Posted: June 29th, 2015

PREDICTION OF UNDIAGNOSED DIABETES AMONG WOMEN IN UAE

PREDICTION OF UNDIAGNOSED DIABETES AMONG WOMEN IN UAE

Introduction

Diabetes mellitus (DM) represents one of the most challenging public health problems of the 21^st century and thus drawing global attention. According to WHO, diabetes mellitus describes as metabolic disorder of multiple etiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.^[1]

Both genetic and environmental factors play a role in the development of DM. Risk factors for DM consist of race, obesity, family history, genetics, age (>45 years old), unhealthy eating habits, metabolic syndrome, high blood pressure and high cholesterol, pre-diabetes, and a history of gestational diabetes. Diabetes can be especially hard on women. The burden of diabetes on women is unique because the disease can affect both mothers and their unborn children. Lifestyle challenges have always been an obstacle in maintaining health, especially in the Middle East and GCC region where it is said that a large number of the population are pre diabetic or have type 2 diabetes.

Diabetes can cause difficulties during pregnancy such as a miscarriage or a baby born with birth defects. Women with diabetes are also more likely to have a heart attack, and at a younger age, than women without diabetes. The main challenges facing diabetic pregnant women in the Middle East, whether the diabetes is gestational or was ongoing prior to their pregnancy, is mainly related to noncompliance to dietary and health guidelines or just having a busy lifestyle.

In 2011, 366 million people have diabetes and half of those (183 million) are undiagnosed. ^[2] Undiagnosed diabetes is defined as diabetes that is identified as part of a health survey, through blood testing, in person not previously known to have diabetes.^[3]

According to the American Diabetes Association’s Standards of Medical Care in Diabetes—2011, type 2 diabetes is frequently not diagnosed until complications appear. “There is frequently a long pre-symptomatic phase before a diagnosis of type 2 diabetes is made”, said Dr. Ratner, a senior scientist of MedStar Health Research Institute.^[4] The high prevalence of undiagnosed diabetes emphasises the importance of early detection of the disease. Early diagnosis of diabetes and pre-diabetes enable the individuals to take important measures towards prevention of complications or further progression of the disease. As many as 20% of people presenting with a new diagnosis of diabetes will already have diabetic microvascular complications, suggesting the disease has been present for 8 to 11 years.^[4] Even though there was no definitive proof of the effectiveness of mass screening of asymptomatic individuals for diabetes, a research conducted by Richard Kahn et al. (2010) has shown that screening for type 2 diabetes is cost effective when started between the ages of 30 years and 45 years, with screening repeated every 3–5 years in the US population.^[5]

The main purpose of this study is to determine the prevalence of undiagnosed diabetes among the university staffs. This research also enables us to assess the risk factors on the occurrence of diabetes. Risk factors associated with diabetes mellitus includes obesity, hypertension, family history, lifestyle etc. Among these, family history has been shown to have strong association with diabetes. A research conducted in Mauritania reported that 27% of T2DM patients have at least one relative with diabetes.^[6] Through our study, we also hope to raise the awareness among womens about the importance of diabetes prevention and early detection. By early detection of the disorder, appropriate therapeutic measures can be taken to prevent or at least to delay the complications of diabetes.

 

Aim of Research

The aim of this study is to predict the prevalence of undiagnosed diabetes among women in UAE

 

Objectives of Research

• To estimate the prevalence of undiagnosed diabetes among women.
• To predict the possible risk factors on the occurrence of diabetes among women
• To raise the awareness among women about the importance of diabetes prevention and early detection.

 

 

 

Literature Review

Xu et al. (2012) have conducted a large population-based study on the detection of pre-diabetes and undiagnosed types 2 diabetes. The objective of conducting the study was to fill the research gap in pre-diabetes and undiagnosed diabetes that have been commonly ignored by the previous studies. In addition, vascular risk factors (VRFs) were believed to have indicated pre-diabetes and undiagnosed type 2 diabetes. Therefore, the study was conducted at the same time to verify the hypothesis. Undiagnosed type 2 diabetes is defined as the subject with type 2 diabetes when neither a medical history of diabetes nor hypoglycemic drugs use was present. In order to carry out the study, multinomial logistic regression was applied to analyze the data. On top of that, medical history, hypoglycemic drug use, fasting plasma glucose level >7.0mmol/l, or post prandial 2-hour plasma glucose level >11.1 mmol/l were used to test the type 2 diabetes. Pre-diabetes was ascertained as fasting plasma glucose level of 6.1 to 6.9 mmol/L, or postprandial 2-hour plasma glucose level of 7.8 to 11.0 mmol/L (WHO 1999) among diabetes-free participants. There were a total of 7567 adults that range from age 20 to 79 years old participate in this study. All the respondents invited are based on geographical area which covered only Tianjin, China. In term of result, Xu et al.(2012) found that 655 (8.7%) of the respondents had pre-diabetes while 721 (9.5%) respondents had type 2 diabetes. In addition, there are 321 (4.2%) among 721 type 2 diabetes patients had undiagnosed type 2 diabetes. According to Xu et al.(2012), women had a higher tendency of prevalence on both types of diabetes compared to men. Furthermore, the prevalence of both types of diabetes will increase correspondingly to the age. Hypertension, overweight, obesity, central obesity, and family history were identified as correlated to pre-diabetes and undiagnosed diabetes whereas; physical inactivity was only correlated to undiagnosed diabetes. In conclusion, there were 13% of the respondents had pre-diabetes and undiagnosed diabetes and almost 45% of the respondents with diabetes are undiagnosed. Lastly, VRFs (hypertension, high adiposity and family history of diabetes) are proved to be the indicators of detecting the pre-diabetes and undiagnosed diabetes. ^[7]

Ghlana Meiloud et al. (2012) conducted a research study to estimate the prevalence of undiagnosed diabetes in Mauritania. The influence of family history on the occurrence of Type 2 diabetes (T2D) was analyzed and the aggregation pattern of T2D was evaluated. For determining the prevalence of unknown diabetes, questionnaire and fasting serum glucose tests were used and the data was compiled from 1278 Mauritanian adults. Detailed family history of diabetes and clinical characteristics were obtained from 421 T2D patients. This study found that the prevalence of undiagnosed diabetes was 4.7 + 1.2% in the studied population. 27% patients with T2D reported at least one relative with diabetes. The study highlighted the importance of family history screening in management of diabetes in Mauritania.^[6]

Laurentius A. Pramono et al. (2010) performed a study on prevalence and predictors of undiagnosed diabetes mellitus in Indonesia. The study was conducted to find out the prevalence and prediction factors of undiagnosed diabetes mellitus in Indonesian adult population. The study design is cross-sectional. The study population is all people above 18 years old and they were diagnosed by using oral glucose tolerance test (OGTT) based on WHO 1999 standard. They were categorized undiagnosed if they were newly diagnosed from the survey. To determine the predictors of undiagnosed diabetes mellitus, the subjects with undiagnosed diabetes were compared with non-diabetes. In this study it is revealed that the prevalence of undiagnosed diabetes mellitus in adult population of Indonesia is 4.1% from total diabetes prevalence of 5.6%. The prevalence of 4.1% is considered as very high because its proportion to total diabetic adult patient is 73.2% and they found that the predictors are age, obesity, central obesity, hypertension, and smoking habit.^[8]

Echouffo-Tcheugui et al. (2012) performed a study on the prevalence of undiagnosed diabetes and its determinants among the adults Cameroon dwellers. On May 17^th 2011, adults participants from the four major Cameroonian cities are invited through the mass media to participate in a community based combined screening diabetes and hypertension tests. In the test, capillary blood is used to measure the fasting blood glucose. There are total of 2120 respondents invited to the study which 1591 (52%) are male participants. All of the male participants received a fasting glucose test which 64.2% of them are found overweight or so called as obese. In addition, the average of the male participant is 43.7 years old. On the other hand, diabetes test was carried and found that the sex specific age adjusted prevalence (for male and female) were 10.1% which 95% of confidence interval is applied ([CI]: 8.1 – 12.1%) whereas 11.2% (95%CI: 9.1 – 13.3%) were found to have any diabetes, and 4.6% (95%CI: 2.6–6.6%) and 5.1% (95%CI: 3.0–7.2%) for screened-detected diabetes, respectively. The prevalence of diabetes is also found to be correlated to the age in men and women (all p ≤ 0.001 for linear trend) which the tendency is getting higher with increasing age. Meanwhile, older age (p < 0.001), region of residence (p < 0.001), excessive alcohol intake (p = 0.02) were significantly associated with screened-detected diabetes. However, physical inactivity, body mass index, and high waist girth were not significantly associated with screened-detected diabetes. In conclusion, the prevalence of undiagnosed diabetes is indicated as very high in among the Cameroonian urban dwellers. When the tendencies of the prevalence are high, the impact of screening for diabetes is expected to have a mass impact. Therefore, there is a need for more proactive policies of early detection of the disease.^[9]

Barrett l. Chapin et al. (1999) conducted a research study to determine the prevalence of undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose among U.S. Army soldiers. The studied population was a prospective, consecutive sample of 625 asymptomatic soldiers presenting to a U.S. Army medical clinic for physical examinations. A 2-h, 75-g oral glucose tolerance test was employed. The study revealed that the prevalence of undiagnosed diabetes was 3 of 625 (0.5%); impaired glucose tolerance, 11 of 598 (1.8%); and impaired fasting glucose 6 of 585 (1.0%). The study showed that the U.S. Army population had a relatively low prevalence rates as compared to those found in NHANES III.^[10]

A cross-sectional study on determination of the prevalence of diagnosed and undiagnosed diabetes, pre-diabetes and identification of associated risk factors in the sample of adult Qatari population was conducted by Abdulbari Bener et al. (2009). The sample in this study was the Qatari nationals above 20 years of age. Methods like questionnaire, physical examination and measurements and laboratory measurements were carried out for the collection of data. Pre-diabetes was determined based on the presence of impaired fasting glucose or impaired glucose tolerance. From the study, they found that the overall prevalence of diabetes mellitus among adult Qatari population was high, 16.7% with diagnosed DM 10.7% and newly diagnosed DM 5.9%. With a total of 13.8%, it was reported that the impaired glucose tolerance (IGT) was diagnosed in 12.5%, while impaired fasting glucose was in 1.3%. The proportion of DM was higher in Qatari women 53.2% than men 46.8% in Qatari and it was mainly from age group 40 to 49 years 31.2%. Major contributors for diabetes disease were smoking habits and family history. The central obesity was associated with higher prevalence of DM and IFG among Qatari men and women. They concluded that there was moderately high prevalence of diabetes mellitus in the adult Qatari population. Smoking habits and family history were the major contributors for diabetes mellitus.^[11]

 

 

 

Methodology

• Study Design : A cross sectional descriptive study
• Study Duration : 6 months
• Location : United Arab Emirates
• Study size : 200 women
• Sampling technique : Random sampling technique.
• Data Collection : Validated questionnaires are used to assess the risk factors

associated with diabetes. For diagnosing diabetes, we will be

using Random Plasma Glucose test (RPG).

• Software analysis : Statistical Package for Social Sciences (SPSS) version 20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flow Chart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

• WHO Consultation. (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Pg 1-59.

 

• International Diabetes Federation. (2013). Undiagnosed Diabetes. IDF Diabetes Atlas Fifth Edition. Retrieved February 22, 2013, from http://www.idf.org/diabetesatlas/5e/undiagnosed-diabetes

 

• Diabetes: the silent pandemic and its impact on Australia (2012). Written by Heart & Diabetes Institute. Pg 1-51.

 

• Robert E. Ratner. (2012). Testing for Diabetes in Asymptomatic Patients. Physician’s Weekly. Retrieved February 23, 2013, from http://www.physiciansweekly.com/diabetes-testing-asymptomatic-patients/

 

• Richard Kahn, Peter Alperin, David Eddy, Knut Borch-Johnsen, John Buse, Justin Feigelman, Edward Gregg, Rury R Holman, M Sue Kirkman, Michael Stern, Jaakko Tuomilehto, Nick J Wareham (2010). Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. Lancet, 375: 1365–74.

 

• Ghlana Meilouda, Imen Arfab, Rym Kefib, Isselmou Abdelhamidc, Fatimetou Vetena, Khaled Lasramb, Nizar Ben Halimb, Abdallahi Sidi Mhameda, Abdoulaye Sambd, Sonia Abdelhakb, Ahmed Ould Houmeidaa (2012). Type 2 diabetes in Mauritania: Prevalence of the undiagnosed diabetes, influence of family history and maternal effect. Primary Care Diabetes, 293: 1-6.

 

• Xu, W., Xu, Z., Jia, J. T., Xie, Y., Wang, H.-X., & Qi, X. (2012). Detection of Prediabetes and Undiagnosed Type 2 Diabetes: A Large Population-Based Study. Canadian Journal of Diabetes, 36(1), 108-113.

 

• Laurentius A. Pramono, Siti Setiati, Pradana Soewondo, Imam Subekti, Asri Adisasmita, Nasrin Kodim, Bambang Sutrisna (2010). Prevalence and Predictors of Undiagnosed Diabetes Mellitus in Indonesia. Indones J Intern Med, 42(4), 216-223

 

• Echouffo-Tcheugui, J. B., Dzudie, A., Epacka, M. E., Choukem, S. P., Doualla, M. S., Luma, H., et al. (2012). Prevalence and Determinants of Undiagnosed Diabetes in an Urban Sub-Saharan African Population. Primary Care Diabetes, 6(1), 229-234

 

• Barrett L. Chapin, Sheryl Medina, Dzung Le, Norman Bussell, Kathy Bussell (1999). Prevalence of Undiagnosed Diabetes and Abnormalities of Carbohydrate Metabolism in a U.S. Army Population. Diabetes Care, 22(3), 426-429

 

• Abdulbari Bener, Mahmoud Zirie, Ibrahim M. Janahi, Abdulla O.A.A. Al-Hamaq, Manal Musallam, Nick J. Wareham (2009). Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population-based study of Qatar. Diabetes Research and Clinical Practice, 84, 99-106