Glucose intolerance and associated factors in the multi-ethnic population of the United Arab Emirates: results of a national survey

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Abstract

Aims:

To determine the prevalence of diabetes and impaired fasting glycaemia (IFG) and associated conditions such as obesity and hypertension, in the multi-ethnic, adult population of the United Arab Emirates in 1999–2000.

Methods:

A stratified, multistage, random sample was selected. Diagnosis was based on the latest recommendations of a WHO Expert Group.

Results:

The overall response rate was 89%. Crude prevalence of diabetes was 20%. It was higher in UAE citizens (25%) than in expatriates (13–19% depending on country of origin). Prevalence of diabetes rose with age to a maximum of 40% after the age of 55 years. Prevalence of impaired fasting glycaemia was 5% in men and 7% in women. Forty-one percent of subjects with diabetes were undiagnosed prior to the survey. Of the previously diagnosed subjects with diabetes, 59% were taking oral hypoglycaemic agents, 8% used insulin and 17% relied on diet alone. Obesity was common in all ethnic groups. Approximately three-quarters of all subjects were either obese (BMI  30) or overweight (BMI 25–29). Presence of diabetes was associated with increasing waist–hip ratio (WHR), age and with systolic blood pressure and ethnicity. Co-morbidity with glucose intolerance occurred with obesity in 8% and with hypertension in 5%. Three-quarters of all subjects had one or more of these conditions.

Conclusions:

Diabetes, obesity and hypertension are extremely prevalent in the adult population of the UAE. Prompt action is required to avert a major public health crisis due to the long-term complications of diabetes in the near future.

Introduction

At the global level, the modern epidemic of type 2 diabetes and its association with the rising prevalence of obesity are well established. Data from the World Health Organization predict doubling in the number of persons with diabetes in the world, from 150 million to 300 million, between the years 2000 and 2025 [1]. However, such estimates rely on a number of extrapolations and there are still many countries in which the prevalence of diabetes remains unknown.

The prevalence of diabetes and its contribution to disease burden in the United Arab Emirates (UAE) has not been established previously. However, clinical observation suggests diabetes and associated non-communicable diseases (NCDs) now have a major impact on the public health of both the indigenous and expatriate communities.

In this article, the results of the Emirates National Diabetes and Coronary Artery Disease Risk Factor Study (ENDCAD) are reported, with respect to diabetes and impaired fasting glycaemia (IFG) and obesity and hypertension. Associations with ethnicity and co-morbidities are also examined.

Section snippets

Background

The UAE is a federation of seven Emirates, situated on the shores of the Arabian Gulf and the Gulf of Oman and sharing land borders with Oman and Saudi Arabia. UAE has a total area of approximately 83,000 km2. With the exception of a few fertile oases, the dominant feature of the landscape is the flat coastal plain, which merges with rolling sand dunes and vast desert hinterland of Arabia.

According to the 1995 census [2], the total population of the UAE was 2.7 million, of whom 20% were UAE

Results

A total of 6564 subjects were invited to attend, of whom 5844 completed the examination. Overall response rate was 89%, which was slightly better among non-citizens than UAE nationals. The study involved 2499 men (43%) and 3345 women (57%). UAE citizens comprised 40% of the total study population. Women outnumbered men by a factor of 2 among UAE citizens. However, both genders were equally represented among expatriates. The large majority of both men and women were aged 25–54 years (Table 1).

Discussion

With a crude prevalence of 20%, diabetes can be considered a serious public health problem in the adult population of the UAE. Prevalence was highest in UAE citizens, one-quarter of all those examined being diagnosed diabetic. Comparable studies in the Gulf region include a prevalence of 12% and 14% in urban men and women, and 7% and 8% in rural men and women, in Saudi Arabia in 1995 [7]. Age-specific prevalence in Bahrain, ranged from 23% in men aged 40–49 years to 37% in women aged 60–69

Acknowledgements

This study was supported and financed by the Federal Ministry of Health of the UAE with the generous assistance of Servier Company.

We greatly appreciate the continuing support of HE Dr. Abdul Raheem Jaffar, Undersecretary, and Dr. Awatef Bu Haliga, Head of the Department of Health Education, Ministry of Health, Abu Dhabi.

We thank Mrs. Wafa Ismail, clinical biochemist from the Department of Chemical Pathology in Mafraq Hospital, Abu Dhabi for supervising the laboratory work during the field

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