Alshaali ABCM LRCPSI MBBCh BAO NUI Dubai Health Authority RISK ASSESSMENT FOR TYPE 2 DIABETES MELLITUS AND ITS DETERMINANTS AMONF ADUTLS ATTENDING PRIMARY HEALTH CARE CENTERS 2012 ID: 916121
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Slide1
Presented by:
Dr
Anood Alshaali (ABCM, LRCPSI, MBBCh, BAO (NUI))Dubai Health Authority
RISK ASSESSMENT FOR TYPE 2 DIABETES MELLITUS AND ITS DETERMINANTS AMONF ADUTLS ATTENDING PRIMARY HEALTH CARE CENTERS, 2012
Slide2INTRODUCTION
Slide3Diabetes mellitus is a major public health problem that is approaching epidemic level globally.
It is a debilitating disease which threatens individuals and community health. The increasing prevalence of diabetes mellitus, particularly type 2 diabetes mellitus, is well documented.
Slide4Slide5415
million people have diabetesBy 2040 this will rise to 642
million The global prevalence of diabetes is 9.1% By 2040, it will rise to 10 %
Slide6Type 2 diabetes mellitus is one of the most prevalent and costly chronic health conditions in the UAE.
Diabetes and its complications have a significant economic impact on the country resources due to its severe, long term debilitating effects on individuals, families and the society at large.
United Arab Emirates
Slide7The International Diabetes Federation (2015) estimated that, the prevalence of diabetes in UAE is
19.3%.
By 2020, it is estimated that, 32 % of the population may have diabetes or pre-diabetes.The Ministry of Health in the UAE also reported that, type 2 diabetes mellitus constitutes the fifth leading cause of death in the population.
Slide8The annual medical cost (2010)
$60 million (AED 220 million) for people who were at risk of developing T2DM.
$597 million (AED 2.2 billion) for those with diagnosed diabetesTHE COST OF TYPE 2 DIABETES MELLITUS
In comparison to the worldwide average expenditure, the mean health expenditure per person with diabetes in the UAE is estimated to be
double
.
Slide9Risk assessment is used to estimate the risk of an outcome for an individual as a function of their baseline characteristics.
Early identification of people who are at risk of developing type 2 diabetes mellitus is a pivotal step to initiative preventive measures, thus avoiding the morbidity and mortality associated with the disease and maximizing the cost effectiveness of services provided.
RISK ASSESSMENT FOR TYPE 2 DIABETES MELLITUS
Slide10Slide11Country
Risk to develop T2DM(%)United State
35.0Australia16.4Libya32.3Lebanon45.0
Egypt54.0
Algeria
38.0
Jordan
39.0
Saudi Arabia
29.4
Slide12United Arab Emirates
The risk of developing type 2 diabetes mellitus is recognized as a public health concern.
MENA (2010) survey reported that, 42% of respondents in UAE were at risk of developing type 2 diabetes mellitus.Abu Dhabi, UAE study (2009 – 2010) showed that, 31% of participants were at increased risk for developing type 2 diabetes mellitus.
Slide1313
DETERMINANTS OF RISK FOR DEVELOPING T2DM
Socio-demographic factorsLife style factorsFamily history of diabetesHistory of elevated blood glucoseHistory of hypertensionKnowledge about diabetesRisk perception to diabetesObesity & central obesity
Slide1414
Measurements of risk for developing T2DM
Slide15Research protocols for estimating individuals’ future risk for developing type 2 diabetes mellitus have depended primarily on biochemical tests.
Such screening tool is invasive, costly and time consuming.
The American Diabetes Association recommends screening for type 2 diabetes mellitus by using the questionnaire to select high-risk individuals and therefore increasing the cost-effectiveness of testing undiagnosed individuals.
Slide16RATIONALE
Slide17Type 2 diabetes mellitus is highly prevalent in UAE.
Type 2 diabetes mellitus can remain asymptomatic for many years.The earlier detection of individuals at high risk for developing type 2 diabetes mellitus is a high priority for primary prevention.
Intervention studies have clearly shown that onset of type 2 diabetes mellitus could be prevented or delayed among high-risk individuals.Assessing the risk profile will be useful in planning for the prevention programmes.17
Slide18OBJECTIVES
Slide19To assess the level of risk for developing type 2 diabetes mellitus.
To identify the determinants of risk for developing type 2 diabetes such as personal characteristics, knowledge, perception and dietary habits. 19
Slide20SUBJECTS & METHODS
Slide21TARGET POPULATION:
Adult aged ≥ 18 years attending the primary health care centers.
EXCLUSION CRITERIA:
Patient diagnosed with diabetes
Pregnant women
STUDY SETTING & DESIGN:
A cross sectional study was carried out in all the primary health care centers affiliated to Dubai Health Authority.
Slide22Sample
size:
Sample size was calculated using the computer program EPI-INFO version “6.04”, using:estimated risk of developing type 2 diabetes mellitus 29.4%degree of precision 4%confidence level 95%
Sample size
515
Slide23Sample
procedure:
Stratified random SampleHealth region 1Health region 23 centersA systematic random sample was carried out for selection of participants3 centers
Slide24Data Collection plan
Questionnaire
interviewPersonal characteristicsKnowledge about diabetesRisk perception for diabetesDietary intakeFinnish diabetes risk scores
Slide25The FINDRISC is used in Finland as part of its national diabetes prevention program
.It is a validated well established method that does not require laboratory measurements.
The Finnish diabetes risk score (FINDRISC) was developed based on 10-year prospective data on the incidence of type 2 diabetes in a population-based cohort study.FINNISH DIABETES RISK SCORE (FINDRISC)
Slide26Slide27Slide28ETHICAL CONSIDERATION
Slide29Ethical procedure was followed according to the Research Ethics Committee approval in Dubai.
Written consents were obtained from the participants
.Confidentiality of the data was maintained throughout the study.
Slide30The collected data was coded and entered to Statistical Package of Social Science (SPSS) version “20" software program.
Frequency tables with number and percent for qualitative data. Descriptive statistics as mean and standard deviation for quantitative data.
Chi square test was used for categorical data. It was replaced by Monte Carlo Exact test in case of small cell frequencies.Logistic regression was used to delineate the predictors for risk of developing type 2 diabetes mellitus. P <0.05 was the cut off level of significance. 30STATISTICAL ANALYSIS
Slide31RESULTS
Slide32Descriptive Characteristics
Slide33AGE
33.55
10.67
Slide34Illiterate/ read & write5.4%
Primary / preparatory14.4%
Secondary41.0%University or higher39.2%SingleMarriedDivorced24.9%72.2%2.9%Educational level
Marital status
Slide3535
Distribution of participants attending the primary health care centers in Dubai, 2012 according to their knowledge level about diabetes.
Slide3636
Distribution of participants attending the primary health care centers in Dubai, 2012 according to their perception level of risk factors to type 2 diabetes mellitus.
Slide3737
Finnish Diabetes Risk Score (FINDRISC) items
Score (points)
No.
( n=515)
%
Age (years)
< 45
0
438
85.0
45-
2
48
9.3
55-
3
20
3.9
65+
4
9
1.8
Family history of diabetes mellitus
No
0
120
23.3
Yes, second degree
3
114
22.1
Yes, first degree
5
281
54.6
Physical activity ≥ 30minutes/day
Yes
0
146
28.3
No
2
369
71.7
Eat vegetable or fruit
Every day
0
344
66.8
Not every day
1
171
33.2
Usage of antihypertensive medication regularly
No
0
452
87.8
Yes
2
63
12.2
Distribution of participants attending the primary health care centers in Dubai, 2012 according to Finnish Diabetes Risk Score (FINDRISC) items.
Slide3838
Finnish Diabetes Risk Score (FINDRISC) items
Score (points)No.
( n=515)
%
History of high blood glucose
No
0
436
84.7
Yes
5
79
15.3
Body mass index
Lower than 25 kg/m
2
0
173
33.6
25-29.9 kg/m
2
1
150
29.1
30 kg/m
2
and above
3
192
37.3
Waist circumference (cm)
Female:
<80
0
85
26.8
80-88
3
72
22.7
>88
4
160
50.5
Male:
<94
0
76
38.4
94-102
3
46
23.2
>102
4
76
38.4
Continued
Slide3939
Distribution of participants attending the primary health care centers in Dubai, 2012 according to the level of risk of developing type 2 diabetes mellitus.
Slide40DETERMINANTS OF RISK
Slide41Distribution
of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and age.
p=0.000
Slide42Distribution
of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and sex.
p=0.041
Slide4343
p=0.030
Distribution of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and educational level.
Slide4444Distribution of participants attending the primary health care centers in Dubai, 2012 according to
level of risk of type 2 diabetes and family history of diabetes.
p=0.000
Slide45Distribution
of participants attending the primary health care centers in Dubai, 2012 according to
level of risk of type 2 diabetes and knowledge level.
Slide4646
p=0.024
Distribution of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and perception level to risk factors of T2DM.
Slide4747
Distribution of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and consumption of refine grains.
p=0.018
Slide4848
p=0.041
Distribution of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and consumption of fried foods.
Slide49Distribution
of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and consumption of fruit & vegetable.
p=0.017
Slide50Distribution
of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and physical activity.
p=0.000
Slide5151
p=0.000
Distribution of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and body mass index.
Slide5252
p=0.000
Distribution of participants attending the primary health care centers in Dubai, 2012 according to level of risk of type 2 diabetes and waist circumference.
Slide5353o Excluding participants with low/ slightly elevated risk to develop T2DM
Finnish
Diabetes Risk factors No. (n=221) o%High/ very high waist circumference
208 94.1
Positive family history of diabetes
199
90.0
Body mass index 25 kg/m
2
or higher
198
89.6
Physical activity < 30minutes /day
185
83.7
Not consuming fruits or vegetables on daily basis
83
37.6
Age 45 years or more
58
26.2
History of high blood glucose
57
25.8
Usage of antihypertensive medication regularly
35
15.8
Prevalence
of risk factors assessed in FINDRISC test among participants at moderate or high/ very high risk of developing type 2 diabetes mellitus within the next ten years.
Slide54Independent variable
B
P-
value
Adjusted
OR
95% C.I.
LL
UL
Age
®
<45years
2.324
0.000
10.22
4.54
23.02
Knowledge level
®
good
0.019
Fair
0.576
0.133
1.78
0.84
3.77
Poor
0.994
0.005
2.70
1.36
5.38
Perception level
®
high
0.024
Medium
0.514
0.166
1.67
0.81
3.47
Low
0.905
0.007
2.47
1.29
4.75
Eating refine grains
®
not daily basis
0.775
0.015
2.17
1.16
4.06
Eating fried
food
®
not daily basis
1.029
0.014
2.80
1.24
6.34
Family history
®
no
2.874
0.000
17.70
9.22
33.97
BMI
®
within normal range
2.016
0.000
7.51
3.61
15.64
Waist circumference
®
within normal range
2.817
0.000
16.73
7.29
38.36
Physical activity
®
≥ 30min/day
1.509
0.000
4.52
2.32
8.81
History of high blood glucose
®
no
2.316
0.000
10.13
4.21
24.36
54
Results of stepwise multiple logistic regressions of factors affecting the risk of developing type 2 diabetes within 10 years among participants attending the primary health care centers in Dubai, 2012
.
Slide55DISCUSSION
Slide56LIBYA STUDY 2009
32.3%
were found to be at moderate or at high/very high risk of developing diabetes within the next 10 years of life.
The most Prevalent Risk Factors:BMI >25 kg/m2
(96.99
%
)
Positive family history of diabetes
(93.02 %)
Physical activity <30 minutes/day
(79.85 %)
High waist circumference (66.67%)
Slide57CENTRAL SAUDI ARABIA STUDY 2010
29.4
% were found to be at moderate /high/very high risk to develop T2DM within 10 years
. More
than
95% of
the targeted group
were found to have :
BMI >25 kg/m2
(98.0%)
Positive
family history of diabetes
(96.6 %)
High/ very high waist circumference (96.0%)
Slide58CONCLUSION
Slide59The overall risk of developing type 2 diabetes mellitus was alarming.
More than forty percent of participants were at moderate, high and very high risk of developing type 2 diabetes mellitus within ten years.Three out of the top four prevalent risk factors are modifiable which strongly underpin the urgent need for interventions to prevent or delay type 2 diabetes mellitus among those at risk.
59
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Slide63THANK YOU