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Nabil Sulaiman
nsulaiman@sharjah.ac.ae n.sulaiman@unimelb.edu.au
Diabetes Supercourse, Alexandria 12 Jan 2009
Methods
Preliminary results Conclusions Recommendations
Summary
Diabetes is a major and complex health problem worldwide. Prevalence in UAE (24% & IGT18%) is the 2nd highest in the world Onset of the disease in the GCC is early in late 20s With early Dx and appropriate Mgt diabetics can live better and longer
1 Nabil
Sulaiman, 2Dhafir Al Badry, 2Najla Sajwany, 1Amal Hussein, 1Saba Saleh, 2Doris Young
2 Ministry
METHODOLOGY
Background
Diabetes is a major and complex health problem worldwide. Diabetes prevalence in UAE is the 2nd highest in the world, reaching about 24% in UAE nationals. The prevalence of pre diabetes is reported to be about 18%. With early identification and appropriate management, people with diabetes can live better and longer
PRELIMINARY RESULTS The study design is a cross sectional baseline survey of patients with diabetes attending Primary Medical Care Centers in Sharjah during 2007/08. Participants: 347 diabetic patients were interviewed and their medical records were cheeked Gender: 65.4% (n= 227) females and 34.6% (n=120) males Nationality: UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, others 10% including Palestine, Lebanon, Yemen, Iraq, Poland , Syria, Iran and Sudan. 1. 2. 3. 4. 5. Data Collection Research Assistant attended diabetes mini clinics at Riffa and Asit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: Patients were invited to participate Patients were interviewed using structured questionnaires Their data were extracted from medical records Data cleaning and analysis was performed using SPSS Marital Status: 8.9% single, 87.9% married, divorced 1.4% and 1.4% widowed. Consanguineous Marriage: 16.4% (n=57) Occupation: : 47.3% housewife, 28.2% clerks, 6.3% students, 0.6%retired. Family History: 23.1% (N=80) had a positive family history of diabetes. Smoking: 3.2% (n=11) current smokers, 3.2% (n=11), ex-smokers, never smoked 93.1% (n=323).
Diabetes Duration (mean) Males (N=120) 7.1 4.9 30.9 6.0 9.9 4.3 26.4% Females (N=227) 8.5 7.4 27.8 5.3 9.4 3.7 31.4%
Aim
To improve diabetes management, control and quality of life of patients with diabetes in UAE
Objectives
1. Establish an electronic database for diabetic patients in Sharjah Diabetes Control Indicators 2. Audit their medical records to identify gaps in management. 3. Pilot test known EB intervention to investigate their appropriateness to Sharjah 4. Determine barriers and facilitators to the implementation of the intervention
Diabetes in family
200
250
body weight and waist circumference from medical records knowledge and attitudes towards healthy eating using physical activity questionnaire and Biochemical indicators such as AbA1c and cholesterol, lipids, blood glucose and urine test
150
150
100
50
None Diet only Tablets only Insulin only 100 Diet & Tablets Diet & Insulin Diet, tablets & Insulin Unknown Others 50 Missing
Frequency
Frequency
0 None Diet only Tablets only Insulin only Diet & Tablets Diet & Insulin Diet, tablets & Insulin Unknown Others
Diabetes in family
Self monitoring
CONCLUSIONS
250
2. There is gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity. 3. Diabetes control in Sharjah measured by HbA1c could be improved compared with international guidelines. 4. Measures to improve control may include employing Diabetes Nurse Educators to assist doctors at the medical centers to train patients as well as CME courses for doctors working at the centers.
Yes No
Frequency
150
100
50
Self monitoring
This project was funded by the University of Sharjah. For information please contact Dr Nabil Sulaiman, HOD Family and Community Medicine, The University of Sharjah E-mail: nsulaiman@sharjah.ac.ae or n.sulaiman@unimelb.edu.au
Study Design
Cross sectional baseline survey of patients with diabetes attending Primary Medical Centers in Sharjah during 2007/08.
Data Collection
Research Assistant attended diabetes mini clinics at Riffa and Wasit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: Patients were invited to participate and interviewed using questionnaires Their data were extracted from medical records Data cleaning and analysis was performed using SPSS
Preliminary Results
Sample: 347 patients Gender: 65.4% females Mean age 53.2 (14.6) BMI 29.8 (5.9)
Nationality
UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, Others: 10% (Palestine, Lebanon, Yemen, Iraq, Syria, Iran and Sudan)
Diabetes in Families
Diabetes in family
250
200
Frequency
150
100
50
Diabetes in family
Marital Status
Marital Status
87.9% married 8.9% single 2.8 divorced/widowed
Gender difference
Diabetes Duration (mean) BMI (kg/m*m) Fasting B Sugar (mmol/l) Diabetes complications% Males (N=120) 7.1 4.9 30.9 6.0 9.9 4.3 26.4% Females (N=227) 8.5 7.4 27.8 5.3 9.4 3.7 31.4%
HbA1c: 78% of patients has HbA1c (>7%) BP: 57% have high BP
Management Methods
Current Diabetes management method
200
150
Frequency
100
50
0 None Diet only Tablets only Insulin only Diet & Tablets Diet & Insulin Diet, tablets & Insulin Unknown Others
Complications (83)
26 (Eye glaucoma, laser surgery) 74 (feet ulcer, loss of sensation) 2 (Kidney: protein urea or albumin urea) 4 (loss of toe/ foot) 6 (angina, heart attack)
Self monitoring
Self monitoring
250
200
Frequency
150
100
50
0 Yes No
Self monitoring
Self Management
I can exercise several times a week (25% strongly agree) I can not exercise unless I feel like exercising (28% strongly agree) I can recognize when my blood sugar is too high (27% strongly agree)
Self Management
I can do what was recommended to prevent low blood sugar (24% SA) I can figure out what self treatment when blood sugar gets high (29% SA) I can fit my diabetes self treatment routine into my usual lifestyle (26% SA)
CONCLUSIONS
Diabetes Mellitus is common problem in primary medical centers in Sharjah. High levels of obesity Low physical activity Gap in self-management education including self monitoring, manifested by high levels of obesity and lack of physical activity.
Recommendations
Diabetes management in Sharjah could be improved compared with international guidelines Measures to improve control:
Diabetes Nurse Educators Patients self management education Peer-led or peer-support models CME for doctors at PHC centers
Thank You