Elsevier

Journal of Diabetes and its Complications

Volume 22, Issue 5, September–October 2008, Pages 317-324
Journal of Diabetes and its Complications

Original articles
An increase in prevalence of diabetes mellitus in Jordan over 10 years

https://doi.org/10.1016/j.jdiacomp.2007.01.004Get rights and content

Abstract

Objective

This study aimed to determine the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glycemia (IFG), identify their associated factors, determine how the prevalence of type 2 DM has changed over 10 years, and assess the awareness and state of control of diabetes in Jordan.

Methods

Data were analyzed from a cross-sectional study that included a random sample of 1121 Jordanians aged 25 years and above. A subject was deemed affected by DM if this diagnosis was known to the patient or if his or her condition complies with the American Diabetes Association definition. IFG was defined as a fasting serum glucose level of ≥6.1 mmol/l (110 mg/dl) but <7 mmol/l. HbA1c >7.5% was defined as “unsatisfactory” metabolic control.

Results

The age-standardized prevalence of diabetes and IFG was 17.1% and 7.8%, respectively, with no significant differences between women and men. Of the 195 diabetic subjects, 146 (74.9%) had been previously diagnosed. More than half (54%) of those previously diagnosed were found to be with unsatisfactory glycemic control. Compared to the 1994 survey, there was a significant increase in the prevalence of diabetes by 31.5%. Increase in age, increase in body mass index, and having a family history of diabetes were associated with increased odds of diabetes and IFG. While the level of education had no effect on IFG, higher level of education was associated with a decrease in the odds of having diabetes.

Conlusion

The prevalence of type 2 diabetes and IFG is high in Jordan and is increasing. More than half of the patients with diabetes have unsatisfactory control. Therefore, they are likely to benefit from programs aimed at encouraging behaviors toward achieving optimum weight as well as physical activity behaviors. Physicians caring for patients with diabetes may need to adopt a more vigorous approach for diabetes control.

Introduction

Diabetes mellitus (DM) is a major risk factor for cardiovascular disease (Jaffe, Nag, Landsman, & Alexander, 2006). It predisposes to vascular, renal, ophthalmic, and neurological complications that impair the quality of life and presents a high burden to both individuals and society in terms of morbidity and economic costs (Engelgau et al., 2004). Diabetes has diverse geographical distribution and varies widely between populations (Harris et al., 1988), reflecting differences in both environmental influences and genetic susceptibility (Amos, McCarty, & Zimmet, 1997). Studies have reported an increasing prevalence of type 2 diabetes, with the most dramatic increase occurring in developing countries (Al-Lawati et al., 2002, Al-Nuaim, 1997, Amos et al., 1997, El Mugamer et al., 1995, Midthjell et al., 1984, Musaiger, 1992). It has been reported that patients with undiagnosed diabetes represent 25% to 66% of the overall diabetic population (Glumer et al., 2003, Wilks et al., 1999). Early recognition and treatment has a potential benefit of reducing the incidence of vascular complications of type 2 diabetes (UK Prospective Diabetes Study Group, 1998). Such complications were reported to be more common in patients with poor metabolic control and a longer course of diabetes (Foss, Paccola, de Souza, & Iazigi, 1989). Obesity and physical inactivity are well-established risk factors that contribute substantially for the increased incidence of diabetes (Zimmet, 1991). In developing countries, increasing life expectancy is an important factor for such increase (McCarty & Zimmet, 1994).

Earlier studies had applied former criteria for the diagnosis of DM (World Health Organization [WHO], 1985), which differ from the more recent criteria currently recommended by the WHO and the American Diabetes Association (ADA; Report of the Expert Committee, 1997, World Health Organization, 1999). In the present study, we used the current ADA criteria to determine the prevalence of type 2 DM and impaired fasting glycemia (IFG), to identify their associated factors, and to determine how the prevalence of type 2 DM has changed in Jordan over 10 years. Furthermore, we assessed the awareness and state of control of diabetes among patients with known diabetes.

Section snippets

Study population and data collection

A survey was conducted in the town of Sarih in Jordan. This town with about 3328 households and 19,227 residents (Department of Statistics 2002-Jordan) was selected because of the presence of a large comprehensive health center in which to perform the study, because of its proximity to the study team, and because this town showed the highest response rate in the 2002 Behavioral Risk Factor Survey (Shehab, Belbeisi, & Walke, 2003). This survey did not show evidence to conclude that this town is

Demographic, anthropometric, and metabolic characteristics of the participants

A total of 1121 participants (394 men and 727 women), aged 25 years and above, were included in this study. Their age ranged from 25 to 85 years with a mean of 46.2. About 52% of the subjects had less than high school education. Fifty-four percent (54%) were married and 43% were single. Their characteristics according to plasma glucose level are depicted in Table 1. The mean age at diagnosis of type 2 DM was 50.0±11.2 years with no gender differences (P=.633). Patients with diabetes and

Discussion

The total number of respondents included in this study was 1121, and the response rate was 94.0%. Work outside the town was the main reason for nonparticipation.

Epidemiological studies in different populations around the world have demonstrated a marked variation in the prevalence of DM, IFG, and rate of awareness and control of diabetes among different countries and among ethnic groups in one country (King & Rewers, 1993). This variation may be partly due to the use of different criteria for

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