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Diabetes Research Initiatives in Sharjah, UAE Nabil Sulaiman [email protected] [email protected] Diabetes Supercourse, Alexandria 12 Jan 2009

Participants 347

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Diabetes Research Initiatives in Sharjah,

UAE Nabil Sulaiman

[email protected]

[email protected]

Diabetes Supercourse, Alexandria 12 Jan 2009

Sharjah Diabetes Study

Background Why the study Methods Preliminary results Conclusions Recommendations

Environmental and behavioral changes

New dietary habits (what and how we eat),

Lack of physical activity,

Overweight/ obesity, and

Stresses of urbanization and working condition will lead to further rise of CVD and diabetes, and their risk factors.

SummaryDiabetes is a major and complex health problem worldwide.

Prevalence in UAE (24% & IGT18%) is the 2nd highest in the world

Onset of the disease in the GCC is early in late 20s

With early Dx and appropriate Mgt diabetics can live better and longer

Sharjah Diabetes Study

N. Sulaiman, Dh. Al Badri, N. Sajwani, S. Saleh, D. Young

Self monitoringNoYes

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250

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Self monitoring

1 Nabil Sulaiman, 2Dhafir Al Badry, 2Najla Sajwany, 1Amal Hussein, 1Saba Saleh, 2Doris Young(1Department of Family and Community Medicine, University of Sharjah, 2 Ministry of Health UAE, 3Department of General Practice, University of Melbourne)

The study design is a cross sectional baseline survey of patients with diabetes attending Primary Medical Care Centers in Sharjah during 2007/08.

Data Collection1. Research Assistant attended diabetes mini clinics at Riffa and Asit

centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals:2. Patients were invited to participate 3. Patients were interviewed using structured questionnaires4. Their data were extracted from medical records5. Data cleaning and analysis was performed using SPSS

Background Diabetes is a major and complex health problem worldwide. Diabetes prevalence in UAE is the 2nd highest in the world, reaching

about 24% in UAE nationals. The prevalence of pre diabetes is reported to be about 18%. With early identification and appropriate management, people with

diabetes can live better and longer

This project was funded by the University of Sharjah. For information please contact Dr Nabil Sulaiman, HOD Family and Community Medicine, The University of Sharjah E-mail: [email protected] or [email protected]

AimTo improve diabetes management, control and quality of life of patients

with diabetes in UAE

Objectives1. Establish an electronic database for diabetic patients in Sharjah

2. Audit their medical records to identify gaps in management.

3. Pilot test known EB intervention to investigate their appropriateness to Sharjah

4. Determine barriers and facilitators to the implementation of the intervention

METHODOLOGY

Diabetes Control Indicators

body weight and waist circumference from medical records knowledge and attitudes towards healthy eating using physical

activity questionnaire and Biochemical indicators such as AbA1c and cholesterol, lipids,

blood glucose and urine test

MissingOthersUnknownDiet, tablets & InsulinDiet & InsulinDiet & TabletsInsulin onlyTablets onlyDiet onlyNone

Current Diabetes management method

PRELIMINARY RESULTS

Participants: 347 diabetic patients were interviewed and their medical records were cheeked

Gender: 65.4% (n= 227) females and 34.6% (n=120) males

Nationality: UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, others 10% including Palestine, Lebanon, Yemen, Iraq, Poland , Syria, Iran and Sudan.

Marital Status: 8.9% single, 87.9% married, divorced 1.4% and 1.4% widowed.

Consanguineous Marriage: 16.4% (n=57)

Occupation: : 47.3% housewife, 28.2% clerks, 6.3% students, 0.6%retired.

Family History: 23.1% (N=80) had a positive family history of diabetes.

Smoking: 3.2% (n=11) current smokers, 3.2% (n=11), ex-smokers, never smoked 93.1% (n=323).

Current Diabetes management method

OthersUnknownDiet, tablets &

Insulin

Diet & Insulin

Diet & Tablets

Insulin onlyTablets only

Diet onlyNone

Freq

uen

cy

200

150

100

50

0

Current Diabetes management method

Diabetes in familyNot sureNoYes

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200

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50

0

Diabetes in family

CONCLUSIONS

1. Diabetes Mellitus is common problem in primary medical centers in Sharjah.

2. There is gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.

3. Diabetes control in Sharjah measured by HbA1c could be improved compared with international guidelines.

4. Measures to improve control may include employing Diabetes Nurse Educators to assist doctors at the medical centers to train patients as well as CME courses for doctors working at the centers.

31.4%26.4%Diabetes complications%

9.4 ± 3.79.9 ± 4.3Fasting B Sugar (mmol/l)

27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes

31.4%26.4%Diabetes complications%

9.4 ± 3.79.9 ± 4.3Fasting B Sugar (mmol/l)

27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes

Current Diabetes management method

OthersUnknownDiet, tablets &

Insulin

Diet & Insulin

Diet & Tablets

Insulin onlyTablets only

Diet onlyNone

Freq

uen

cy

200

150

100

50

0

Current Diabetes management method

Diabetes in familyNot sureNoYes

Fre

qu

en

cy

250

200

150

100

50

0

Diabetes in family

Sharjah Diabetes Study

Aim

To improve diabetes management, control and quality of life of patients with diabetes in UAE

Sharjah Diabetes Study

Objectives

Identify gaps in diabetes management

Determine barriers and facilitators to implementation of known interventions

Pilot test known EB intervention in Sharjah

Study Design

Cross sectional baseline survey of patients with diabetes attending Primary Medical Centers in Sharjah during 2007/08.

Data Collection

Research Assistant attended diabetes mini clinics at Riffa and Wasit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals:Patients were invited to participate and interviewed using questionnairesTheir data were extracted from medical recordsData cleaning and analysis was performed using SPSS

Diabetes Control Indicators

Medical Records:Biochemical indicators such as HbA1c and cholesterol, lipids, blood glucose and urine testWeight and waist circumference

Patients questionnaire:Knowledge and attitudes healthy eating physical activity

Preliminary Results

Sample: 347 patients

Gender: 65.4% females

Mean age 53.2 (14.6)

BMI 29.8 (5.9)

Nationality

UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, Others: 10% (Palestine, Lebanon, Yemen,

Iraq, Syria, Iran and Sudan)

Diabetes in Families

Diabetes in familyNot sureNoYes

Fre

qu

ency

250

200

150

100

50

0

Diabetes in family

Marital StatusMarital Status 87.9% married 8.9% single 2.8 divorced/widowed

Consanguineous Marriage: 16.4% (n=57)

Gender difference

31.4%26.4%Diabetes complications%

9.4 ± 3.79.9 ± 4.3Fasting B Sugar (mmol/l)

27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes

31.4%26.4%Diabetes complications%

9.4 ± 3.79.9 ± 4.3Fasting B Sugar (mmol/l)

27.8 ± 5.330.9 ± 6.0BMI (kg/m*m)

8.5 ± 7.47.1 ± 4.9 Duration (mean)

Females

(N=227)

Males

(N=120)

Diabetes

HbA1c:

78% of patients has HbA1c (>7%) BP:

57% have high BP

Management Methods

Current Diabetes management method

OthersUnknownDiet, tablets &

Insulin

Diet & Insulin

Diet & Tablets

Insulin onlyTablets only

Diet onlyNone

Fre

qu

ency

200

150

100

50

0

Current Diabetes management method

Complications (83) 26 (Eye glaucoma, laser surgery)

74 (feet ulcer, loss of sensation)

2 (Kidney: protein urea or albumin urea)

4 (loss of toe/ foot)

6 (angina, heart attack)

Self monitoring

Self monitoringNoYes

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ency

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Self monitoring

Self Management

I can exercise several times a week (25% strongly agree)

I can not exercise unless I feel like exercising (28% strongly agree)

I can recognize when my blood sugar is too high (27% strongly agree)

Self Management

I can do what was recommended to prevent low blood sugar (24% SA)

I can figure out what self treatment when blood sugar gets high (29% SA)

I can fit my diabetes self treatment routine into my usual lifestyle (26% SA)

CONCLUSIONS

Diabetes Mellitus is common problem in primary medical centers in Sharjah.

High levels of obesity

Low physical activity

Gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.

Recommendations

Diabetes management in Sharjah could be improved compared with international guidelines

Measures to improve control: Diabetes Nurse Educators Patient’s self management education Peer-led or peer-support models CME for doctors at PHC centers

Thank You