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

2. 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

3. 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 < 5,000 5,000–74,000 75,000–349,000 350,000–1,499,000 1,500,000–4,999,000 > 5,000,000 No data available

4. Worldwide prevalence of diabetes in 2030 (projected) Total cases > 300 million adults Number of persons < 5,000 5,000–74,000 75,000–349,000 350,000–1,499,000 1,500,000–4,999,000 > 5,000,000 No data available Adapted from WHO Diabetes Programme Facts and Figures: www.who.int/diabetes/facts/world_figures/en. Accessed 1 August, 2006.

5. Prevalence of diabetes in Eastern Mediterranean and Middle East Region in 2003 International Diabetes Federation. Diabetes Atlas. 2 nd Edition. www.eatlas.idf.org. Accessed 27 October, 2006. 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

6. Diabetes in USA

7. King H et al. Diabetes Care 1998;21:1414–31 DevelopedDevelopingAll countries 300 250 200 150 100 50 0 Number of adult population with diabetes (millions) 1995 2025 135 51 89 300 72 228 ↑ 41% ↑ 156% ↑ 122% Global burden of diabetes 1995–2025

8. PREVALENCE OF MALE OBESITY

9. PREVALENCE OF FEMALE OBESITY

10. *Per 1000 patient years Adapted from UK Prospective Diabetes Study Group Lancet 1998;352:837-853. UKPDS Results: Causes of Death Intensive Conventional CauseRate*% Rate*% MI7.6428 42 Stroke1.6 91.3 7 Sudden death0.9 51.6 8 PVD0.1 10.3 2 All macrovascular 10.2 5711.2 59 Renal disease0.3 20.2 1 Cancer4.4254.4 23 Other specified2.4132.7 14 Unknown0.5 30.2 1 Total17.9 10018.9 100

11. Diabetes In Jordan

12. Map Of JORDAN

13. Diabetes & IGT In Jordan Overall Prevalence (WHO Criteria) Ajlouni K, et al ; J. Int. Med., 244: 317-323, 1998 %

14. Diabetes Mellitus In Jordan Prevalence by Age Ajlouni, K, et al ; J. Int. Med., 244: 317-323, 1998 Yr % Age Categories

15. Diabetes & IGT In Jordan Prevalence By Age % yr Ajlouni K, et al ; J. Int. Med., 244: 317-323, 1998

16. Diabetes Mellitus in Jordan Prevalence by Other Variables Smoking: NS, Sex: NS % Ajlouni K, et al ; J. Int. Med., 244: 317-323, 1998

17. IGT In Jordan Prevalence By Other Variables * * = NS Sex : NS, Smoking : NS Ajlouni K, et al, J. Int. Med. ; 244: 317-323, 1998 %

18. 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)(%) IGT682729.71014.7 Control144106.9 Ammari F., et al, Practical Diabetes International; vol. 15 (5), 1998 P-value = 0.12 * * WHO Criteria

19. Relationship Of Some Variables To Subsequent Progression To Type 2 DiabetesVariableTotal(n) % Converted To Type 2 Diabetes P-value Age < 40 yr > 40 yr 77130 3.913.10.055 HypertensionNoYes157477.017.00.07 Family History NoYes 96994.213.1 0.05 Ammari F., et al, Practical Diabetes International; vol. 15 (5), 1998

20. 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)

21. 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)

22. 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)

23. 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)

24. 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)

25. 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)

26. 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)

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

28. 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)

29. 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)

30. (NCEP May 2001, 3 out of 5)

31. Distribution Of Co-Morbidities By BMI 2004 43210 2.2%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

32. 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 %

33. 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

34. Causes of end-stage renal disease in patients on haemodialysis (HD) in Jor dan in 2002 vs. 2003 Abdallah S et al. Eastern Mediterranean Health Journal, 2007, 13 (4):803-809 n= 1711 %

35. 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):803-809

36. 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 %

37. EUXAPIΣΤŴ Mercie Dankee Gracias Thank You