IDF-EMME Region Meeting September 7-9, 2007 Cairo, Egypt.
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Transcript of 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
Ajlouni K, et al ; J. Int. Med., 244: 317-323, 1998
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
%
Ajlouni K, et al ; J. Int. Med., 244: 317-323, 1998
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%)
Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)
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
Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)
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
Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)
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
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
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
Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)
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
Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)
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
Sunnoqrut N et al, Program of 1st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)
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
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, 2004
%
n =
171
1
Abdallah S et al. Eastern Mediterranean Health Journal, 2007, 13 (4):803-809
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 %
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