Epidemiology of diabetes mellitus in Oman results from two decades of research

This study aimed to describe the epidemiology of diabetes mellitus over the past two decades in Oman, particularly in terms of its prevalence and incidence. In addition, the study sought to estimate the future incidence of diabetes in Oman. Three national and three regional surveys conducted between 1991 and 2010 were analysed to obtain the age-adjusted prevalence and undiagnosed proportion of type 2 diabetes mellitus [T2DM] among Omani subjects aged >/=20 years. Diabetes mellitus registers and published studies were used to determine incidence rates of both type 1 diabetes mellitus [T1DM] and T2DM in Oman. Linear regression was used to determine trends and projections for diabetes in 2050. The age-adjusted prevalence of T2DM in Oman varied from 10.4% to 21.1%, while the highest prevalence of impaired fasting glucose was found in males [35.1%]. In comparison to men, higher incidence rates of T2DM were found in women [2.7 cases compared to 2.3 cases per 1,000 person-years, respectively]. No significant trends were observed for the prevalence or incidence of T2DM in both genders. Undiagnosed T2DM was more common in men [range: 33-68%] than women [range: 27-53%]. The results of this study show that by 2050, there will be an estimated 350,000 people with T2DM living in Oman [a 174% increase compared to estimates for 2015]. Health authorities need to prioritise diabetes prevention and control in order to prevent or delay long-term complications and avert a potential epidemic of diabetes in Oman

HbA1c levels among primary healthcare patients with type 2 diabetes mellitus in Oman

To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c [HbA1c] levels compared to older patients, and to determine the factors associated with higher HbA1c levels. Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios [OR], and 95% confidence intervals [CI] from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate [eGFR], tobacco use, and healthcare index as predictors of good [HbA1c <7%] vs.poor [>/= 7%] glycemic control. Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old [OR=1.7; 95% CI 1.1 to 2.6] and 60+ year [OR=2.5; 95% CI 1.6 to 4.0], female gender [OR=1.5; 95% CI 1.2 to 2.0] and in patients with eGFR >/= 60 mL/min/1.73 m[2] [OR=1.9; 95% CI 1.1 to 3.3]. Longer duration of diabetes [>/= 5years] and treatment with oral agents or insulin were inversely related to good glycemic control. Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams

Characteristics, management, and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman

To determine clinical characteristics, management, and in-hospital outcomes of diabetic and non-diabetic patients admitted with acute coronary syndrome [ACS] in Oman. Data were analyzed from 1583 consecutive patients admitted to various hospitals in Oman with ACS from May 8 to June 6, 2006, and from January 29 to June 29, 2007, as part of the Gulf RACE [Registry of Acute Coronary Events]. The ACS patients were stratified into those with and without diabetes mellitus. In this study, 588 [37%] patients were diabetic with a mean age of 59 years and included more female than male diabetics [43% versus 33%; p<0.001]. Diabetic patients were more likely to present with unstable angina [55% versus 44%; p<0.001] and less likely to present with ST elevation myocardial infarction [20% versus 27%; p=0.001]. Both groups received ACS treatment equally; however, diabetic patients were more likely to be treated with glycoprotein IIb/IIIa antagonists and angiotensin-converting enzyme inhibitors or receptor blockers. Diabetic patients experienced more recurrent ischemia [12% versus 8%; p=0.043], heart failure [29% versus 23%; p=0.009], cardiogenic shock [7.5% versus 4.6%; p=0.018], and ventilator requirement [7.3% versus 4.1%; p=0.006]. When adjusted for age and gender, diabetes status was an independent risk factor of in-hospital mortality in ACS patients [adjusted odd ratio, 1.68; 95% confidence interval, 1.02-2.77; p=0.042]. Diabetic ACS patients have different clinical characteristics and poorer outcomes. Present treatment strategies are not sufficient to counter the adverse impact of diabetes. More effective and evidence-based therapeutic strategies should be identified and used in diabetic ACS patients

Pregnancy outcomes of diabetic women: charting Oman's progress towards the goals of the saint vincent declaration

Oman provides comprehensive care for the detection and management of diabetes during pregnancy with the goal of reducing or eliminating adverse outcomes for mothers and newborns. We assessed the outcome of pregnancies complicated with diabetes as compared to healthy controls. A 1-year retrospective review of registry records was conducted on pregnant women with gestational diabetes mellitus [GDM] and pre-gestational diabetes mellitus [PGDM]. Of the 5394 women registered, 225 had GDM and 56 had PGDM. Fourteen cases of GDM and 2 cases of PGDM were excluded. For each patient recruited, the next healthy control of the same age and parity was selected. Nearly 80% of diabetic women achieved good glycemic control [hemoglobin A1c <7%]. Adjusted for hypertension and body mass index, the risk of macrosomia was three times higher among women with GDM [OR=3.03, 95% CI=1.36-6.75] and up to seven times higher among those with PGDM [OR=7.20, 95% CI=2.30-22.61]. A significantly higher risk of cesarean delivery was observed among women with GDM [OR=2.70, 95% CI=1.17-4.03] and PGDM [OR=4.39, 95% CI=1.68-11.49]. Admission to the special care baby unit was higher among infants born to mothers with PGDM [OR=5.70, 95% CI=2.40-13.51] and GDM [OR=2.85, 95% CI=1.68-4.83]. The findings indicate that many of the unfavorable pregnancy outcomes of diabetes for women and infants have not been brought under control despite the comprehensive care provided. Further studies are recommended to evaluate the system of care provided to pregnant women and to identify gaps in achieving the goals of the St. Vincent Declaration

Epidemiological transition of some diseases in Oman: a situational analysis

During the past 35 years Oman has undergone a rapid socioeconomic and epidemiological transition leading to a steep reduction in child and adult mortality and morbidity due to the decline of various communicable diseases, including vaccine-preventable diseases. Good governance and planning, together with leadership and commitment by the government, has been a critical factor in this reduction. However, with increasing prosperity, lifestyle-related noncommunicable diseases have emerged as new health challenges to the country, with cardiovascular diseases, diabetes and obesity in the lead among other chronic conditions. Appropriate prevention strategies for reducing the burden of noncommunicable diseases are discussed

Knowledge, attitudes and prevalence of tobacco use among physicians and dentists in Oman

Tobacco use among Omani physicians and dentists has not been studied, so we conducted a cross sectional survey using a WHO questionnaire to measure prevalence and to learn about smoking practices among this population and about their knowledge and attitudes of the health effects of tobacco use and tobacco control. The 1191 subjects who participated [787 men and 404 women] ranged in age from 24 to 65 years with a mean [SD] of 41.7 [6.8] years for men and 38.1 [6.9] years for women. The prevalence of tobacco use was 16.4% among males and less than 1% among females. Manufactured cigarettes were the most common form of tobacco used [14.7%], followed by smokeless tobacco [2.2%] and waterpipes [1.7%]. Tobacco users were significantly less favorable to strict control and policy measures than never tobacco users and had less knowledge of some of the heatlh effects of tobacco use. Tobacco use among physicians and dentists in Oman is lower than in other countries in the region, but remains a cause of concern. Programs and policies should strive to maintain the low level of tobacco use or reduce it further

Prevalence and determinants of waterpipe tobacco use among adolescents in Oman

To assess the prevalence and determinants of waterpipe use among school-going adolescents in Oman. A cross-sectional, school-based study was conducted in 2003 involving 9 regions of Oman, as part of the Global Youth Tobacco Survey. Participants were requested to complete an anonymous questionnaire containing demographic characteristics, current and previous use of waterpipe tobacco, attitudes towards cigarette smoking, parents' and friends' cigarette smoking habits. Proportions were used to calculate prevalence rates and logistic regression analysis to obtain odds ratio [OR] and 95% confidence interval [CI]. 1,962 students participated of whom 1,005 [51.2%] were males. Eighty-eight percent were between 13 and 16 years of age. Five hundred and twenty-two [26.6%] reported ever smoking waterpipe tobacco while 189 [9.6%] were current users. Among males, 155 [15.5%] were current users while among females only 24 [2.6%] smoked currently. Study participants were more likely to use waterpipe if they had a parent or friend who smoked cigarettes. Adolescents were, however, less likely to use waterpipe tobacco if they believed that cigarette smoking was harmful to health. Students who were receiving 500 Baisas [US$ 1.3] or more per day pocket money were more likely to use waterpipe tobacco compared to those receiving less [OR 3.3, 95% CI 2.3 to 4.6]. In multivariate analysis, the OR for males being a smoker of waterpipe tobacco compared to females was 4.46 [95% CI, 2.38 to 8.35]; while the OR for most or all friends smoking cigarettes compared to non-smoking was OR 5.65 [95% CI 2.87 to 11.13]. Study participants who perceived smoking as harmful to health were less likely to use waterpipe tobacco compared to those who did not believe smoking was harmful [OR 0.31, 95% CI 0.29 to 0.92] and those receiving 500 Baisas or more [OR 2.2, 95% CI 1.5 to 3.2]. Waterpipe smoking among Omani adolescents is an emerging public health concern. Efforts to prevent adolescent smoking should be designed with knowledge of associated factors of such behaviour and should include all forms of tobacco

Prevalence and 10-year secular trend of obesity in Oman

To determine the prevalence of overweight and obesity by age, gender and region and to assess the difference between rural and urban populations and determine the trends of the past decade. Analysis of nationally represented samples from 2 cross-sectional surveys conducted in 1991 and 2000, containing 5,086 and 6,400 Omani citizens aged >=20 years. Body mass index [BMI] [weight in kg] divided by height [in meters squared] was calculated using measured height and weight data. Overweight was defined as BMI 25-29.9 kg/m2 and obesity as BMI >= 30 kg/m2. In the year 2000, the age adjusted prevalence of obesity reached 16.7% in men, compared to 10.5% in 1991 [p<0.001]. In women, the prevalence was 23.8% in 2000, compared to 25.1% in 1991 [p=0.231]. Similarly, the prevalence of overweight increased among men, from 28.8-32.1% [p=0.011] and decreased among women, from 29.5-27.3% [p=0.053]. When obesity and overweight were combined, there was a significant increase in men [9.5%; p for the change <0.001] and decrease in women [3.5%; p for the change <0.003]. Obesity and overweight combined was markedly more common in the Southern part of Oman [70%] compared to Northern areas [32-57%]. People living in urban areas were more obese [21.1%] than those living in the rural communities [13.1%] [p<0.001]. The prevalence of obesity is high in Oman and has increased predominantly among men. Primary prevention programs are needed to counteract this condition and its cardiovascular and metabolic complications

Diabetes in Oman: Comparison of 1997 American diabetes association classification of diabetes mellitus with 1985 WHO classification

Diabetes mellitus [DM] is a major public health problem in Oman. We evaluated the impact of the revised diagnostic criteria for DM adopted by the American Diabetes Association [ADA] on the prevalence of diabetes and impaired glucose tolerance [IGT], and on the classification of individuals among the Omani population. Subjects and We used the dataset of the National Diabetes Survey, conducted in 1991 and involving 4682 subjects who did not have any missing data on fasting and 2-hour glucose. The subjects comprised 2002 males and 2680 females aged 20 years or above. Data were analyzed using the ADA criteria [diabetes as fasting plasma glucose [FPG] 7 mmol/L, impaired fasting glucose [IFG] as FPG 6.1 mmol/L and <7 mmol/L], and compared these with the World Health Organization [WHO] criteria [diabetes as FPG 7.8 mmol/L and/or 2-hour post-glucose load 11.1 mmol/L, IGT as FPG <7.8 mmol/L, and 2-hour post-load 7.8-11.1 mmol/L]. Applying the ADA criteria on the Omani population resulted in an overall reduction of diabetes prevalence by 2.2% [95% confidence interval [CI] 1.6% to 2.8%], and a 4.8% reduction of IGT [95% CI 3.8% to 5.8%]. Over 29% of diabetics classified by the WHO criteria were reclassified as being normal or having IFG by the ADA criteria. Around 3.6% of those who were normoglycemic by the WHO criteria were classified as having diabetes or IFG by the ADA criteria. In all but one region of Oman, the prevalence of diabetes and IFG using the ADA criteria was lower compared to the prevalence using the WHO criteria. Gender, age and body mass index did not seem to pose an increased risk to the probability of being diagnosed by one criteria or the other or both together. The adoption of the ADA criteria in Oman will significantly reduce the prevalence of diabetes and IGT. In addition, the glycemic status of a substantial number of individuals will be changed from normal to either being diabetic or having IGT

Vitamin use and atherosclerotic heart disease mortality: a matched case-control study in Maryland

The effect of any vitamin use was assessed in 175 subjects who died of atherosclerotic heart disease [ASHD] and 350 age and sex matched controls recruited from Washington county, Maryland, between May through November 1989. Vitamin use was inversely associated with the risk of death from ASHD [crude relative odds 0.83 [95% C.I. 0.53 to 1.29; p = 0.413]]. After adjustment for multiple cardiovascular risk factors using conditional logistic regression, the protective effect of vitamins in lowering the risk of ASHD was enhanced, [adjusted relative odds 0.61 [95% C.l. 0.37 to 0.99 p= 0.047]]. Other significant risk factors for ASHD were current cigarette smoking [adjusted relative odds 2.63 [95% C.l. 1.46 to 4.7; p = 0.001]], taking two or more medications concurrently [other than antihypertensive and antihyperlipidemic drugs] [adjusted relative odds 2.28 [95% C.l. 1.46 to 3.55; p= 0.001]] and being on antihypertensive treatment [adjusted relative odds 1.63 [95% C.l. 1.06 to 2.49; p = 0.025]]. Systolic and diastolic blood pressure, blood cholesterol, education and body mass index were found not to be significantly associated with ASHD after adjusting for current treatment for hypertension, current cigarette smoking and taking more than two medications