Situation of Diabetes and Related Factors Among Qatari Adults: Findings From a Community-Based Survey

Level of knowledge, attitude and practice towards diabetes among nationals and long-term residents of Qatar: a cross-sectional study

OBJECTIVES

This study examines the levels of knowledge, attitude and practices (KAP) towards diabetes among Qatar nationals and long-term residents and its association with participants' selected demographics.

SETTING

A cross-sectional study conducted in public areas in all the eight municipalities of Qatar from July to October 2018.

PARTICIPANTS

2400 participants from the general public (nationals and long-term residents) stratified by gender, age and nationality across all geographic locations in Qatar.

PRIMARY AND SECONDARY OUTCOME MEASURES

Responses were scored from 0% to 100% and KAP scores were classified as low (0%-49%), intermediate (50%-74%) or high (75%-100%). Analyses and comparisons were performed using descriptive statistics and χ² test at 5% level.

RESULTS

Most participants (54%) had an intermediate overall KAP score, 43% had a low score and only 3% had a high score. The knowledge scores were the lowest among participants, 69% had low, 29% had intermediate and only 2% had high scores. Participants scored better in attitude and practice; the percentages of participants who scored high, intermediate and low were 32%, 55% and 13% for attitude, and 37%, 33% and 30% for practice, respectively. Except for age, level of knowledge significantly varied by gender, nationality and diabetes-related diagnosis (p<0.001); attitude and practice levels differed significantly in all four factors. Areas where participants were deficient include: diabetes types, risk factors, signs and symptoms, complications, recommended daily exercise, normal fasting glucose level, preventive measures, management and control and understanding about complexity of diabetes.

CONCLUSIONS

Participants generally have intermediate levels of positive attitudes and practices towards diabetes but low knowledge in diabetes-related factors. The data suggest that future communications should focus on educating the public and conduct mass campaigns about diabetes to improve knowledge especially targeting men and women, and both nationals and expatriates.

Characterizing epidemiology of prediabetes, diabetes, and hypertension in Qataris: A cross-sectional study

OBJECTIVES

To characterize the epidemiologic profiles of prediabetes mellitus (preDM), diabetes mellitus (DM), and hypertension (HTN) in Qataris using the nationally representative 2012 Qatar STEPwise Survey.

METHODS

A secondary data analysis of a cross-sectional survey that included 2,497 Qatari nationals aged 18-64 years. Descriptive and analytical statistical analyses were conducted.

RESULTS

Prevalence of preDM, DM, and HTN in Qataris aged 18-64 years was 11.9% (95% confidence interval [CI] 9.6%-14.7%), 10.4% (95% CI 8.4%-12.9%), and 32.9% (95% CI 30.4%-35.6%), respectively. Age was the common factor associated with the three conditions. Adjusted analyses showed that unhealthy diet (adjusted odds ratio (aOR) = 1.84, 95% CI 1.01-3.36) was significantly associated with preDM; that physical inactivity (aOR = 1.66, 95% CI 1.12-2.46), central obesity (aOR = 2.08, 95% CI 1.02-4.26), and HTN (aOR = 2.18, 95% CI 1.40-3.38) were significantly associated with DM; and that DM (aOR = 2.07, 95% CI 1.34-3.22) was significantly associated with HTN. Population attributable fraction of preDM associated with unhealthy diet was 7.7%; of DM associated with physical inactivity, central obesity, and HTN, respectively, was 14.9%, 39.8%, and 17.5%; and of HTN associated with DM was 3.0%.

CONCLUSIONS

One in five Qataris is living with either preDM or DM, and one in three is living with HTN, conditions that were found to be primarily driven by lifestyle factors. Prevention, control, and management of these conditions should be a national priority to reduce their disease burden and associated disease sequelae.

Dysbiosis of the Salivary Microbiome is Associated with Hypertension and Correlated with Metabolic Syndrome Biomarkers

BACKGROUND

Hypertension (HT) is an idiopathic disease with severe complications and a high incidence of global mortality. Although the disease shares characteristic features with diabetes and obesity, the complex interplay of endogenous and environmental factors is not well characterized. The oral microbiome has recently been studied to better understand the role of commensal microorganisms in metabolic disorders, including HT, although its role in disease etiology is unclear.

METHODS

To bridge this gap, we compared the oral microbiome and clinical chemistry of adult subjects enrolled at Qatar Biobank. Clinical chemistry was performed using Roche Cobas-6000 analyzer. Saliva samples were subjected to 16S rRNA sequencing using Illumina MiSeq platform. Cross-gender comparisons were made between control (males/females) (C-M and C-F) and HT (HT-M and HT-F) groups.

RESULTS

The HT groups had higher (p ≤ 0.05) BMI, plasma glucose, insulin, C-peptide, and alkaline phosphatase (ALP) concentrations. Triglycerides, cholesterol, LDL-cholesterol, and sodium ions were similar among the groups. The microbiome was predominantly occupied by Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. Firmicutes were higher (p ≤ 0.05) in the HT groups, whereas Proteobacteria was only higher in the C-F group. Prevotella and Veillonella were significantly higher in the HT groups and exhibited a positive correlation with blood pressure and hyperglycemia. In contrast to other studies, the mathematical summation of priori-select microbes reveals that nitrate-reducing microbes were higher in the HT groups compared with the controls.

CONCLUSION

In conclusion, these observations suggest a strong association of HT with microbial dysbiosis, where microbial species other than nitrate-reducing microbes contribute to blood pressure regulation. The findings affirm plausible microbial signatures of hypertension and suggest manipulating these microbes as a novel treatment modality. Future experiments are warranted for the mechanistic investigation of hypertension metagenomics and microbial activity.

Disease Burden, Mechanism and Management of Obesity – Where Do We Stand?

The role of increased body mass index in general morbidity and mortality is well documented. This global public health issue continues to represent a major burden and threat to health systems and the population’s wellbeing. Global statistics show that the prevalence of obesity has increased about three times since the mid-1970s, and an upward trend is still observed, not only in developed but also in developing countries. We used several databases, including PubMed, ProQuest, and Google Scholar, to perform a literature search and review on obesity. Keywords such as “obesity”, “overweight”, and “BMI” were used in combination with multiple keywords such as “mechanism”, “factors”, “socio-economic”, “environmental”, “social determinants”, “management”, “treatment”, “non-traditional treatment”, “alternative therapies”, “non-pharmaceutical treatment” etc. and related phrases. According to the literature, the management of obesity is difficult due to the complex nature of this problem in terms of its course, complications, risks, and etiological factors. The role of alternative therapies in obesity management is still unclear, and further research is needed in this area. Recently introduced weight-loss and -management devices can also help in losing excess bodyweight. The present article summarizes relevant information related to obesity, collected from different regions of the world, and discusses diverse interventional approaches to treat obesity.

Serum Magnesium and Cognitive Function Among Qatari Adults

Background: Previous studies found that low blood magnesium increases the risk of several diseases such as cardiovascular diseases (CVD), diabetes, and hypertension. These ailments are associated with declined cognitive function.

Objective: We aimed to examine the association between serum magnesium and cognitive function among Qatari adults. In addition, we assessed the interaction relation between low serum magnesium, hypertension, and diabetes in relation to cognitive function.

Method: Data from 1,000 Qatari participants aged ≥20 years old who participated in the Qatar Biobank (QBB) Study were analyzed. Serum magnesium was measured by an automated calorimetric method and suboptimal magnesium was characterized by <0.85 mmol/l. Cognitive function was determined by measuring the mean reaction time (MRT) based on a computer-based, self-administered test. Multivariable linear regression was used to examine the relation between serum magnesium concentrations and cognitive function.

Results: The prevalence of suboptimal magnesium was 57.1%. Across the four quartiles of serum magnesium from the lowest to the highest, the regression coefficients (95% CI) for MRT were 0 (reference), −17.8, −18.3, and −31.9 (95% CI 2.4–3.1; p for trend 0.05). The presence of hypertension and diabetes significantly increased the MRT. Women with suboptimal magnesium and hypertension had the highest MRT.

Conclusion: The prevalence of suboptimal magnesium is high in Qatar. There was a direct association between serum magnesium and cognitive function. Low magnesium concentrations were associated with a longer MRT.

Association of low serum magnesium with diabetes and hypertension: Findings from Qatar Biobank study

AIM

We aimed to examine the association between serum magnesium and diabetes and hypertension among Qatari adults.

METHODS

In the cross-sectional study, we used data from 9693 Qatari participants aged 20 years and above attending the Qatar Biobank (QBB) Study. Blood samples were analyzed in a central lab. Habitual food consumption was assessed by a food frequency questionnaire. Reduced rank regression was used to construct magnesium related dietary pattern (MRDP) using serum magnesium as a response variable. Diabetes was defined by blood glucose, HbA1c or known diabetes. Prediabetes was defined as HbA1c between 5.7% and 6.4%. Subclinical magnesium deficiency was defined as serum magnesium <0.85 mmol/L.

RESULTS

The prevalence of diabetes, prediabetes and subclinical magnesium deficiency was 18.9%, 11.5% and 59.5%, respectively. Across the quartiles of serum magnesium from high to low, the prevalence ratios (PR 95%CI) for diabetes were 1.00, 1.35, 1.88, and 2.70 (95%CI 2.38-3.05), respectively (p for trend <0.001). The presence of hypertension significantly increased the probability of diabetes along a wide range of low serum magnesium. A low intake of MRDP was also positively associated with diabetes and high HbA1c.

CONCLUSION

Subclinical magnesium deficiency is common in Qatar and associates with diabetes, prediabetes and hypertension in Qatari adults.

An Overview of Disease Burden, Mechanism, Traditional and Non-traditional Management of Type 2 Diabetes

Diabetes is a major global health problem leading to high morbidity, mortality, and economic burden. Diabetes is connected to complex social, environmental, and behavioral factors and requires multisectoral evidence-based strategies to reduce its incidence and prevalence. Here we attempt to connect existing diabetes data with the underlying mechanism of the disease, while touching disease processes and traditional management approaches for diabetes and its complications. The major objective of this manuscript is to examine the effect of nontraditional treatment modalities, e.g. non-pharmaceutical interventions, supplements, alternative and integrative therapies etc., on diabetes. We performed an extensive literature search and review using electronic databases (PubMed and Google Scholar) to examine recent and historical diabetes statistics, the underlying mechanism of the disease, traditional treatments, remission possibility, and finally, the role of alternative therapies and supplements in its management. We found that there is no sufficient evidence to make most of the alternative therapies the first line of management and prevention approach for diabetes. Long-term and large-scale studies are needed to evaluate the safety and efficacy of alternative medicine. We feel that this review could urge other health researchers to plan comprehensive studies to examine the role of alternative or newly-identified therapies in diabetes. Also, this information can be useful for diverse health professionals and policymakers in developing and implementing evidence-based strategies.

Knowledge and Perception of Diabetes and Available Services among Diabetic Patients in the State of Qatar

INTRODUCTION

Diabetes is a major public health concern in Qatar. This study examined diabetes knowledge and perception of available services for diabetes control among diabetic patients in Qatar.

METHODS

Data from 300 diabetic patients were collected through face-to-face interviews using a semi-structured questionnaire between February and May 2015 at Hamad Medical Corporation healthcare facilities in Qatar. Survey responses were represented as frequencies, and Chi-square tests were used to compare proportions across gender. A p-value of 0.05 was considered statistically significant.

RESULTS

31% of patients had Type 1 Diabetes (T1D) (females 36.6%, males 26.5%) and 54% had Type 2 Diabetes (T2D) (males 56.6%, females 50%). Knowledge about diabetes types did not differ by sex (P=0.16). 32.3% of patients were treated for diabetes-related complications including: high cholesterol (39.2%), vision problems (33.1%), hypertension (30.0%), and foot problems (25.1 %). Most patients were diagnosed at primary care clinics (41.7%). During visits, 78.3% of patients reported that they were fully advised about different diabetes tests. 57.0% of patients had ≥4 visits for diabetes checkups in the past 12 months. 66.7% of patients reported that they were confident or very confident in managing their diabetes as a result of their healthcare visits in the past year. The majority of patients reported receiving diabetes-related guidance from physicians (89.7%).

CONCLUSIONS

Study participants had variable knowledge of diabetes, its complications and risk factors, and services available to diabetics. More comprehensive education and awareness about diabetes is recommended for both patients and family members. At the provider level, further improvement in patient counseling and promotion of available services can be beneficial.

The prevalence and characteristics of overweight and obesity among students in Qatar

OBJECTIVES

To estimate the prevalence of overweight and obesity using World Health Organisation (WHO) cut-offs for the body mass index (BMI) among students of the general population living in Qatar in the period 2015-2016.

STUDY DESIGN

Cross-sectional study.

METHODS

The study includes 164,963 students aged 5-19 years. The body weight and height were measured to calculate the BMI. The WHO standard cut-offs were used to categorise the BMI into severe thinness (BMI z-score <-3), thinness (BMI z-score ≥-3 to <-2), normal (BMI z-score ≥-2 to <1), overweight (BMI z-score ≥+1 to <+2) and obese (BMI z-score >+2).

RESULTS

Overweight and obesity prevalence was 44.8% and 40.4% among males and females and 45.6% and 40.9% among Qatari and non-Qatari students, respectively. Odds of obesity and overweight status were significantly higher among 10-14 and 15-19 age groups than 5-9 years age group (P < 0.001). By sex, males had 1.48 times higher odds of having obesity than females (P < 0.001), and Qatari nationals had 1.4 times higher odds of obesity than non-Qataris (P < 0.001). Although non-Qatari males also had higher odds of being overweight than females (odds ratio [OR] = 1.05, P = 0.0006), the opposite was seen among Qatari students (OR = 0.95, P = 0.01).

CONCLUSION

The result of this survey provides evidence of a high prevalence of overweight and obese students living in Qatar. Therefore, preventive strategies are essential in this population to lower the incidence of being overweight and obesity.

Obesity and Related Factors Among Children and Adolescents in Qatar

Overweight and obesity are major public health issues worldwide impacting millions of people. The prevalence of increased body weight among children and adolescents is becoming a global phenomenon. The State of Qatar is also experiencing the effects of obesity pandemic among adults and younger populations. In order to examine obesity and overweight parameters, a literature review was carried out using key scientific databases. Furthermore, this mini-review examines the selected factors that could be associated with obesity and overweight situation among children and adolescents living in Qatar. The results showed that the obesity is indeed a major public health issue among youth in Qatar.

An Overview of Infant Mortality Trends in Qatar from 2004 to 2014

Background Infant mortality is an important health indicator that estimates population well-being. Infant mortality has declined globally but is still a major public health challenge. This article provides the characteristics, causes, burden, and trends of infant mortality in Qatar. Methods Frequencies, percentages, and rates were calculated using data from birth-death registries over 2004-2014 to describe infant mortality by nationality, gender, and age group. We calculated the relative risks of the top causes of infant mortality among subgroups according to the 10^th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10, Version 2016). Results During 2004-2014, 204,224 live births and 1,505 infant deaths were recorded. The infant mortality rate (IMR) averaged 7.4/1000 live births (males 8.1, females 6.6, non-Qataris 7.7, and Qataris 6.8). IMR declined 20% from 2004 to 2014. The decline in IMR was significant for the overall population of infants (p=0.006), male infants (p=0.04), females (p=0.006), and for non-Qatari males (p=0.007) and non-Qatari females (p=0.007). The leading causes of infant mortality were congenital malformations (all types) (34.5%), low birth weight (LBW) (27%), and respiratory distress of newborns (2.8%). Male infants had a higher risk of mortality than female infants due to a congenital malformation of lungs (p=0.02), other congenital malformations, not elsewhere classified (p=0.01), and cardiovascular disorders (p=0.05). Conclusion The study shows that infant mortality among male infants is high due to the top infant mortality-related disorders, and male infants have a higher risk of mortality than female infants.

An Overview of Food Patterns and Diet Quality in Qatar: Findings from the National Household Income Expenditure Survey

INTRODUCTION

Availability of accurate data pertaining to a population's dietary patterns and associated health outcomes is critical for proper development and implementation of related policies. This article is a first attempt to share the food patterns, amounts and diet quality among households (HH) in Qatar.

METHODS

Data from the 2012-2013 Qatar National Household Income and Expenditure Survey (HIES) was used. This cross-sectional survey included 3723 HH (1826 Qatari HH and 1897 non-Qatari HH). Dietary data on monthly amounts food items available at HH according to the nationality was used. The food items were expressed in terms of grams per capita per day and aggregated into groups to examine the food patterns, energy, and adequacy.

RESULTS

The overall average amount of purchased food at HH in Qatar was 1885 g/capita/day. Qatari HH purchased more food (2118 g/capita/day) versus non-Qataris (1373 g/capita/day); however, the percentages of the amounts purchased by food types were similar among both nationalities. Average daily energy (kcal) per capita was almost double among Qatari HH (4275 kcal) vs. non-Qatari HH (2424 kcal). The food items under subsidy program for Qatari citizens provided 1753 kcal/capita/day and accounted for 41% of total daily energy. Proteins (29.2), fats (39.2), sodium (3.3), and vitamin C (32.5) had higher than recommended levels of nutrient density (grams per 1000 kcal). Calcium (227), vitamin A (302.3), fiber (2.0), and carbohydrates (132.6) had lower than recommended levels of nutrient energy density (g/1000 kcal).

CONCLUSIONS

The study predicts unhealthy dietary habits among HH in Qatar and provides useful information for policy makers and healthcare community.