idf-emme region meeting september 7-9, 2007 cairo, egypt

IDF-EMME Region MeetingSeptember 7-9, 2007

Cairo, Egypt

Diabetes Mellitus in Jordan:“A Worsening National Health Problem”

Mohamed M. El-Zaheri, MD, FACEClinical Associate Professor of Medicine (JU).Consultant Internist – Endocrinologist, National Center of Diabetes, Endocrine & Genetic Diseases.Chairman, Department of Internal Medicine,Jordan Hospital & Medical Center.President, The Jordanian Society For The Care Of Diabetes.

Amman, JORDAN

Adapted from WHO Diabetes Programme Facts and Figures: www.who.int/diabetes/facts/world_figures/en. Accessed 1 August, 2006.

Worldwide prevalence of diabetes in 2000

Number of persons< 5,0005,000–74,00075,000–349,000350,000–1,499,0001,500,000–4,999,000> 5,000,000No data available

Worldwide prevalence of diabetes in 2030 (projected)

Total cases > 300 million adults

Number of persons< 5,0005,000–74,00075,000–349,000350,000–1,499,0001,500,000–4,999,000> 5,000,000No data available Adapted from WHO Diabetes Programme Facts and Figures:

www.who.int/diabetes/facts/world_figures/en. Accessed 1 August, 2006.

Prevalence of diabetes in Eastern Mediterranean and Middle East Region in 2003

International Diabetes Federation. Diabetes Atlas. 2nd Edition. www.eatlas.idf.org. Accessed 27 October, 2006.

Egypt9.8%3.9 million

Pakistan8.5%6.2 million

Saudi Arabia9.4%1 million

United Arab Emirates20.1%0.4 million

Afghanistan8.2%0.9 million

Sudan3.1%0.5 million

Yemen7.7%0.6 million

Total cases > 19 million adults

Diabetes in USADiabetes in USA

King H et al. Diabetes Care 1998;21:1414–31

Developed Developing All countries

300

250

200

150

100

50

0

Nu

mb

er o

f ad

ult

po

pu

lati

on

w

ith

dia

bet

es (

mil

lio

ns)

1995

2025

135

51

89

300

72

228

↑ 41%

↑ 156%

↑ 122%

Global burden of diabetes 1995–2025Global burden of diabetes 1995–2025

PREVALENCE OF MALE OBESITYPREVALENCE OF MALE OBESITY

PREVALENCE OF FEMALE OBESITYPREVALENCE OF FEMALE OBESITY

*Per 1000 patient years

Adapted from UK Prospective Diabetes Study Group Lancet 1998;352:837-853.

UKPDS Results: Causes of Death

Intensive ConventionalCause Rate* % Rate* %

MI 7.6 42 8 42Stroke 1.6 9 1.3 7Sudden death 0.9 5 1.6 8PVD 0.1 1 0.3 2All macrovascular 10.2 57 11.2 59Renal disease 0.3 2 0.2 1Cancer 4.4 25 4.4 23Other specified 2.4 13 2.7 14Unknown 0.5 3 0.2 1Total 17.9 100 18.9 100

Diabetes In Jordan

Map OfJORDAN

Diabetes & IGT In JordanOverall Prevalence (WHO Criteria)

0

2

4

6

8

10

12

14

16

DM IGT

M

F

T

Ajlouni K, et al ; J. Int. Med., 244: 317-323, 1998

%

Diabetes Mellitus In JordanPrevalence by Age

0

5

10

15

20

25

30

%

25 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70 - 79

80 +

Ajlouni, K, et al ; J. Int. Med., 244: 317-323, 1998

Yr

%

Age Categories

Diabetes & IGT In JordanPrevalence By Age

0

5

10

15

20

25

30

25-29 30-39 40-49 50-59 60-69 70-79 =/>80

DM

IGT

%

yr


Diabetes Mellitus in JordanPrevalence by Other Variables

0

5

10

15

20

25

OB FH HTN HChol HTG illet

No

Yes

Smoking: NS, Sex: NS

%


IGT In JordanPrevalence By Other Variables

0

5

10

15

20

25

OB FH HTN Hcol HTG illet

No

Yes*

* = NS Sex : NS, Smoking : NS

Ajlouni K, et al, J. Int. Med. ; 244: 317-323, 1998

%

Natural History of IGT in N. Jordan( Over a period of 2 Years )

GroupGroup TotalTotal RevertedReverted

To NormalTo Normal Progressed ToProgressed To

Type 2 DiabetesType 2 Diabetes

(n)(n) (n) (n) (%)(%) (n)(n) (%)(%)

IGTIGT 6868 2727 29.729.7 1010 14.714.7

ControlControl 144144 1010 6.96.9

Ammari F., et al, Practical Diabetes International; vol. 15 (5), 1998P-value = 0.12

*

* WHO Criteria

Relationship Of Some Variables To Subsequent Progression To Type 2 Diabetes

VariableVariableTotalTotal

(n)(n)

% Converted To% Converted To

Type 2 DiabetesType 2 DiabetesP-valueP-value

AgeAge < 40 yr< 40 yr

> 40 yr> 40 yr

7777

1301303.93.9

13.113.1 0.0550.055

HypertensionHypertension

NoNo

YesYes

157157

4747

7.07.0

17.017.0 0.070.07Family HistoryFamily History

NoNo

YesYes

9696

9999

4.24.2

13.113.1 0.050.05Ammari F., et al, Practical Diabetes International; vol. 15 (5), 1998

AgeAge

0

50

100

150

200

250

300

<20 20- 39 40- 59 60- 79 >=80

1%5%

40%

49%

5%

n= 539

ageyears

Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

0

10

20

30

40

50

60

<6 6-6.9 7-7.9 8-8.9 9-9.9 10-10.9

11-11.9

>=12

GLYCOSYLATED HEMOGLOBIN

8%

18%

16% 16%17%

10%

7%8%

n= 283

HbA1c % %

74% of patients haveHbA1c ≥ 7%

(and 42% ≥ 9%)


0

20

40

60

80

100

120

140

160

<200 200-249 250-299 300-349 350-399 >=400

TOTAL CHOLESTEROLTOTAL CHOLESTEROL

64%

26%

8%1% 1% <1%

n= 228

mg/dl

36% of patients have theircholesterol ≥ 200 mg/dl


0

20

40

60

80

100

120

140

<100 100-129 130-159 160-199 200-249 >=250

LOW DENSITY LIPOPROTIEN CHOLESTEROLLOW DENSITY LIPOPROTIEN CHOLESTEROL

51%

25%

13%

9% 1% 1%

n= 224

mg/dl

49% of patients haveLDL ≥100 mg/dl


0

20

40

60

80

100

120

<150 150-249 250-499 500-999 1000-1999

>=2000

TRIGLYCERIDES

45%

27%

21%

6% <1%

n= 225

mg/dl

55% of patients haveTG ≥150 mg/dl


0

10

20

30

40

50

60

70

<30 30-39 40-49 50-59 60-69 >=70

HIGH DENSITY LIPOPROTIEN CHOLESTEROL

21%

29%

25%

13%

8%

4%

n= 224

mg/dl

50% of patients haveHDL < 40 mg/dl


0

5

10

15

20

25

30

35

40

45

<30 30-39 40-49 50-59 60-69 >70

n = 128

HDL – Cholesterol, MALES

26%

33%

23%

11%

5%2%

59% have HDL levels <40mg/dl

mg/dl


0

5

10

15

20

25

30

<30 30-39 40-49 50-59 60-69 >70

n = 96

HDL – Cholesterol, FEMALES

mg/dl

16%

24%

27%

15%

11%

7%

67% have HDL levels <50 mg/dl

0

20

40

60

80

100

120

n= 545

4%

20%

9%

20%

4%

14%

10%

8%6%

TYPE OF ANTI-DIABETIC TREATMENT

36% on insulin (8%+OAA)

40% on Sulphonylurea


The change in Prvalence 0f type 2 DM in Jordan between 1994 & 2004

Ajlouni K et al, The Journal of Diabetes and its Complications, (in press)

•

(NCEP May 2001,3 out of 5)

Distribution Of Co-Morbidities By BMI

20042004

00 11 22 33 44

BMIBMI ≤≤3030 37.5%37.5% 26.5%26.5% 23.0%23.0% 10.8%10.8% 2.2%2.2%

>30>30 17.5%17.5% 26.3%26.3% 28.4%28.4% 19.4%19.4% 8.3%8.3%

TotalTotal 27.2%27.2% 26.4%26.4% 25.8%25.8% 15.3%15.3% 5.4%5.4%

n= 1121 (total)

Age-specific prevalence of the metabolic syndrome among Jordanians aged ≥25 years by sex

Khader Y et al, J Diabetes and its Complications 21 (2007) 214-219

%

Causes of end-stage renal disease in patients on haemodialysis (HD) in Jordan, 2004

Abdallah S et al. Eastern Mediterranean Health Journal, 2007, 13 (4):803-809

%

n= 1711

Causes of end-stage renal disease in patients on haemodialysis (HD) in Jordan in 2002 vs. 2003


n= 1711

%

Causes of end-stage renal disease in patients on haemodialysis (HD) in Jordan, 2004

%

n =

171

1


Conclusions- Diabetes Prevalence in Jordan is High and Is Rising at a Rate of 4% per Decade.

- Risk Factors for DM Include Obesity, Illiteracy, Hypertension, Hyperlipidemia and Advancing Age.

- Prevalence of The Metabolic Syndrome Above Age 25 is 36.3 %

EUXAPIEUXAPIΣΤΣΤŴŴMercieMercieDankeeDankeeGraciasGracias

Thank YouThank You

idf-emme region meeting september 7-9, 2007 cairo, egypt

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