Fatma Al-Maskari

Prevalence of risk factors for diabetic foot complications

BackgroundFoot complications are common in diabetic patients and are considered one of the most expensive diabetes (DM) complications to treat. The aim of this study was to determine the prevalence and risk factors for foot complications among diabetic patients in Al-Ain district, United Arab Emirates (UAE).MethodsThe study was part of a general cross-sectional survey carried out to assess the prevalence of DM complications in Al-Ain district, UAE. A sample of 513 diabetic patients with a mean age of 53 years (SD: ± 13) were randomly selected during 2003/2004. All completed an interviewer-administered questionnaire and underwent medical assessment including foot examination and assessment of presence of peripheral neuropathy (PN) and peripheral vascular disease (PVD).ResultsForty nine percent of the study populations were diagnosed to have DM without presenting with symptoms of diabetes and 35% had hypertension. The majority (86%) had type 2 DM. Of the total sample, 39% (95% CI: 35.1-43.7%) had PN and 12% (95% CI: 8.8–14.4%) had PVD. There were no cases of amputation and only one case had previous history of lower extremity ulceration. Significant risk factors for PN and PVD were: male gender, poor level of education, UAE nationality, increased duration of diabetes, type 2 DM, presence of hypertension and microalbuminuria (MA).ConclusionDespite the low prevalence of foot ulceration and amputation among the study population, nevertheless, a substantial proportion had potential risk factors for foot complications.

Prevalence of diabetic retinopathy in the United Arab Emirates: a cross-sectional survey

BackgroundDiabetic retinopathy (DR) is one of the leading causes of blindness. The aim of this study was to estimate the prevalence and determinants of retinopathy among diabetics in Al-Ain city, United Arab Emirates (UAE).MethodsThe study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes (DM) complications including retinopathy among known diabetic patients in Al-Ain District, UAE. Patients were randomly selected during 2003/2004. Patients completed an interviewer-administered questionnaire carried out by treating doctors and underwent a complete medical assessment. All patients were examined for evidence of diabetic retinopathy by ophthalmologist and their fundi were examined using slit lamp examination and fundus photography of each eye through dilated pupils.ResultsA sample of 513 diabetic patients was selected with a mean age of 53 years (SD ± 13.01). Retinopathy was present in 19% (95% CI: 15.1–23.5%) of the study population. Most patients (74%) were not aware of their condition. The disease was more common among males (24.2 vs. 13.9%; p = 0.016), increased with increasing age (p = 0.004) and disease duration (p = 0.0001). Type I DM was a highly significantly contributing risk factor (38.3% for type 1, vs. 16.4% for type 2; p < 0.0001). Retinopathy was higher among patients with hypertension, microalbuminuria, peripheral vascular disease, coronary artery disease and neuropathy.ConclusionThe prevalence of DR in the UAE was (19%) and significantly affected elderly males. Regular screening to detect DR is highly recommended as with the early detection of proliferative retinopathy and timely laser photocoagulation which are known to prevent most of the diabetes related blindness.

Assessment of the direct medical costs of diabetes mellitus and its complications in the United Arab Emirates

BackgroundDiabetes mellitus (DM) is a major health problem in the United Arab Emirates (UAE) and is well recognized as a major and increasing burden to the countrys resources due to its severe, long term debilitating effects on individuals, families and the society at large. The aim of the study was to estimate the direct annual treatment costs of DM and its related complications among patients in Al-Ain city, UAE.MethodsA sample of 150 DM patients were enrolled during 2004-2005, and their medical costs over the ensuing 12 months was measured, quantified, analyzed and extrapolated to the population in Al-Ain and UAE, using conventional and inference statistics. The costs were converted from UAE Dirhams to US Dollar, using the official conversion rate of US

Indoor air pollutants and health in the United Arab Emirates

(1 USD = 3.68 AED).ResultsThe total annual direct treatment costs of DM among patients without complications in Al Ain-UAE, was US

Assessment of dietary practice among diabetic patients in the United arab emirates.

1,605 (SD = 1,206) which is 3.2 times higher than the per capita expenditure for health care in the UAE (US

Strengthening public health medicine training for medical students: Development and evaluation of a lifestyle curriculum

497) during 2004 (WHO, 2004). However, this cost increased 2.2 times with the presence of DM related complications for patients with microvascular complications, by 6.4 times for patients with macrovascular complications and 9.4 times for patients with both micro and macrovascular complications. Likewise, the annual direct hospitalization costs of DM patients increased by 3.7 times for patients with microvascular complications, by 6.6 times for patients with macrovascular complications and by 5 times for patients with both micro and macrovascualr complications. Overall, costs increased with age, diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycemic agents or with diet control only.ConclusionsDM direct treatment costs increased with the presence and progression of chronic DM related complications. Hospitalisation costs constituted a large proportion and were increasingly higher with the presence and progression of DM related complications. To reduce the impact on healthcare resources, efforts should be made to prevent progression to DM complications, by implementing guidelines for diabetes care, screening for complications and better management.

Prevalence and determinants of microalbuminuria among diabetic patients in the United Arab Emirates

Background: Comprehensive global data on the health effects of indoor air pollutants are lacking. There are few large population-based multi–air pollutant health assessments. Further, little is known about indoor air health risks in the Middle East, especially in countries undergoing rapid economic development. Objectives: To provide multifactorial indoor air exposure and health data, we conducted a population-based study of indoor air pollution and health in the United Arab Emirates (UAE). Methods: We conducted a cross-sectional study in a population-based sample of 628 households in the UAE. Indoor air pollutants [sulfur dioxide (SO2), nitrogen dioxide (NO2), hydrogen sulfide (H2S), formaldehyde (HCHO), carbon monoxide (CO), and particulate matter] were measured using passive samplers over a 7-day period. Health information was collected from 1,590 household members via in-person interviews. Results: Participants in households with quantified SO2, NO2, and H2S (i.e., with measured concentrations above the limit of quantification) were twice as likely to report doctor-diagnosed asthma. Participants in homes with quantified SO2 were more likely to report wheezing symptoms {ever wheezing, prevalence odds ratio [POR] 1.79 [95% confidence interval (CI) 1.05, 3.05]; speech-limiting wheeze, POR 3.53 (95% CI: 1.06, 11.74)}. NO2 and H2S were similarly associated with wheezing symptoms. Quantified HCHO was associated with neurologic symptoms (difficulty concentrating POR 1.47; 95% CI: 1.02, 2.13). Burning incense daily was associated with increased headaches (POR 1.87; 95% CI: 1.09, 3.21), difficulty concentrating (POR 3.08; 95% CI: 1.70, 5.58), and forgetfulness (POR 2.68: 95% CI: 1.47, 4.89). Conclusions: This study provides new information regarding potential health risks from pollutants commonly found in indoor environments in the UAE and other countries. Multipollutant exposure and health assessments in cohort studies are needed to better characterize health effects of indoor air pollutants.

Hypokalemic periodic paralysis: a case series, review of the literature and update of management.

OBJECTIVES The aim of this study was to assess dietary practices and risk profile (hypertension, obesity, lipid profile and glycemic control) among people with diabetes in Al-Ain District, United Arab Emirates (UAE). METHODS During 2006, we performed a cross-sectional study of diabetic patients attending diabetic outpatient clinics at Tawam Hospital and primary health care centers in Al-Ain District. Subjects completed an interviewer-administered questionnaire, blood pressure, body mass index, percentage body fat and abdominal circumference were measured and recorded and the most recent HbA1c levels and fasting lipid profile were identified. RESULTS A sample of 409 diabetic patients was recruited, 50% of whom were illiterate. Only 24% read food labeling. 76% reported being unable to distinguish clearly between low and high carbohydrate index food items and no one reported counting calorie intake. 46% reported that they had never been seen by dietician since their diagnosis. Their overall risk profile, notably body weight, lipid profile and blood pressure, was very unfavorable; more than half of the study sample had uncontrolled hypertension and uncontrolled lipid profile and the majority was overweight (36%) or obese (45%). Abdominal obesity was particularly common (59%). Only 31% had an HbA1c of less than 7%. CONCLUSIONS The dietary practices of diabetic patients in the UAE are inadequate and need improvement.

The prevalence of macrovascular complications among diabetic patients in the United Arab Emirates

Background: Lifestyle factors are major determinants for health and safety. Although many graduates lack interviewing and observational skills for prevention and student lifestyle often deteriorates during training, few medical schools teach comprehensive assessment of lifestyle, particularly in the context of the home environment. Aims: A lifestyle curriculum was developed to teach basic causality and provide practical experience in assessing nutrition, exercise, safety, tobacco addiction, and food hygiene, together with generic skills in history taking, on-site observation, researching and presenting. Methods: Lifestyle has been integrated into the first-year curriculum, evaluated, and improved at the United Arab Emirates University since 2001. After an introduction to determinants of health, students conduct a home interview and observational survey for family residential and traffic safety, smoking, and food hygiene. For nutrition and exercise, students assess personal lifestyle. Generic skills are developed in the context of lifestyle. Evaluations were by faculty and students, including assessed impact on knowledge, skills, and personal lifestyle. The lifestyle curriculum was compared with other countries by detailed search. Results: Detailed evaluation found strong agreement/agreement among students that knowledge had improved on: counselling of patients and families 97%, promoting healthy lifestyles 100%; interviewing 88%; history taking 84%; using research for medical practice 89%; and importance of prevention 96%. Eighty six percent were stimulated to think in new ways about health. Improved personal diet was reported by 60% (p < 0.0004) and exercise by 55% (p < 0.0004), while 36% of non-users started wearing a safety belt in front (p < 0.0004) and 20% in the rear (p = 0.008). Literature review found comprehensive lifestyle curricula to be rare. Conclusions: A lifestyle curriculum developed prevention-oriented history-taking and observation skills for health maintenance, addressing health priorities, improving medical student lifestyle, and strengthening generic skills. Since lifestyle is a major determinant of health, medical schools should consider development of an appropriate curriculum to address their local and national health priorities.

Physical Activity and Reported Barriers to Activity Among Type 2 Diabetic Patients in the United Arab Emirates

BackgroundMicroalbuminuria (MA) represents the earliest clinical evidence of diabetic nephropathy and is a predictor of increased cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of MA among diabetic patients in the Al-Ain district of the United Arab Emirates (UAE).MethodsThe study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes mellitus (DM) complications in Al-Ain district, UAE and was the first to assess the prevalence of MA among diabetic patients. A sample of 513 diabetic patients with a mean age of 53 years (SD: ± 13) was randomly selected during 2003/2004. All patients completed an interviewer-administered questionnaire and underwent medical assessment. First morning urine collections were obtained and were tested for clinical proteinuria using urine dipsticks and for MA using the single Micral-Test II strips.ResultsMA was found in 61% (95% CI: 56.7–65.7) of the sample and the rate was significantly higher among males, positively related to body mass index (BMI), type 2 DM and presence of other DM complications such as diabetic retinopathy and neuropathy. Of the total sample population, 12.5% (95% CI: 8.1-14.1) had clinical proteinuria.ConclusionThe prevalence rate of MA was considerably high ( 61%) among diabetic patients in the UAE. Therefore, regular screening for MA is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease).