medical research in qatar

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The new collaborative graduate program leading to the PhD degree in Medical Sciences is a research-based interdisciplinary program, committed to training PhD candidates as the next generation of health scientists and research leaders in Qatar.

Investigating and finding solutions to pressing research problems lies at the core of the research graduate program, the scope and depth of which will encompass published results and demonstrate mastery of the major health problems in Qatar.

The collaborative PhD program provides a common core curriculum to equip students with core knowledge to support their pursuit of a PhD in one of three disciplines (Biomedical Sciences or Medical Sciences or Pharmaceutical Sciences) with the aim of bridging basic research, translational therapeutics and clinical medicine in areas related to cancer, diabetes and infectious diseases.

The program is based on collaborative interprofessional health education and training that eliminates unnecessary duplication in curriculum and infrastructure, creates opportunities to address common research themes, aligns resources based on functions and synergies, establishes targeted strategic direction and enhances the academic program to meet community needs without losing the autonomy of participating programs.

Locally, the PhD program collaborates in students’ supervisions and research with Hamad Medical Corporation (HMC), Weill-Cornell Medicine Qatar (WCMC - Qatar), Qatar Cardiovascular Research Center (QCRC), Primary HealthCare Corporation (PHCC) and the National Center for Cancer Care and Research (NCCCR).

Further international collaborations in the areas of teaching and research with various educational and medical institutions in the US, UK and Australia are being expanded.

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Sidra Medicine is a unique academic medical and research center based in Doha, Qatar. Our ambition is to carry out research that provides accurate and timely diagnoses for women and children with complex conditions, and to pioneer new approaches to disease management and treatments.

The Core Facilities at Sidra Research house innovative, state-of-the art platforms to support our mission and vision, from cutting-edge advanced diagnostics (applied genomics, proteomics, flow cytometry, microscopy, etc.) to advanced therapies manufacturing (Cell and Gene Therapy Facility). In addition, Sidra Research has an actively growing Clinical Trials Office that leads clinical studies to transform patient care through research.

Over the years, we have established strategic partnerships with service providers to bring these platforms to the wider local and regional community. Our experienced staff also offer regular training, education and capacity building initiatives for students and the scientific community in Qatar and beyond.

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Director's Message

The QURBC will serve to enhance and advance the work on biomedical research at QU, the expertise from the College of Health Science programs, College of Arts & Science, College of Engineering, College of Medicine and from College of Pharmacy will be of immense value to the Center's work. QUBRC will leverage QU's interdisciplinary status, incorporating key players in the field of biomedical research at QU related Colleges and research centers.Population, Health and Wellness sector is one of the important research areas in the research road map for the 5 years (2014-2019) that was launched by Qatar University to enhance building an educated, healthy and well- informed community in Qatar. Qatar University (QU) has established a dedicated center for biomedical research. The Biomedical Research Center (QUBRC) - September 2014 - was the culmination for the successful biomedical program that was established since1984. The Biomedical program was the first of its kind outside United States and was an important addition to support College of Pharmacy and the new established Faculty of Medicine at the university. This illustrious history of quality and excellence in biomedical research will allow the QUBRC to become a leading partner in the biomedical research field at a national, regional and international level.

On the other hand, the Center will seek for collaboration with the organizations such as the Ministry of Public Health , Hamad Medical Corporation, Weill Cornell Medical College in Qatar, Sidra Medical and Research Center, Qatar Biomedical Research Institute, and Anti-Doping Lab Qatar.

Through its activities and functions, the center will focus on research, training, and services in applied and basic biomedical research in two major areas: metabolic diseases (chronic non-communicable diseases), namely cardiovascular diseases, Type 2 diabetes, obesity & cancer and infectious diseases. QUBRC is a supporting testament of Qatar University for Qatar Vision 2030 and the national priorities for scientific research in Qatar, which include research related to public health and medical sciences.

Asma Ali Jassim Althani Director, Biomedical Research Center

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• Open access
• Published: 27 January 2011

Medical education and research environment in Qatar: a new epoch for translational research in the Middle East

• Lotfi Chouchane 1 ,
• Ravinder Mamtani 1 ,
• Mohammed H Al-Thani 2 ,
• Al-Anoud M Al-Thani 2 ,
• Marco Ameduri 1 &
• Javaid I Sheikh 1  

Journal of Translational Medicine volume  9 , Article number:  16 ( 2011 ) Cite this article

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Recent advances in medical technology and key discoveries in biomedical research have the potential to improve human health in an unprecedented fashion. As a result, many of the Arab Gulf countries, particularly Qatar are devoting increasing resources toward establishing centers of excellence in biomedical research. However, there are challenges that must be overcome. The low profile of private medical institutions and their negligible endowments in the region are examples of such challenges. Business-type government controlled universities are not the solution for overcoming the challenges facing higher education and research programs in the Middle East.

During the last decade, Qatar Foundation for Education, Science and Community Development has attracted six branch campuses of American Institutions of higher learning to the Education City in Qatar, a 2500-acre area, which is rapidly becoming a model of integrating higher education and research in the region. Not-for profit, time-tested education institutions from abroad in public-private partnership with local organizations offer favorable conditions to build robust research programs in the region. Weill Cornell Medical College in Qatar (WCMC-Q) of Cornell University is an example such an institution. It is the first and only medical school in Qatar.

WCMC-Q's interwoven education, research and public health based framework lays a sturdy foundation for developing and implementing translational medicine research programs of importance to the State of Qatar and Middle Eastern nations. This approach is yielding positive results. Discoveries from this program should influence public policy in a positive fashion toward reducing premature mortality and morbidity due to diabetes, obesity, heart disease and cancer, examples of health conditions commonly encountered in Qatar.

Introduction

A monarchy, Qatar has been ruled by the Al-Thani family since the mid-1800 s. Since its independence in 1971, the nation has undergone remarkable social, economic and industrial development. Recently, the State of Qatar won the bid to host 2022 FIFA World Cup. It is evident that Qatar has transformed itself from a poor British territory into a wealthy oil and natural gas rich state that provides ample growth opportunities for businesses, social events, education and research institutions. According to the Qatar Statistics Authority, on Sept. 30, 2010, there were 1,642,235 Qatari residents, approximately 350,000 of who are Qatari citizens. The remaining residents are expatriates chiefly from South Asia and from non-oil-rich Arab states.

Countries in the Middle East including Gulf Cooperation Council (GCC) nations such as Qatar and United Arab Emirates have experienced a reduction in their mortality rates. In general, life expectancy has increased and people are living longer, many with debilitating non- communicable diseases (NCDs), such as diabetes, cancer and heart disease [ 1 , 2 ].

Health care continues to evolve in the GCC nations. The nations have committed to combating the widespread prevalence of NCDs and the morbidity associated with them [ 2 ]. Qatar has been at the forefront of initiating new research, clinical and community projects in controlling these diseases. In general, Qatar's goal is changing from a disease based approach to a more comprehensive evidence based integrative multidisciplinary care and a preventive approach to disease and patient management. Evidence based approach will necessitate developing programs aimed at high quality basic science and public health research with a view to improve the quality of life, and reduce morbidity and premature mortality associated with commonly occurring chronic diseases such as diabetes, obesity and cancer. Education programs, which offer opportunities for research and ideal clinical experience, are required. Developing translational research programs in the Middle East is imperative.

But building a robust, viable research culture in the Middle East is a challenge. There are several reasons for this - one, the Arab world's 200 universities have almost negligible endowments with business and lack adequate venture capital; two, most Arab universities are largely state owned and spend only around one percent of their budgets on research compared to an international average of 35 percent; three, some wealthy countries in the region are lacking in their human capacity building but have funding; and four, low and middle income nations are lacking in financial resources despite having well-educated professionals and scientists [ 3 ].

Based on our own collective experience in global health, medical education and research, we feel business-type government controlled universities are not the solution for overcoming the challenges facing higher education and research programs in the Middle East. However, not-for profit, time-tested education institutions from abroad with local financial support and working in close collaboration with the host country's institutions show promise and may offer exciting opportunities. A case in point is Weill Cornell Medical College in Qatar (WCMC-Q). WCMC-Q's interwoven framework of education, research, public health and clinical components lays a sturdy foundation for developing evidence based translational research as discussed in this review.

We begin our review by briefly discussing the educational and research environment. Our discussion continues on Medical Education in Qatar, and provides a summary of student demographics and their interests, and pre-medical and medical education programs at WCMC-Q. This is followed by a brief description of WCMC-Q's public health and research activities. We then summarize the challenges WCMC-Q faces and the opportunities it provides to its faculty and their collaborators. Documenting our experience and the lessons learnt might be instructive to those considering establishing similar programs internationally.

Research and Education Environment in Qatar

Qatar Foundation (QF), which was established in 1995, is an independent, private, not for profit organization, whose mission is "to prepare the people of Qatar and the region to meet the challenges of an ever-changing world, and to make Qatar a leader in innovative education and research." Under the leadership of His Highness Sheikh Hamad Bin Khalifa Al-Thani, the Emir of Qatar and founder of Qatar Foundation, and Her Highness Sheikha Mozah Bint Nasser Al-Missned, Chairperson of Qatar Foundation, the Foundation is "transforming Qatari society by educating the rising generation to the highest world standards - these will be the skilled professionals who will be the country's future leaders. It is turning Qatar into a producer of knowledge by building a research base. Some of the new ideas will reach the stage of commercialization, helping diversify the economy" [ 4 ].

Under the umbrella of QF, there are several premier research and or education institutions. These include the Education City (EC) of which WCMC-Q is an integral part, Qatar Science & Technology Park (QSTP) and the Qatar National Research Fund (QNRF). The overall intent is to connect the industry, academic and government sectors into what is commonly referred to as the Triple Helix model [ 4 , 5 ]. The model provides a conceptual framework for regional development.

Education City in Doha, home to six American University branch campuses including Cornell, Georgetown, Texas A&M and Carnegie Mellon, is the flagship of Qatar Foundation. It is spread over 2,500 acres. With the exception of Weill Cornell Medical College of Cornell University, programs offered by the EC universities initially were limited to undergraduate degrees but recently graduate degrees have been initiated by Virginia Commonwealth University and Texas A&M University-Qatar. Additionally, there are plans for EC universities to collaborate with the industry as their research programs mature.

QSTP facilitates the engagement of the private sector with the universities, as a base for multi-national and national companies to establish research centers, and an opportunity for knowledge-based entrepreneurs to create new businesses. It has already attracted tenants such as EADS, Microsoft, ExxonMobil, GE and Shell, the latter of which is to set up a $100 m gas- to-liquids research center. R&D is focused in areas related to the economy of Qatar, such as gas and petrochemicals, healthcare, information and communication technologies, water technologies, the environment and aircraft operations. QSTP also recently announced two venture-capital funds of $130 m to help commercialize local innovations, and the QNRF is providing public funding needed to support basic and applied research.

In accordance with its mission, the Qatar Foundation has embarked on an innovative and visionary set of initiatives to create lasting benefits for the country of Qatar and to increase the visibility of Qatar within the global community. A crucial component of these initiatives is the establishment of infrastructure aimed at improving the health and quality of life of the Qatari population. Weill Cornell Medical College in Qatar's charge includes a leadership role in the effort to address important biomedical research and healthcare needs in Qatar.

The main focus of Qatar Foundation' s mission is a partnership building approach which allows institutions in Qatar with similar objectives in medical education, research, public health and healthcare to come together: WCMC-Q and its US-based sister institution WCMC-NY, Hamad Medical Corporation (HMC), Sidra Medical and Research Center, QSTP, Supreme Council of Health (SCH), and QF the Qatar Foundation (Figure 1 ). Qatar's commitment to research is evident in many reports and comments of scientists from around the world [ 6 ].

WCMC-Q's Collaboration with Core Qatar Partner is Key to Advancing Translational Medicine in Qatar . Each component is a cog in the "central wheel", which represents the Translational Medicine enterprise in Qatar. WCMC-Q: Weill Cornell Medical College in Qatar; HMC: Hamad Medical Corporation; SIDRA: a teaching hospital; Safallah: Special Learning and Research Center for children with disabilities; QSTP: Qatar Science and Technology Park.

Medical Education

WCMC-Q, a branch campus of Weill Cornell Medical College in New York (NY), is the unique medical school in Qatar. It is located in Doha, Qatar, about 11,000 KM distant from its parent campus in New York. WCMC-Q is housed in Education City. WCMC-Q awards the same MD degree as the main campus in New York.

This institution, its students, faculty, educational, clinical and research resources, processes and traditions are in the early stages of development. WCMC-Q graduated its inaugural class in May 2008. Its students and faculty, as well its local affiliate Hamad Medical Corporation (HMC) faculty, are remarkably diverse in terms of their cultural, social and educational backgrounds.

WCMC-Q currently offers three separate educational programs: a) two year premedical program, b) four year medical (MD) program and c) one-year foundation program (primarily aimed at Qatari students), which provides intensive training to high school graduates in science, math and English to better prepare them for the pre-medical program.

WCMC-Q medical student demographics and interests

Tables 1 and 2 show the demographics of the current student body (Foundation, Pre-medical and Medical Programs), which are composed of students from 36 different countries with Qatari nationals constituting 18% of the student body. The male and female percentage distribution of students is about 54 and 46 respectively.

Table 3 displays the numbers of graduating students in years 2008, 2009 and 2010, and those who conducted research under supervision of at least 8 weeks in duration during their four years of medical education training at WCMC-Q. The table also shows the numbers of students who engaged in local/global public and other volunteer activities. It is noteworthy that 53 to 100% of graduating students engaged in research under supervision. As is evident from the table there is also an increasing student interest in global health activities. Our students have traveled to India, Nepal, Tanzania and Haiti to gain this type of experience.

WCMC-Q education programs

Pre medical education.

The Pre medical education program at WCMC-Q is a flexible two or three-year program to which students are admitted following their high school education. Most students take the two-year option with condensed mathematics and sciences courses. For those students coming from a disadvantaged high school background or in need of development in their English skills, a one-year Foundation Program has been added before the premedical program. The Foundation Program offers pre-college courses in the sciences and an English as a Second Language (ESL) course, along with a focus on developing study skills and professionalism. This is quite different from the typical situation in the US, where, barring very few exceptions, all students entering a medical school have completed a four-year undergraduate degree.

The Premedical Program at WCMC-Q offers a range of courses chosen to meet WCMC Q admission requirements and to offer breadth of education. While most of the courses focus on mathematics, physics, chemistry, and biology, an effort has been made to offer humanities and social science courses such as psychology and medical ethics. While such a curriculum may appear rigid and too heavily science-oriented, it allows for a solid and integrated learning experience. There is a close and continuous interaction among the faculty delivering the courses, and the students have the opportunity to better appreciate the unifying themes and concepts lying behind the nominally distinct sciences.

Additionally, premedical students have the opportunity to participate in research projects under the guidance of premedical, medical, and research faculty. The Premedical Program has been very successful in producing student capable to enter the Medical Program and to perform at the high level there required.

Medical program

WCMC-Q and NY use the same curriculum and learning objectives. The curriculum, which integrates basic with clinical sciences, is progressive, challenging and rigorous. It engages students in active learning, self-directed inquiry, and small group discussions. These methods are integrated with seminars and lectures provided by faculty from WCMC-Q, NY, and Hamad Medical Corporation (HMC), an affiliate of WCMC-Q.

The medical curriculum is designed to provide students a series of integrated, interactive courses. The first and second year basic science curriculum consists of five courses and an introduction to clinical skills. These courses are - Molecules Genes & Cells, Human Structure & Function, Host Defenses, Brain and Mind, and Basis of Disease. There are two additional clinical based courses, Medicine Patients & Society I and II, which the students must complete before beginning their clinical experience in the third year. The third and fourth year clinical curriculum requires completing several required core clinical clerkships and electives, and one course, Advanced Basic Science. The students complete their core clerkships in medicine, primary care, neurology, obstetrics and gynecology, pediatrics, psychiatry, and general surgery at HMC affiliates in Qatar. Additionally, almost all the students spend approximately 12 weeks at New York Cornell Presbyterian - Cornell and affiliated hospitals where they complete sub-internships and electives. The clerkship sites in Qatar, developed in collaboration with HMC, include Hamad General Hospital (in-patient, ER and outpatient clinics), Women's Hospital, Shafallah Center, Primary Health Centers (PHC) and other local hospitals and centers. Students also complete a two-week required clerkship in public health and another short course, Medicine, Patients and Society III aimed at promoting humanistic practice. The public health course encourages working in teams and building partnerships, which promote coordination of written and oral communication skills. These skills are vital to public health professionals and researchers.

WCMC- Q's program prepares its students exceptionally well. This is reflected in their performance on the standardized test, namely the United States Medical Licensing Examination (USMLE), which is a three-part examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Here we report on the performance of the students who took the USMLE Step 1 and II examinations for the first time in the period 2006 - 10. As can be seen from the Table 4 the USMLE I passing rate of WCMC-Q students is 86% as compared to 93% for the US students. This difference is not statistically significant. Table 5 shows the USMLE II passing rate for both the US and WCMC-Q students is 96%.

WCMC-Q gradating class of 2010 demonstrated the high quality of their education by being able to successfully compete and secure residency spots in their fields of interest at excellent institutions in the US (See Table 6 ). Out of 17 graduating students, 11 (65%) are pursuing postgraduate residency training in the US. Four (23%) have decided to take research fellowships at US institutions and the remaining two (12%) have opted for postgraduate education at HMC. These results reflect very positively on the quality of the WCMC-Q program leading to the M.D. degree.

Research is growing at WCMC-Q and will provide many opportunities to our students in years ahead. While opportunities for off site student field placements are limited, our partnerships with government and health care institutions are beginning to produce positive results.

Public Health Agenda and Activities

WCMC-Q is committed to working with local public health and global partner institutions that will be most appropriate at this stage to advance most effectively the mission of WCMC-Q in education, research, and patient care, as well as population well being of people in the State of Qatar.

In this context WCMC- Q is embarking on the following public health agenda in the three areas of education, research and community related matters:

Education: to strengthen and augment existing educational activities; and develop and implement new programs. Examples of these include a) student exchange programs and b) courses and programs related to disciplines such as research methodology, public health, nanotechnology, nutrition, bio-informatics, and public health.

Research: to expand and increase collaborative global and local research initiatives especially on topics of public health importance such as obesity and motor vehicle accidents. We will increase public health research on projects of relevance to the local communities in Qatar. This will be done in close cooperation with the Department of Public Health, Supreme Council of Health (SCH), Qatar and other stakeholders.

Community and related matters: to enhance community, health awareness and patient care related services that support the needs of people in Qatar.

Biomedical and Translational Research

WCMC-Q's research program aims to a) build a self-sustaining core of top biomedical scientists by recruiting, retaining, and training top talents, and b) establish strong research programs in Qatar which target important public health problems and healthcare issues. WCMC-Q research program is consistent with the State of Qatar's strategy on education, research, community development and health care (Figure 2 ).

The growing collaborative Biomedical Research Program in Qatar .

WCMC-Q has made excellent progress in establishing a world-class research enterprise located in Qatar conducting cutting-edge biomedical research. This enterprise is attracting, retaining and developing research talent. The College's project is work in progress. It will contribute to the ground-breaking scientific ideas and allow for appropriate commercialization of research findings with QSTP. The creation of such an enterprise is a long-term endeavor that faces many challenges, examples of which include: 1) the challenge faced by translational medicine, which is the difficulty in truly being a trans-disciplinary science that brings together researchers and practitioners that traditionally work within their own "silos" of practice [ 7 ], 2) the creation of sustainable research infrastructure, 3) building a strong research community, 4) recruiting and retaining top-notch faculty and researchers, and 5) lack of recognition of Qatar as a core member of the global research community. Despite these challenges Qatar has made considerable progress and initiated many projects, which will lay solid foundation for effective clinical and preventing strategies in combating NCDs. These strategies will not only reduce the incidence of these diseases but also reduce pain and alleviate suffering associated with them. An outline of QF's and WCMC's projects and other initiatives appears below.

Opportunities

There are many research opportunities available to the students and faculty at WCMC- Q. An example of such opportunities is the availability of research funds through the Qatar Foundation's Qatar National Priority Research Program (NPRP). This program funds meritorious proposals ranging from US$ 20,000 up to US$ 350,000 per year for a duration of one, two or three years. The program encourages local and international collaboration. More recently, QNRF launched a new program, called National Priorities Research Program - Exceptional Proposals (NPRP-EP). This new program seeks investigators with proposals of high merit, which require extra funds and more time for their completion. The program provides up to US $ 5 million per project for a maximum period of five years.

In continuing to nurture various opportunities, and develop and implement the translational research program, WCMC-Q will be guided by the following objectives:

Using bench-to -bedside research approach in addressing Qatar's major health problems such as diabetes, cancer, obesity and heart disease.

Building local research capacity by establishing sustainable training programs/courses for students and physicians.

Developing and nurturing viable, collaborative partnerships with local and international institutions to further enhance research-building capacity.

Establishing an Institute for Global and Public Health, which will engage in research that can positively influence public policy so as to address major health problems such as obesity and motor vehicular accidents.

Reflected in WCMC-Q objectives are several integrated translational medicine research proposals that have been developed and funded by Qatar Foundation's Qatar National Priority Research Program (NPRP). Others have been submitted for funding to the same agency. We present synopsis of three of such proposals.

1. Genomics and proteomics of breast cancer in Arab populations

The main goal of this project is to address key questions of the nature of genetic predisposition and protein biomarkers for certain types of breast cancer particularly frequent in Arab populations and to translate that to clinical management, including diagnosis, prevention and therapeutics. It aims to establish excellence in the Middle East/North Africa region in the cancer research field, which could be an instrument to tackle the fragmentation of cancer research in the Arab countries.

2. Public health and genomic aspects of obesity in Qatar

This multidisciplinary project aims to identify and understand the a) epidemiologic risk factors of obesity, b) the functions and interactions of macromolecules in cells and c) decipher the biological mechanisms of obesity among Qataris. The study findings will be used in developing novel strategies in the treatment and prevention of obesity in Qatar and other nations in the region.

3. Nanotechnologies and treatment of obesity

This project explores the significance of nanotechnological approach in the treatment of obesity. The results of this project will play a fundamental role in setting the stage for major programs in Nano-Medicine and Stem Cell-Based therapies and technologies in Qatar, as well as the translation of the scientific discoveries from such programs in predictive medicine for the prevention and treatment of obesity and metabolic diseases.

We should comment on one other translational research development. Given the high prevalence of diabetes and obesity in Qatar, WCMC-Q is establishing new Diabetes, Obesity and Metabolic Syndrome centre (DOMS). The DOMS Center's ultimate vision is to create a solid infrastructure, which supports the growth of collaborative and multidisciplinary research initiatives in Qatar. The Center's state of the art facilities dealing with genomics, proteomics, imaging, and computational and health quantitative sciences will be available to the scientists for their research projects. The Center will also develop educational and training programs, and partner with Supreme Council of Health on topics of public health importance to the country and the region.

The above multidisciplinary projects with national and global partners have investigators from different backgrounds. The research findings from these projects have the potential of significantly improving the treatment, management, and prevention of commonly occurring non-communicable diseases such as diabetes, cancer and obesity. The findings will also help in the development and implementation of population based health promotion programs.

Promising collaborative multidisciplinary translational research as illustrated in this review is an encouraging development in Qatar and its neighboring GCC nations by extension. WCMC-Q's interwoven education, research and public health based framework provides a robust platform for translational medicine research programs. This approach is yielding positive results. Discoveries from this program should influence public policy in a positive way. Our approach encourages local and global collaboration and partnership with investigators and research institutions from around the world. Our research initiatives have sparked optimism among public health officials, clinicians, and researchers to fully seize the new opportunities in reducing premature mortality and morbidity associated with NCDs such as diabetes, cancer, heart disease and obesity. We feel many studies that are under way in Qatar will provide promising prevention strategies and life saving treatments for the people in the State of Qatar and its neighboring nations.

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Acknowledgements

We thank Donney Moroney, MA Director of Student Affairs and Counseling in compiling student data information.

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Lotfi Chouchane, Ravinder Mamtani, Marco Ameduri & Javaid I Sheikh

Supreme Council of Health, P.O. Box 42, Doha, Qatar

Mohammed H Al-Thani & Al-Anoud M Al-Thani

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Authors' contributions

LC and RM conceived the manuscript and its design; provided detailed ideas and discussions, and contributed to the manuscript writing on the introduction, medical education program, and challenges and opportunities sections of the article. LC contributed to manuscript writing of the research environment in Qatar. RM contributed to the manuscript writing of the public health and student data components of the article. MA conceptualized and wrote the premedical education component of the manuscript. MHA and AMA - provided ideas and discussions on the history of Qatar, Qatar Foundation and the opportunities section of the article. JIS made intellectual contributions; participated actively in revising the final draft of the manuscript and contributed in figures. All authors read and approved the final manuscript.

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Chouchane, L., Mamtani, R., Al-Thani, M.H. et al. Medical education and research environment in Qatar: a new epoch for translational research in the Middle East. J Transl Med 9 , 16 (2011). https://doi.org/10.1186/1479-5876-9-16

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DOI : https://doi.org/10.1186/1479-5876-9-16

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• v.8; 2017 Dec

Perceptions and attitudes to clinical research participation in Qatar

a Department of Medicine and Clinical Research Core, Weill Cornell Medicine in Qatar, Qatar Foundation-Education City, Doha, Qatar

Sopna M. Choudhury

Sahar agouba, lina h.m. ahmed, odette chagoury, shahrad taheri.

b Department of Medicine, Weill Cornell Medicine in New York, New York, USA

Associated Data

Recruitment into clinical research studies is a major challenge. This study was carried out to explore the perceptions and attitudes towards clinical research participation among the general public in Qatar. A population based questionnaire study was carried out at public events held in Qatar. Residents of Qatar, 18 years or above in age were surveyed, anonymously, following verbal consent. Descriptive and multivariate analyses were conducted. We administered 2517 questionnaires to examine clinical research participation, of which 2379 complete forms were analyzed. Those who had previously been approached to participate in research completed a more detailed assessment. Data showed that only 5.7% participants (n = 134) had previously been approached to participate in a clinical research study. Of these 63.4% (n = 85) had agreed to participate while 36.6% (n = 49) had declined. The main reasons for declining participation included: time constraint (47.8%, n = 11), ‘fear’ (13.0%, n = 3), lack of awareness about clinical research (8.7%, n = 2) and lack of interest (8.7%, n = 2). ‘To help others’ (31.8%, n = 27) and ‘thought it might improve my access to health care’ (24.7%, n = 21) were the prime motivators for participation. There was a general agreement among participants that their previous research experience was associated with positive outcomes for self and others, that the research conduct was ethical, and that opportunities for participation will be welcomed in future. More than ten years of stay within Qatar was a statistically significant determinant of willingness to participate, adjusted odds ratio 5.82 (95% CI 1.93–17.55), p = 0.002. Clinical research participation in Qatar needs improvement. Time constraints, lack of trust in and poor awareness about clinical research are main barriers to participation. Altruism, and improved health access are reported as prime motivators. Deeper insight in to the factors affecting clinical research participation is needed to devise evidence based policies for improvement in recruitment strategies.

1. Introduction

Recruitment into clinical research studies is a major continuing challenge [1] . The general public and patients are still not fully aware of the importance of participation in clinical research studies for the development and implementation of medical advances [2] . Not all clinical research studies meet their recruitment targets, and as few as 6% of eligible subjects may participate in a clinical research trial [3] , [4] .

Insufficient recruitment into research studies has significant implications [3] . Clinically important findings may be missed due to statistical non-significance, preventing or causing delays in demonstrating the value of interventions in clinical practice [2] . Many clinical research trials are abandoned or produce equivocal results due to recruitment difficulties. This leads to loss of return on the resources expended in designing, developing, setting up, and conducting a clinical research trial as well as implications for the reputation of study investigators and institutions associated with an unsuccessful study [2] , [4] .

The Middle East and North Africa (MENA) region is undergoing rapid development and population expansion. This has been accompanied by an increasing prevalence of both acute and chronic medical disorders. In particular, there is an alarming increase in the prevalence of obesity and type 2 diabetes mellitus, particularly in countries that are part of the Gulf Cooperation Council (GCC). To tackle the region's health challenges, there is an urgent need for clinical research studies, and in particular, randomized controlled trials. Clinical trial participant density in the MENA region is less than 1%, suggesting that a sizable population has not yet been engaged in clinical research [5] . Clinical research remains under-developed in the MENA region. Despite growing investment supported by the wealth of the region, clinical research in the MENA region accounts for 0.5% of the total global clinical trial sites compared to 66% in North America and Western Europe [6] .

While there are structural and demographic challenges for the successful conduct of clinical research in the MENA region, little is known about perceptions of clinical research by potential participants. Surveys of attitudes to research participation in the MENA region have been limited [7] . To improve the success of clinical research studies, it is necessary to identify and explore the factors involved in low study enrollment and the public's perceptions towards research [2] . The aim of our study was to determine the perceptions towards clinical research in Qatar, a GCC country, where there is an increasing need to determine effective approaches to key medical disorders through the conduct of successful clinical research studies.

A questionnaire survey was conducted at two major public events held in Doha in Qatar between December 2014 and February 2015. National events are well attended in Qatar. The events for data collection marked Qatar's National Day and Qatar's National Sports Day, respectively. Both events attract large numbers of people from all backgrounds, therefore closely representing Qatar's multicultural population. Of the 2.3 million population in Qatar, the indigenous Qataris make up between 10 and 15% [8] [9] , while the rest are expatriates. The proportion of Qataris in our study was 10.5% while remainder were expatriates.

The survey was conducted to explore the existing attitudes and behaviors prevalent among the population in Qatar. All visitors who came to a health awareness booth and who were able to speak, read and understand Arabic or English were approached about completing an anonymous survey and consented verbally by majority female clinical research coordinators. A semi structured questionnaire, available in English and Arabic, was then completed with residents of Qatar who were 18 years or above in age. Those who had previously participated in research studies were asked to rate a set of 23 pre-defined statements relating to their research experience on a Likert Scale ranging between Strongly Disagree to Strongly Agree. Tourists and visitors were excluded. The anonymous survey was approved and given exempt status by the Joint Institutional Review Board (JIRB) of Weill Cornell Medicine - Qatar and Hamad Medical Corporation (Doha, Qatar).

2.1. Statistical analysis

Completed surveys were analyzed on SPSS version 23. Descriptive analyses were conducted along with univariate and multivariate analyses to explore the relationships amongst different variables and willingness to participate in clinical research. Univariate analysis was performed by using Pearson's Chi Square tests and multivariate analysis using logistic regression. All potential confounding variables (gender, age, BMI, length of stay, education level, employment and comorbidity) were included in the final multivariate logistic regression model. Multicollinearity was assessed by performing bivariate linear regression between the variables and calculating the variance inflation factor (VIF). A VIF of <2.5 was deemed to indicate no evidence of multicollinearity [10] . A two sided P value of <0.05 was considered to be statistically significant. Participants were divided into three categories based upon their country or region of origin: Qataris (Q), Non-Qatari Arabs (NQA) and Non-Arabs (NA).

A total of 2517 adults were surveyed with 2379 valid responses. Invalid surveys included those from ineligible participants (visitors or less than 18 years old individuals) or insufficient data (missing all or 90% or more of the responses to the survey). Approached subjects were approximately equally distributed by gender (females, 46%), and were employed (70%), living in Qatar ≤10 years, and had a good level of education (72% with college education and above) ( Table 1 ). The majority of the surveyed population had never been approached or invited to participate in a clinical research study. These did not vary by length of stay (88.5% length of stay ≤10 years, 89.1% length of stay >10 years). Of the 5.6% participants (n = 134) who had previously been approached to participate in clinical research, 63.4% (n = 85) had agreed to participate while 36.6% (n = 49) had declined. Data for this question was missing for the remaining 5.6% (n = 132) surveyed.

Demographic characteristics of surveyed population with valid responses (n = 2379).

3.1. Participants in clinical research

Among those who had previously participated in a clinical research study, 48.8% were Non-Arab nationalities (n = 41), 41.7% were Non-Qatari Arabs (n = 35) and 9.5% were Qatari participants (n = 8).

There were no significant differences observed in the demographic characteristics of the three groups. However, while the majority of Qatari participants were between 25 and 34 years of age, the Non-Qatari Arabs and Non-Arab participants were mostly in the age group between 35 and 44 years, with the majority having resided in Qatar for ten years or less. The majority of participants in all three groups were well-educated with four years of college or above education and employed at the time of the survey.

In those who had participated in research, male participants (60.2%, n = 50) outnumbered female participants (39.8% n = 33). The majority of participants were between 25 and 44 years of age (69.4%, n = 59) with a little over half having resided in Qatar for less than or equal to ten years. Participants in this group displayed high levels of education with approximately two thirds having attained a college degree or above. A similar proportion were employed at the time of survey. No participant in this cohort had received less than elementary education ( Table 2 ).

Comparison of demographic characteristics of surveyed population who had agreed to participate in clinical research with those who did not participate in clinical research.

Those who had lived in Qatar for over ten years were more likely to have participated in research than those who had lived for ten years or under. This was statistically significant in both the univariate (p = 0.004) and multivariate (p = 0.002) analyses ( Table 3 ). Those who resided in Qatar for more than ten years were almost 6 times more likely to have participated in a clinical study, adjusted odds ratio 5.82 (95% CI 1.93–17.55).

Multivariate analysis of factors associated with participation in clinical research.

Participants had mostly participated in studies about diabetes (37%) and heart disease (7.4%), which are common health problems in Qatar. Simple data collection methods such as questionnaires (n = 39), demographic data (n = 37), physical examination (n = 36), biological sample collection (n = 32) and interviews (n = 29) were most abundantly used while clinical trials followed in fewer numbers (n = 13; Fig. 1 ).

Data collection methods used in studies that respondents participated in.

Participants were asked to rate their reasons for participation in clinical research on a scale of 1–3, where 1 was ‘the most important’, 2 was ‘second most important’ and 3 was ‘third most important’ factor ( Fig. 2 ). Based on the responses; ‘to help others’ was the most important driving factor in research participation. The next most important motivators were ‘thought it might improve my access to healthcare’ (n = 21) and ‘to help myself’ (n = 21). Financial factors, ‘for the money’, were mostly considered as least important.

Motivators for participation rated on a scale 1 to 3.

Fig. 3 shows responses regarding previous research participation. Participants showed high levels of agreement to statements that implied that their research experience was associated with positive outcomes for self and others (A, D, E, G, H, K, M, O), research conduct was ethical (I, L, Q, U, W), and opportunities for participation were and would be welcome (B, N, V). There was either no or little disagreement to these statements. Statements that gathered significant disagreement included those that indicated that research had strong emotional repercussions (C, E, J) and that the research procedures were ‘too long’, ‘boring’ or ‘inconvenient’ (R, S, T).

Respondents' agreement and disagreement on statements related to participation in clinical research.

A I gained something positive from participating.

B Knowing what I know now, I would participate in clinical research if given the opportunity.

C The research raised emotional issues for me that I had not expected.

D I gained insight about my experiences through research participation.

E The research made me think about things I didn't want to think about.

F I found the questions too personal.

G I found participating in the clinical research personally meaningful.

H I believe the clinical research results will be useful to others.

I I trusted that my replies would be kept private.

J I experienced intense emotions during the research session and/or parts of the study.

K I think clinical research is for a good cause.

L I was treated with respect and dignity when I participated in clinical research.

M I found participating in clinical research beneficial to me.

N I was glad to be asked to participate.

O I like the idea that I contributed to science.

P I was emotional during the research session.

Q I felt I could stop participating at any time.

R I found participating boring.

S The study procedures took too long.

T Participating in clinical research was inconvenient for me.

U Participation was a choice I freely made

V Had I known in advance what participating would be like I still would have agreed to participate.

W I understood the consent form.

3.2. Declined participation in research

Of those who had declined consent to participate in research, 46.9% (n = 23) reported reasons for their decision. Time constraint (47.8%, n = 11) was the most prevalent reason for refusing participation followed by ‘fear’ (13.0%, n = 3), lack of awareness about clinical research (8.7%, n = 2), and lack of interest in research (8.7%, n = 2). Few stand-alone comments were classified as ‘others’ (21.7%, n = 5; Fig. 4 ). Of those who declined, 8.3% (n = 4) were Qataris, 52.1% (n = 25) were Non-Qatari Arabs and 39.6% (n = 19) were Non-Arab nationalities.

Reasons for declining consent to participate in clinical research.

Other reasons include:

1. ‘Because they (are not) raising awareness about these researches and the result is unknown’

2. ‘For personal reasons/I feel my rights aren't protected and I don't trust the research conductor’

3. ‘It depends on the type of participation’

4. ‘I didn't think about that’

5. ‘Recruitment team didn't call back when he expressed interest’.

4. Discussion

This was the first public survey of clinical research participation taking place in Qatar, and among the handful conducted in the Gulf Cooperation Council (GCC). The survey aimed to identify levels of research participation and to assess existing attitudes regarding clinical research participation in Qatar amongst those who had been approached to participate in research. There is an increasing need for clinical research studies in Qatar, making it essential to gain insight about the thoughts, beliefs and concerns of people regarding clinical research [11] , [12] . Due to the common origin and similar socio-demographics of GCC countries, the findings may be generalizable for a region that is set on the path of developing novel interventions and clinical services.

Our survey demonstrated that, among participants who had been approached to participate in research, those who participated previously in research outnumbered those who had declined. Although comparable findings can be found in other studies from the GCC [13] , [14] the present levels of participation need improvement. Killawi et al. observed that more often than not, their participants would return for the research interview after finishing with their doctor's appointment, especially if they had to see the doctor while in the middle of their interview [13] .

There is a significant pool of potential subjects who are not approached for participation in clinical research. According to Gilliss and colleagues, since most recruitment is carried out in hospitals or clinical settings, the larger population becomes excluded from the recruitment process altogether [15] . This gap is rarely explored in the literature and therefore requires an in-depth insight to modify present recruitment strategies. Outreach strategies need to be devised for recruitment from this untapped, potentially eligible, population.

Our survey results show relatively consistent demographic findings for both ‘participated’ and ‘non-participated’ groups. Both groups comprised a majority of young to middle aged, well educated, employed individuals who work less than or equal to forty hours per week and have lived in Qatar for less than or equal to ten years. Males outnumbered females in both the groups. The difference, however, was less in the group that declined participation.

Existing research literature shows contrasting evidence about women's participation in clinical research. While there are studies that show increased likelihood of women to participate in research [16] , [17] some conclude that they are underrepresented [18] . Some well recognized limiting factors identified in research literature include childcare, poverty and transport. There are certain patriarchal cultures in which women are either not fully empowered to take decisions independently [19] requiring consultation with family members before committing to a research study [13] . The participation of women in clinical research is generally encouraged [18] ; however, none of the female participants in our survey reported any of the above reasons for non-participation. In fact, their reasons to decline or accept participation were similar to those reported by the male participants. This may be because of the affluence and greater family support in the GCC, where childcare, poverty, and lack of transportation are lesser issues.

4.1. Barriers to research participation

Time constraint was the most frequently cited reason for refusal to participate in clinical research followed by fear, lack of awareness and lack of interest. This was reported significantly by the expatriate population, especially in the Non-Arab group, as an overriding barrier to research participation. This is compatible with findings both in local and international literature [15] , [16] . It is difficult for expatriates and ethnic minorities to attend somewhat lengthy and frequent study appointments as they often work long hours or over time, which may incur financial loss as well as job insecurity, leading to refusal to participate [14] , [15] .

While time has widely been reported as one of the prime barriers in participation in clinical research, ‘fear’, ‘mistrust’ and ‘misconceptions’ have been more thoroughly explored in the literature [7] , [13] , [14] , [15] , [16] , [20] , [21] . Our survey showed that among those who reported ‘fear’ and ‘mistrust’ as a reason for refusal to participate belonged mostly to Qatari and other Arab nationalities. Greater engagement between clinical researchers and the public can address some of the issues highlighted.

Fear was reported by at least three out of twenty-five participants from the Non-Qatari Arab group. While two plainly reported being just ‘afraid’ of participation, one described it as ‘fear of taking medications and their side effects’. Although the numbers of these participants is not large in our survey, this fear echoes notably in the literature where potential subjects have raised concerns about being treated as a ‘guinea pig’ or receiving ineffective treatment or placebo [20] .

While current evidence shows that these barriers resonate primarily from marginalized or underserved minority ethnic groups [13] , [15] , [16] , it is intriguing that these sentiments are raised by the local population and people who speak the native language, as well as share ethnic origins. Such misconceptions and more were also observed by a study conducted in Saudi Arabia while assessing awareness about clinical research trials among cancer patients and their families [14] . The study revealed misconceptions like ‘no clinical trials were conducted in the Arab world’ or that they were not performed under ‘regulatory authority supervision’ and ‘without the subject's consent.’

Fear and mistrust within the Arabic speaking participants may stem from a general ‘lack of awareness’ about clinical research, which is a fairly new, yet emerging phenomenon in this region. The ‘lack of awareness’ appeared to be unrelated to education as all the Arabic speaking participants of our survey (Qataris and Non-Qataris alike) had an above secondary level education with majority having completed four years of college.

The few primary studies from the Arab region have identified a lack of awareness or lack of familiarity with research as a leading cause of non-participation and declined consent [13] , [14] . An absence of a research culture at large may be a key factor in discouraging participation in research [16] . While our survey results hinted at the ‘lack of knowledge’ about clinical research in responses e.g. fear and mistrust, there were at least two occasions where the participants (one Qatari and the other a Non-Arab) categorically admitted ‘lack of awareness’ verbatim.

Although none of the Non-Arab participants reported either fear or mistrust in our survey, there has been reference to insecurity in this group, especially among the Hindi speaking population, in work by Killawi et al. [13] where they observed vulnerability fears and concerns over negative repercussions to any (perceivably) undesirable responses. They were also hesitant upon sharing private information.

It was also observed that majority of the research participation refusals came from the Arabic-speaking participants in our survey. This finding is compatible with the empirical work done by Killawi et al. on recruitment and clinical research conduct in Qatar [13] . However, a study of similar nature done in Kuwait, a neighboring GCC country, showed a different trend where South Asians were the largest group to decline consent followed by Arabs and South-East Asians [16] .

4.2. Motivators for research participation

According to our survey, altruism followed by personal and monetary benefits were the most frequently reported motivating factor in research participation across all nationalities. These findings compliment evidence found in previous literature [20] , [21] , [22] . Altruism has moral and ethical roots and may impart a sense of fulfillment or usefulness to the participants [22] . Improved access to health care or free lab investigations is a widely-reported facilitator to clinical research participation, especially for subjects who already have a certain disease or condition or have to pay for these services [15] , [16] , [20] , [22] , [23] .

While monetary incentives are supported in international literature as effective facilitators in research participation [24] , a local study [13] and our findings show contrasting trends where reimbursements or financial benefits were usually turned down. Monetary or financial benefits were generally considered to be least important by our participants. Both the Qatari and other Arab nationalities considered monetary incentives as the least important factor in participation. One third of the Non-Arab participants ranked it as the most important factor, while the remaining thought of it as the least important.

The length of stay in Qatar was a statistically significant predictor of research participation in our survey results. Those who had lived in Qatar for more than ten years (regardless of their region of origin) were almost six times more likely to participate in a research study. There were similar numbers of Arabic (n = 18) and non-Arabic (n = 14) speaking participants who had lived in Qatar for more than ten years and participated in a clinical study. There is sparse evidence in existing literature about the possible association between duration of stay and willingness to participate. It may be postulated that those who have stayed for ten years or longer are socially and economically more established, have less at stake, and therefore feel reasonably more confident while agreeing to participate in research. The greater length of stay may also allow greater exposure to ongoing research studies.

Maximum participation was seen among the South East Asian nationalities followed by other Arab and Qatari population. This trend is commensurate with findings by Tariq et al., whereby South-East Asians were the least likely to decline participation [16] .

Prior experience with participation in a medical research study is a recognized determinant of willingness to participate [1] . Our study confirms this as majority of participants who agreed that their previous research experience had positive outcomes and was ethically conducted, showed strong inclination to the prospect of future research participation, if approached.

The participants in our survey did not find the research they had participated in as lengthy and tedious, or emotionally challenging. This may be correlated to the relatively simple research designs that the participants had participated in e.g. surveys, interviews etc. with very few having enrolled in more complex clinical research trials. There is evidence that the more complex the research procedures are (e.g. long consenting procedures and consent forms, more frequent visits, and changes in care), and despite potentially greater benefits, the more people choose to decline as it is ‘easier to say NO’ than to participate [25] .

4.3. Strengths and limitations

This study is the first large-scale population based study examining research participation in Qatar and the Gulf Cooperation Council region. However, more in-depth exploration is needed through qualitative work to further determine the drivers of research participation/refusal further. Missing data were also a limitation of this study. Participants refused responses to either parts or whole of survey sheet after showing initial interest. A sampling plan was not utilized. The respondents were those who attended specific health awareness booths resulting in potential selection bias. The study did not explore attitudes towards clinical research amongst those who had not been approached to participate in clinical research. However, given that research participation requires explanation, discussion, and contemplation, it is unclear whether responses from those who have not been approached to participate will be reflective of their views when they are approached for research. Future work should explore this in more detail.

5. Conclusion

The levels of clinical research participation in Qatar need improvement. Access to the public for recruitment is limited and a large section of population is not approached for research participation. Time constraint has been the most frequently reported barrier, while altruism has been the prime facilitator in clinical research enrollment. Culturally compatible recruitment strategies must be devised for the diverse population of Qatar that demonstrates multispectral factors for accepting or declining participation. While this survey provides a window into an otherwise sparsely explored area, more in-depth research is required to assess the prevalent attitudes and behaviors regarding clinical research in Qatar.

Conflict of interest

The authors declare no conflict of interest.

Author's contributions

ST conceived the study and its design. HT, SC, and OC oversaw the collection and analysis of the data and contributed to the manuscript. SA, LA and AA were responsible for data handling and data checking. OO contributed to data analysis. HT and SC drafted the manuscript. ST and OC contributed further to the manuscript. All authors contributed to the final work.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Funding statement

The study was funded by the Qatar Foundation through the Biomedical Research Program at Weill Cornell Medicine in Qatar. ST has received funding from the Qatar National Research Fund (grants: NPRP 8-912-3-192 and NPRP 4-1392-3-345). The funding agencies had no influence on the design, development, conduct, conclusions, and reporting of the study.

Acknowledgements

The authors would like to thank all the colleagues at Clinical Research Core at Weill Cornell Medicine in Qatar for collecting and entering the survey data. We are grateful to Ms. Nouf Al Kuwari and Mr. Saif Hayek for their valuable input during data cleaning and checking.

Appendix A Supplementary data related to this article can be found at https://doi.org/10.1016/j.conctc.2017.10.010 .

Appendix A. Supplementary data

The following is the supplementary data related to this article:

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US Agrees to Delay Senator Bob Menendez's Corruption Trial Over Wife's Health

US Agrees to Delay Senator Bob Menendez's Corruption Trial Over Wife's Health

FILE PHOTO: U.S. Senator Bob Menendez (D-NJ) attends a Senate Finance Committee hearing on the 2025 budget on Capitol Hill in Washington, D.C., U.S., March 21, 2024. REUTERS/Elizabeth Frantz/File Photo

By Jonathan Stempel

NEW YORK (Reuters) - U.S. prosecutors asked a federal judge on Wednesday to delay the corruption trial of New Jersey Senator Bob Menendez and his wife by at least two months, after lawyers for Nadine Menendez said she faced a serious medical condition that required surgery.

In a letter to U.S. District Judge Sidney Stein in Manhattan, prosecutors asked that the May 6 trial date be pushed back to July or August, though they still oppose granting the Menendezes' requests to be tried separately.

Prosecutors said the government "takes seriously the unexpected medical development," and that an adjournment would let the Democratic senator focus on his wife's health. They opposed Nadine Menendez's request for an indefinite adjournment.

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Lawyers for the senator and his wife did not immediately respond to requests for comment.

Nadine Menendez has not disclosed her medical condition, but her lawyers said it would require surgery within four to six weeks and potentially significant follow-up treatment.

They also said that she would not be in a "physical or psychological condition" to participate in the currently scheduled trial, which is expected to last six weeks.

The couple and two other defendants have been charged in a wide-ranging bribery conspiracy, and have pleaded not guilty.

Prosecutors accused the senator of accepting cash, gold bars and a luxury car to wield his influence at home and on behalf of Egypt's and Qatar's governments. They also charged the Menendezes with obstruction of justice.

Senator Menendez was forced to give up his chairmanship of the Senate Foreign Relations Committee following his arrest last September, and has resisted many calls to resign.

He is up for re-election in November but chose not to run in New Jersey's Democratic primary, and instead hopes to run as an independent if he is exonerated.

Democrats and independents who caucus with them hold a 51-49 Senate majority. Several seats held by Democrats or independents may be closely contested in November's election, and a seat in West Virginia is widely expected to turn Republican.

(Reporting by Jonathan Stempel in New York; Editing by Peter Graff)

Copyright 2024 Thomson Reuters .

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Diabetes and Ramadan discussed at WCM-Q Grand Rounds

The latest installment of Weill Cornell Medicine-Qatar’s (WCM-Q) Grand Rounds Live Webinar Series discussed the practicality of people with type 2 diabetes fasting during the holy month of Ramadan.  

Aimed at physicians, nurses, dentists, pharmacists, allied health professionals, researchers, educators, and students, the webinar was designed to ensure that participants can estimate the risk of fasting in people with type 2 diabetes, understand the role of education, help manage diabetes, and examine the role of technology in managing diabetes during Ramadan.

The webinar was led by Dr. Mohamed Hassanein, professor of medicine at Mohammed Bin Rashid University of Medicine and Health Sciences and Gulf Medical University in the United Arab Emirates (UAE), who highlighted the prevalence of type 2 diabetes and the importance of keeping people aware of the condition in relation to Ramadan fasting.

Dr. Hassanein is also a senior consultant in endocrinology and diabetes at Dubai Hospital, the chair of the Diabetes and Ramadan International Alliance, and the associate editor of the Dubai Diabetes and Endocrinology Journal . He has co-authored multiple recommendation papers on diabetes and Ramadan, including the IDF-DAR Diabetes and Ramadan Practical Guidelines in 2016 and 2021.

Referencing the 2021 DAR Global Survey , the largest study of 15,902 people with type 2 diabetes, Dr. Hassanein said: “Fasting during Ramadan is associated with changes in blood glucose levels. The potential risks of fasting for people with type 2 diabetes include hypoglycemia, hyperglycemia, diabetic ketoacidosis, and dehydration & thrombosis. Many people with diabetes do not only come with a glycemic issue but frequently have a package of other complications like hypertension, hyperlipidemia, neuropathy, retinopathy, microalbuminuria, nephropathy/chronic kidney disease (CKD), macrovascular disease, and diabetic foot problems, so quantifying the exact risk of the person with diabetes is essential to avoid fasting-related complications.

To make fasting safer, Dr. Hassanein recommends assessing the risk of fasting, monitoring blood glucose levels, seeking fluids and dietary advice, following guidance on physical activity and exercise, adjusting medication, creating a better understanding of when to break the fast, and recognizing hypo and hyperglycemia symptoms.

Dr. Hassanein concluded by saying that although the majority of fasting people with type 2 diabetes experience no complications, a comprehensive pre-Ramadan assessment is essential. With just over 40% of people with type 2 diabetes not receiving any diabetes-related education, he points out the importance of a Ramadan-focused education and ensuring pre-Ramadan treatment adjustments to improve safety for those on insulin or sulphonylurea (SU).