007 showed an age-adjusted prevalence rate for diabetes of 12% in the Bedouin urban population compared to 8% among Jews. The prevalence rate was especially notable among Bedouins in the 40-49 year age group where it was three times higher than in the Jewish population of the same age. The adherence rate to diabetes treatment was 27% among the Bedouins compared to 42% in the Jewish population. The Bedouin population was also less compliant with follow-up blood tests: 22% of the Bedouin patients had no HbA1C measurements over the course of the previous year, compared to 13% of the Jews. The rates of controlled diabetic patients were lower among the Bedouins than the Jews (29.5% vs 57%, respectively)[43 ]. The results of studies on the prevalence of obesity and diabetes type 2 among Bedouins in the Negev are summarized in Table Table3 3 . While the life expectancy of Israeli Arabs was lower than Israeli Jews from 1975-2004, the gap decreased between 1975 and 1998. However, since 1998 the gap has increased again and the difference in 2004 was 3.2 years more for Israeli Jewish men and 4 years more for Israeli Jewish women. The main causes of death that lead to the gap in life expectancy are chronic diseases, especially ischemic heart disease and diabetes[11 ]. The Arab community of Israel is characterized by a high rate of consanguinity. One study investigated the effect of consanguinity on multifactorial common adult morbidity, including T2DM. There was no significant difference in T2DM between patients with consanguinity and those without[12 ]. Another study that investigated the existence of a direct genetic association that affects the development of diabetes demonstrated that distinct genetic backgrounds are responsible for the development of beta-cell dysfunction and insulin resistance among Arabs[13 ]. Obesity comprises a central element in the development of T2DM and the risk of diabetes increases substantially with increased body mass index (BMI)[14 ]. A study from central Israel showed that the mean BMI of 18-year-old Jews and Arabs is similar. This finding changes with age so that 52% of Arab women are classified as obese compared with 31% of Jewish women and 25% of Arab men compared to 23% of Jewish men. A central group pointed to in this study was Arab women aged 55-64 years where the rate of obesity reaches 70%[16 ]. A study of randomly recruited healthy, overweight Arabs (BMI > 27) attending a primary healthcare clinic in Israel revealed that 27% of them had undiagnosed T2DM, 42% had impaired glucose tolerance (IGT), and only 31% had a normal OGCT. The metabolic syndrome was diagnosed in 48%[17 ]. There is evidence from various populations that IGT and impaired fasting glucose (IFG) often are associated with different groups of patients[18 ]. The study from Israel assessed insulin resistance and impaired pancreatic function among overweight Arab patients with IFG only, IGT only or IFG and IGT (combined glucose intolerance-CGT) compared to those with a normal response to glucose (NGT). Patients with IFG and CGT were more obese and had higher values of insulin resistance compared to those with IGT only or normal fasting glucose. There was no statistically significant difference in insulin resistance between patients with IGT only and those with NGT. Beta-cell function was depressed in patients with IGT only and CGT compared to those with IFG and NGT, while beta-cell function indices in patients with IFG were similar to those with NGT[19 ]. 26. Aravind SR, Al Tayeb K cheap dissertation writing uk, Ismail SB, Shehadeh N, Kaddaha G, Liu R, Balshaw R, Lesnikova N, Heisel O, Girman CJ, et al. Hypoglycaemia in sulphonylurea-treated subjects with type 2 diabetes undergoing Ramadan fasting: a five-country observational study. Curr Med Res Opin. 2011; 27 :1237–1242. [PubMed ] Results of studies on the prevalence of obesity, pre-diabetes and diabetes type 2 in the Arab Israeli population 27. Nseir W, Haj S, Beshara B history essay on the cold war, Mograbi J, Cohen O. Seeking out high risk population: the prevalence characteristics and outcome of diabetic patients of arab ethnicity hospitalized in internal medical and acute coronary units in Israel. Int J Endocrinol. 2013; 2013 :371608. [PMC free article ] [PubMed ] This review surveys the literature published on the characteristics and implications of pre-diabetes and type 2 diabetes mellitus (T2DM) for the Arab and Bedouin populations of Israel. T2DM is a global health problem. The rapid rise in its prevalence in the Arab and Bedouin populations in Israel is responsible for their lower life expectancy compared to Israeli Jews. The increased prevalence of T2DM corresponds to increased rates of obesity in these populations. A major risk group is adult Arab women aged 55-64 years. In this group obesity reaches 70%. There are several genetic and nutritional explanations for this increase. We found high hospitalization rates for micro and macrovascular complications among diabetic patients of Arab and Bedouin origin. Despite the high prevalence of diabetes and its negative health implications, there is evidence that care and counseling relating to nutrition business internship cover letter examples, physical activity and self-examination of the feet are unsatisfactory. Economic difficulties are frequently cited as the reason for inadequate medical care. Other proposed reasons include faith in traditional therapy and misconceptions about drugs and their side effects. In Israel, the quality indicators program is based on one of the world’s leading information systems and deals with the management of chronic diseases such as diabetes. The program’s baseline data pointed to health inequality between minority populations and the general population in several areas, including monitoring and control of diabetes. Based on these data, a pilot intervention program was planned, aimed at minority populations. This program led to a decrease in inequality and served as the basis for a broader free essay about english, more comprehensive intervention that has entered the implementation stage. Interventions that were shown to be effective in other Arabic countries may serve as models for diabetes management in the Arab and Bedouin populations in Israel. Although these overall data are troubling, recent findings are more encouraging. Once considered a disease of western society, type 2 diabetes mellitus (T2DM) has now spread to every country in the world, with Asia accounting for 60% of the world’s diabetic population[1 ]. Obesity and T2DM have become a central medical problem among immigrants and minorities[2 ]. 31. Telman G, Kouperberg E, Sprecher E, Yarnitsky D. Ethnic differences in ischemic stroke of working age in northern Israel. J Stroke Cerebrovasc Dis. 2010; 19 :376–381. [PubMed ] Today, about 61% of the Negev Bedouins live in permanent towns and 39% live in unauthorized villages. There is a large difference in living conditions between these two groups. The latter live in huts or tents without official supplies of water or electricity. Houses are heated in the winter primarily by burning wood over open fires. Cooking is done on gas stoves or open fires. The sanitation level is very low with no central sewerage or garbage removal. These conditions affect morbidity, adherence to treatment and access to healthcare services[9 ]. 45. Rabaev E, Sagy I, Zaid EA, Nevzorov R, Harman-Boehm I, Zeller L, Barski L. [Differences in clinical characteristics and outcomes of diabetic ketoacidosis (DKA) in Jewish and Bedouin patients] Harefuah. 2014; 153 :134–138, 241. [PubMed ] 39. Ben Assa S. The medical work among the Bedouin in the Negev. Harefuah. 1961; 67 :211–212. A quality indicators program in the community has been in existence in Israel for the last 15 years. It is based on some of the world’s leading information systems with data regarding sociodemographic factors, drug therapy, healthcare services, laboratory and imaging data, and recording of chronic diseases. It consists of several domains, including preventive medicine and management of chronic diseases. The program has led to an improvement in the quality of medical care, including diabetes control. 33. Salameh S, Hochner-Celnikier D, Chajek-Shaul T, Manor O, Bursztyn M. Ethnic gap in coronary artery disease: comparison of the extent, severity, and risk factors in Arab and Jewish middle-aged women. J Cardiometab Syndr. 2008; 3 :26–29. [PubMed ] Israel has a national health insurance law. In accor-dance with this law, the population receives medical care through non-profit medical organizations. The work principle of these medical organizations is based on the patient-oriented model based on primary care in the community by a team of doctors and nurses with specialist consultants, if required[10 ]. Although the Arab and Bedouin populations of Israel live in the same geographical area as the Jews and have at their disposal the same broad basket of healthcare services, they are separate ethnic groups embracing a different lifestyle, nutritional habits and environmental exposures. Furthermore, in recent years, the Arab population of Israel has experienced a rapid change towards a westernized lifestyle. 44. Yoel U, Abu-Hammad T, Cohen A, Aizenberg A, Vardy D, Shvartzman P. Behind the scenes of adherence in a minority population. Isr Med Assoc J. 2013; 15 :17–22. [PubMed ] Results of studies on the prevalence of obesity and diabetes type 2 among Bedouins in the Negev 4. Vaag AA, Grunnet LG, Arora GP, Brøns C. The thrifty phenotype hypothesis revisited. Diabetologia. 2012; 55 :2085–2088. [PMC free article ] [PubMed ] A recent study evaluated the reasons for non-treat-ment of cardiovascular disease and its risk factors in the Bedouin population. Structured interviews on knowledge and attitudes relating to chronic diseases and their treatment were conducted among patients with T2DM, hypertension and lipid metabolic disorders. Ninety-nine high and 101 low-adherent patients were interviewed. More patients in the low-adherence group believed that traditional folk treatment was an alternative to prescription drugs for the treatment of T2DM, hypertension and hyperlipidemia and 10% took traditional drugs only. Patients in the group that was classified as undertreated believed that adverse drug effects were more harmful than the disease itself (65% vs 47%, respectively) and this was also the reason for the cessation of treatment among 47% who were classified as low-adherent[44 ]. 24. Tirosh A, Calderon-Margalit R, Mazar M, Stern Z. Differences in quality of diabetes care between Jews and Arabs in Jerusalem. Am J Med Qual. 2008; 23 :60–65. [PubMed ]
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