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210404P - EPIDEMIOLOGY OF DIABETES

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Presentation prepared by Professor Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics, King Fahad Medical City

 

OVERVIEW - 1:

  • Diabetes mellitus is defined with hyperglycemia as a central feature.
  • Two main forms of diabetes may be defined.: (a) Insulin dependent diabetes (IDDM) is the most serious form. (b) Non-insulin dependent diabetes (NIDDM) is found in both the obese and non-obese. 
  • IDDM is due to loss of islet cells of the pancreas.
  • The incidence of diabetes in increasing and it is feared that it may become an epidemic in some places.
  • The incidence of IDDM is lower than that of NIDDM.


OVERVIEW - 2: Risk factors and complications

  • The risk factors of IDDM are both genetic and environmental. Variation of incidence over time, by ethnicity, and among migrants suggest environmental factors.
  • NIDDM has both genetic and environmental factors. It is associated with lifestyle, physical inactivity, obesity, fat distribution, and poor nutrition.
  • The complications of diabetes are microvascular (retinopathy, nephropathy, and neuropathy) or macrovascular (atherosclerosis, myocardial infarction, angina pectoris, stroke, and aneurysms).


DIABETES: Prevention

  • Screening for diabetes is a preventive approach however interest in screening for diabetes has waned because many causes of minor glucose intolerance are not significant on follow-up.
  • Prevention of NIDDM depends on lifestyle changes in diet, exercise, smoking, and alcohol intake.
  • Control of blood sugar levels reduces both microvascular and macrovascular complications.


MINISTRY OF HEALTH - HEALTH SURVEY REPORT 2019: Diabetes

  • 8% of respondents reported being diagnosed with diabetes, with a coverage rate of 42%
  • Reported percentages among males and females are similar, and the likelihood of being treated for diabetes varies between males and females (38% for males and 46% for females).
  • The percentage of diabetes generally increases with age. Half of the population (51%) between 70 and 79 years have been diagnosed with diabetes, as compared to 2% in individuals between 15 and 29 years. 40% of individuals over the age of 80 have been diagnosed with diabetes.
  • Non-Saudi respondents have a lower percentage (5%) compared to Saudi respondents (9%).
  • The percentage receiving treatment was similar between Saudis (42%) and non-Saudis (41%).


DIABETES MELLITUS IN SAUDI ARABIA - 1:

Authors: Mohamed Abdulaziz Al Dawish, Asirvatham Alwin Robert, Rim Braham, Ayman Abdallah Al Hayek, Abdulghani Al Saeed, Rania Ahmed Ahmed, Fahad Sulaiman Al Sabaan.

Title: Diabetes Mellitus in Saudi Arabia: A Review of the Recent Literature.

Citation: Curr Diabetes Rev 2016;12(4):359-368.

  • The World Health Organization (WHO) has reported that Saudi Arabia ranks the second highest in the Middle East, and is seventh in the world for the rate of diabetes.
  • It is estimated that around 7 million of the population are diabetic and almost around 3 million have pre-diabetes.
  • Even more worrying perhaps, is the increasing pattern of diabetes noted in Saudi Arabia in the recent past. In fact, diabetes has approximately registered a ten-fold increase in the past three eras in Saudi Arabia.
  • Diabetes mellitus (DM) has been found to be related to high mortality, morbidity and vascular complications, accompanied by poor general health and lower quality of life.
  • In Saudi Arabia, DM is quickly reaching disturbing proportions and becoming a significant cause of medical complications and even death.
  • However, when compared with the developed countries, the research work conducted, focusing particularly on the incidence, prevalence and socio-demographic properties of DM is woefully inadequate.
  • The health burden due to DM in Saudi Arabia is predicted to rise to catastrophic levels, unless a wide-ranging epidemic control program is incorporated, with great emphasis laid on advocating a healthy diet, including exercise and active lifestyles, and weight control.
  • To properly manage DM in Saudi Arabia, a multidisciplinary approach is required.


CARDIOVASCULAR DISEASES IN PATIENTS WITH DIABETES:

Authors: Asirvatham Alwin Robert , Mohamed Abdulaziz Al Dawish    

Title: Cardiovascular Disease among Patients with Diabetes: The Current Scenario in Saudi Arabia

Citation: Curr Diabetes Rev 2021;17(2):180-185

  • One of the well-recognized conditions linked to diabetes mellitus (DM) is cardiovascular disease (CVD).
  • Those affected by DM face a greater risk for early onset of CVD. Although huge strides have been made in cardiovascular therapy and prevention, with striking results in decreasing diabetes-related coronary mortality in developed countries, the morbidity and mortality due to CVD continue to remain high among patients with diabetes.
  • While there is an increasing incidence of cardiovascular event survivors with DM across the world, the number of DM patients with higher cardiovascular risk is predicted to soar, presenting a massive challenge for health care systems globally, including Saudi Arabia.
  • A report of the Saudi Scientific Diabetes Society indicates that more than 50% of patients with DM die due to cardiovascular causes.
  • In fact, Saudi Arabia globally ranks among the top 10 countries in the prevalence of diabetes.
  • However, the incidence of CVD and its risk factors among patients with diabetes in Saudi Arabia have not yet been well documented.
  • This review aims to present an overview of CVD among patients with DM in Saudi Arabia, through a comprehensive review of currently available published literature.
  • The findings indicate that diabetes linked CVD burden in Saudi Arabia is expected to exponentially increase to a very high degree unless a wide-ranging epidemic control program is initiated.
  • The findings emphasize the need for maintenance of a healthy diet accompanied by exercise, an active lifestyle and weight control measures among the population.
  • It is essential that the health care system focus on raising awareness among the population, and implement appropriate measures for prevention, early detection and suitable management of CVD among patients with DM.


DIABETES TRENDS IN SAUDI ARABIA:

Authors: Asirvatham A Robert , Mohamed A Al Dawish 

Title: The Worrying Trend of Diabetes Mellitus in Saudi Arabia: An Urgent Call to Action

Citation: Curr Diabetes Rev 2020;16(3): 204-210.

  • From last few years, the pervasiveness of diabetes mellitus (DM), in Saudi Arabia, is growing at a frightening rate. Overall, one-fourth of the adult population is affected by DM, which is further predicted to rise to more than double by the year 2030.
  • The most alarming is possibly the escalation propensity of diabetes, in recent years, where a nearly ten-fold increase has been witnessed over the past thirty years in Saudi Arabia.
  • However, the number of research arbitrations on the prevalence and incidence of DM is woefully inadequate, as compared to developed countries.
  • Apart from this, most of the existing research data carried out in Saudi Arabia is cross-sectional, with small sample sizes, which most often involve only certain parts of the country.
  • The present scenario demands more multidimensional and multisectoral research to strengthen the evidence base and to accumulate greater knowledge as a basis for 

 

DIABETIC COMPLICATIONS:

Authors: Asirvatham Alwin Robert, Mohamed Abdulaziz Al Dawish 

Title: Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia

Citation: Diab Vasc Dis Res 2019 May;16(3): 227-235.

  • Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels.
  • Vascular complications cause majority of the morbidity, hospitalizations, and mortality of patients with diabetes mellitus.
  • Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed.
  • The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people.
  • The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030.
  • In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia.
  • However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia.