IDF-EMME Region Meeting September 7-9, 2007 Cairo, Egypt

Diabetes Mellitus in Jordan: “A Worsening National Health Problem” Mohamed M. El-Zaheri, MD, FACE Clinical 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: Accessed 1 August, Worldwide prevalence of diabetes in 2000 Number of persons < 5,000 5,000–74,000 75,000–349, ,000–1,499,000 1,500,000–4,999,000 > 5,000,000 No data available

Worldwide prevalence of diabetes in 2030 (projected) Total cases > 300 million adults Number of persons < 5,000 5,000–74,000 75,000–349, ,000–1,499,000 1,500,000–4,999,000 > 5,000,000 No data available Adapted from WHO Diabetes Programme Facts and Figures: Accessed 1 August, 2006.

Prevalence of diabetes in Eastern Mediterranean and Middle East Region in 2003 International Diabetes Federation. Diabetes Atlas. 2 nd Edition. Accessed 27 October, Egypt 9.8% 3.9 million Pakistan 8.5% 6.2 million Saudi Arabia 9.4% 1 million United Arab Emirates 20.1% 0.4 million Afghanistan 8.2% 0.9 million Sudan 3.1% 0.5 million Yemen 7.7% 0.6 million Total cases > 19 million adults

Diabetes in USA

King H et al. Diabetes Care 1998;21:1414–31 DevelopedDevelopingAll countries Number of adult population with diabetes (millions) ↑ 41% ↑ 156% ↑ 122% Global burden of diabetes 1995–2025

PREVALENCE OF MALE OBESITY

PREVALENCE OF FEMALE OBESITY

*Per 1000 patient years Adapted from UK Prospective Diabetes Study Group Lancet 1998;352: UKPDS Results: Causes of Death Intensive Conventional CauseRate*% Rate*% MI Stroke Sudden death PVD All macrovascular Renal disease Cancer Other specified Unknown Total

Diabetes In Jordan

Map Of JORDAN

Diabetes & IGT In Jordan Overall Prevalence (WHO Criteria) Ajlouni K, et al ; J. Int. Med., 244: , 1998 %

Diabetes Mellitus In Jordan Prevalence by Age Ajlouni, K, et al ; J. Int. Med., 244: , 1998 Yr % Age Categories

Diabetes & IGT In Jordan Prevalence By Age % yr Ajlouni K, et al ; J. Int. Med., 244: , 1998

Diabetes Mellitus in Jordan Prevalence by Other Variables Smoking: NS, Sex: NS % Ajlouni K, et al ; J. Int. Med., 244: , 1998

IGT In Jordan Prevalence By Other Variables * * = NS Sex : NS, Smoking : NS Ajlouni K, et al, J. Int. Med. ; 244: , 1998 %

Natural History of IGT in N. Jordan ( Over a period of 2 Years ) GroupTotalReverted To Normal Progressed To Progressed To Type 2 Diabetes Type 2 Diabetes (n)(n)(%)(n)(%) IGT Control Ammari F., et al, Practical Diabetes International; vol. 15 (5), 1998 P-value = 0.12 * * WHO Criteria

Relationship Of Some Variables To Subsequent Progression To Type 2 DiabetesVariableTotal(n) % Converted To Type 2 Diabetes P-value Age < 40 yr > 40 yr HypertensionNoYes Family History NoYes Ammari F., et al, Practical Diabetes International; vol. 15 (5), 1998

Age 1% 5% 40% 49% 5% n= 539 age years Sunnoqrut N et al, Program of 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

GLYCOSYLATED HEMOGLOBIN 8% 18% 16% 17% 10% 7% 8% n= 283 HbA1c % % 74% of patients have HbA1c ≥ 7% (and 42% ≥ 9%) Sunnoqrut N et al, Program of 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

TOTAL CHOLESTEROL TOTAL CHOLESTEROL 64% 26% 8% 1% <1% n= 228 mg/dl 36% of patients have their cholesterol ≥ 200 mg/dl Sunnoqrut N et al, Program of 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

LOW DENSITY LIPOPROTIEN CHOLESTEROL 51% 25% 13% 9%1% n= 224 mg/d l 49% of patients have LDL ≥100 mg/dl Sunnoqrut N et al, Program of 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

TRIGLYCERIDES 45% 27% 21% 6%<1% n= 225 mg/dl 55% of patients have TG ≥150 mg/dl Sunnoqrut N et al, Program of 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

HIGH DENSITY LIPOPROTIEN CHOLESTEROL 21% 29% 25% 13% 8% 4% n= 224 mg/dl 50% of patients have HDL < 40 mg/dl Sunnoqrut N et al, Program of 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

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 1 st Joint JSED-AACE Congress, May 17-19,Amman, Jordan (Abstract # OP3)

n = 96 HDL – Cholesterol, FEMALES mg/dl 16% 24% 27% 15% 11% 7% 67% have HDL levels <50 mg/dl

Rx result 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 1 st 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 %10.8%23.0%26.5%37.5%≤30BMI 8.3%19.4%28.4%26.3%17.5%>30 5.4%15.3%25.8%26.4%27.2%Total

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) %

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): % n= 1711

Causes of end-stage renal disease in patients on haemodialysis (HD) in Jor dan in 2002 vs Abdallah S et al. Eastern Mediterranean Health Journal, 2007, 13 (4): n= 1711 %

Causes of end-stage renal disease in patients on haemodialysis (HD) in Jordan, 2004 % n = 1711 Abdallah S et al. Eastern Mediterranean Health Journal, 2007, 13 (4):

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 %

EUXAPIΣΤŴ Mercie Dankee Gracias Thank You