1. Diabetes Research Initiatives in Sharjah, UAE Nabil Sulaiman nsulaiman@sharjah.ac.ae n.sulaiman@unimelb.edu.au Diabetes Supercourse, Alexandria 12 Jan 2009

2. Sharjah Diabetes Study  Background  Why the study  Methods  Preliminary results  Conclusions  Recommendations

3. Environmental and behavioral changes New dietary habits (what and how we eat), Lack of physical activity, Overweight/ obesity, and Stresses of urbanization and working condition will lead to further rise of CVD and diabetes, and their risk factors.

4. 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

5. Sharjah Diabetes Study N. Sulaiman, Dh. Al Badri, N. Sajwani, S. Saleh, D. Young

8. 1 Nabil Sulaiman, 2 Dhafir Al Badry, 2 Najla Sajwany, 1 Amal Hussein, 1 Saba Saleh, 2 Doris Young ( 1 Department of Family and Community Medicine, University of Sharjah, 2 Ministry of Health UAE, 3 Department of General Practice, University of Melbourne) The study design is a cross sectional baseline survey of patients with diabetes attending Primary Medical Care Centers in Sharjah during 2007/08. Data Collection 1.Research Assistant attended diabetes mini clinics at Riffa and Asit centres and diabetes clinic at Al-Qassimi and Kuwaiti Hospitals: 2.Patients were invited to participate 3.Patients were interviewed using structured questionnaires 4.Their data were extracted from medical records 5.Data cleaning and analysis was performed using SPSS Background  Diabetes is a major and complex health problem worldwide.  Diabetes prevalence in UAE is the 2 nd 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 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.aunsulaiman@sharjah.ac.ae n.sulaiman@unimelb.edu.au 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 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 METHODOLOGY Diabetes Control Indicators  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 PRELIMINARY RESULTS  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.  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). CONCLUSIONS 1.Diabetes Mellitus is common problem in primary medical centers in Sharjah. 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.

9. Sharjah Diabetes Study Aim To improve diabetes management, control and quality of life of patients with diabetes in UAE

10. Sharjah Diabetes Study Objectives Identify gaps in diabetes management Determine barriers and facilitators to implementation of known interventions Pilot test known EB intervention in Sharjah

11. Study Design Cross sectional baseline survey of patients with diabetes attending Primary Medical Centers in Sharjah during 2007/08.

12. 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

13. Diabetes Control Indicators Medical Records: Biochemical indicators such as HbA1c and cholesterol, lipids, blood glucose and urine test Weight and waist circumference Patients questionnaire: Knowledge and attitudes healthy eating physical activity

14. Preliminary Results Sample: 347 patients Gender: 65.4% females Mean age 53.2 (14.6) BMI 29.8 (5.9)

15. Nationality UAE 83.9%, Pakistan 3.5%, Egypt 2.6%, Others: 10% (Palestine, Lebanon, Yemen, Iraq, Syria, Iran and Sudan)

16. Diabetes in Families

17. Marital Status 87.9% married 8.9% single 2.8 divorced/widowed Consanguineous Marriage: 16.4% (n=57)

18. Gender difference

19. HbA1c: 78% of patients has HbA1c (>7%) BP: 57% have high BP

20. Management Methods

21. 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)

22. Self monitoring

23. 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)

24. 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)

25. 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.

26. Recommendations Diabetes management in Sharjah could be improved compared with international guidelines Measures to improve control: Diabetes Nurse Educators Patient’s self management education Peer-led or peer-support models CME for doctors at PHC centers

27. Thank You