Diabesity in the Arabian Gulf: Challenges and Opportunities

Diabesity [diabetes associated with obesity] is a major global and local public health concern, which has almost reached an epidemic order of magnitude in the countries of the Arabian Gulf and worldwide. We sought to review the lifestyle trends in this region and to highlight the challenges and opportunities that health care professionals face and attempt to address and correct them. In this regard, we aimed to review the regional data and widely held expert opinions in the Arabian Gulf and provide a thematic review of the size of the problem of diabesity and its risk factors, challenges, and opportunities. We also wished to delineate the barriers to health promotion, disease prevention, and identify social customs contributing to these challenges. Lastly, we wished to address specific problems with particular relevance to the region such as minimal exercise and unhealthy nutrition, concerns during pregnancy, the subject of childhood obesity, the impact of Ramadan fasting, and the expanding role of bariatric surgery. Finally, general recommendations for prevention, evidence-based, and culturally competent management strategies are presented to be considered at the levels of the individual, community, and policymakers

Association of fto rs9939609 with obesity in the kuwaiti population: a public health concern?

Objective: To investigate the effect of the common fat mass and obesity-associated [FTO] gene polymorphism rs9939609 on body mass index [BMI] in one of the most obese populations worldwide

Subjects and Methods: Genotypic data for FTO rs9939609 were available for 1,034 unrelated Kuwaiti adults obtained from Kuwait's Dasman Diabetes Institute and Kuwait University. The association between the FTO polymorphism with BMI as continuous and categorical [normal BMI [< 25] vs. overweight/obese [> 25]] variables was analyzed using both linear and logistic regression models, respectively,with the assumption of both dominant and additive genetic models performed using the SNPassoc package from R statistics

Results: The A allele was associated with increased BMI [Beta = 1.21; 95% CI = 0.16-2.26; p = 0.023]. In concordance, the categorical BMI [normal vs. overweight/ obese] also showed a significant association between the A allele and overweight/obesity [OR = 1.47; 95% CI = 1.01-2.12; p = 0.041]. However, no association between the FTO variant was observed with cardiometabolic traits

Conclusion: We observed an association between the common FTO rs9939609 polymorphism and increased BMI [overweight/ obesity] in Kuwaiti adults, which is consistent with previous research in other populations. Our findings encourage further investigation of genetic variants to elucidate the mechanisms involved in the development of obesity in such an obesogenic population

Knee osteoarthritis in type 2 diabetes mellitus: does insulin therapy retard osteophyte formation?

Objective: The aim of this study was to investigate whether or not radiographic changes observed in knee osteoarthritis [OA] in type 2 diabetes mellitus [T2DM] patients on insulin therapy differed from those not on insulin

Material and Methods: A cross-sectional study was performed in 311 subjects: 211 T2DM patients and 100 without diabetes [controls] in Mubarak Hospital, Kuwait. Patients were categorized into 3 groups: T2DM patients not on insulin [G1, n = 99], T2DM patients on insulin [G2, n = 112] and a nondiabetic control group [G3, n = 100]. Plain X-ray of both knees was used to assess the changes of knee OA and graded using the Kellegren-Lawrence scale [0-4] and the Osteoarthritis Research Society International Atlas grading scale [0-3]. A total of 622 knee X-rays were evaluated. SPSS version 21.0 was used for data analysis

Results: A highly significant association [p < 0.0001] was observed for joint space narrowing [JSN] as well as for osteophyte formation between the three groups. Comparing G2 and G3, a highly significant association [p < 0.0001] was retained for JSN [201 [89.7%] vs. 199 [99.5%]] and for osteophyte formation [26 [11.7%] vs. 72 [36.0%]]. Comparing G1 and G2, significantly less osteophyte formation was noted in G2 patients compared to G1 patients [26 [11.7%] vs. 39 [19.7%], p = 0.02]. Multivariate logistic regression analysis showed that the G2 group had less chance of osteophyte formation than either the G1 group or G3 control group [OR = 0.294, p = 0.008 and OR = 0.098, p < 0.001, respectively]

Conclusion: Our findings show that T2DM patients with OA knees on insulin therapy have less radiographic osteophytes compared to T2DM patients not on insulin

Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus

We aimed to assess the efficacy of short-term oral vitamin D supplementation on peripheral neuropathy in patients with type 2 diabetes. Materials and This prospective, placebo-controlled trial included 112 type 2 diabetic patients with diabetic peripheral neuropathy [DPN] and vitamin D [25[OH]D] deficiency. Patients were sequentially assigned to a treatment group [n = 57] and a placebo group [n = 55]. DPN was assessed using a neuropathy symptom score [NSS], a neuropathy disability score [NDS] and a nerve conduction study [NCS]. Vitamin D status was determined by measuring the serum total 25[OH]D concentration. Patients received either oral vitamin D[3] capsules or starch capsules once weekly for 8 weeks. The primary outcome was changes in NSS and NDS from baseline. The secondary outcome was changes in the NCS result. Serum 25[OH]D concentrations significantly improved after oral vitamin D supplementation in the treatment group when compared to the placebo group [32.8 +/- 23.7 vs. 1.1 +/- 3.6, p < 0.0001]. Similarly, the improvement in NSS values was significantly greater in the treatment group than in the placebo group [-1.49 +/- 1.37 vs. -0.20 +/- 0.59, p < 0.001]. No improvement was observed for NDS and NCS between the 2 groups after treatment. Short-term oral vitamin D[3] supplementation improved vitamin D status and the symptoms of neuropathy in patients with type 2 diabetes

Hepatitis C virus infection in a population with high incidence of type 2 diabetes: Impact on diabetes complications

A growing number of reports suggest a connection between hepatitis C virus [HCV] infection and type 2 diabetes [T2D]. However, the association of HCV infection with diabetes-related complications has not yet been clarified. The aim of this study was to determine the prevalence of HCV infection in T2D-patients in Kuwait which has a high incidence of type 2 diabetes, and to investigate the association between HCV viremia and diabetes-related complications. A total of 438 patients with T2D [325 Kuwaitis and 113 Egyptians], and 440 control subjects, were enrolled for this study. HCV infection was assessed by testing for serum HCV-specific antibodies, and by detection of HCV RNA. HCV viral load and hemoglobin A1c [HbA1c] levels were assessed in patients with and without diabetes complications. Thirty one [7%] out of 438 T2D-patients had evidence of HCV infection compared to 4 [1%] out of 440 control adults [p < 0.0001]. The prevalence of HCV infection in Kuwaiti and Egyptian T2D-patients was 3% and 18%, respectively. Most of the HCV sequences detected in T2D patients and control subjects were of genotype 4. The HbA1c levels in T2D-patients with HCV viremia were significantly higher than those in HCV-negative patients. HCV viremia, female sex, age, family history of diabetes were found to be independent risk factors for diabetes complications. The results suggest that T2D-patients in Kuwait have higher prevalence of HCV infection than controls, and that HCV viremia is associated with diabetes-related complications

Prevalence of type 2 diabetes mellitus among Kuwaiti children and adolescents

To determine the prevalence of type 2 diabetes among 6- to 18-year-old Kuwaiti children. Children with type 2 diabetes were identified at 182 schools [50 primary, 63 intermediate, and 69 secondary] randomly selected using the 2000/2001 educational districts' registers as a sampling frame. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 2 diabetes was based on the World Health Organization and the American Diabetes Association criteria. Type 2 diabetes was identified in 45 of the 128,918 children surveyed, thereby giving an overall prevalence of 34.9 per 100,000 [95% confidence interval [CI] 24.7-45.1]. There was a significant difference in prevalence between males [47.3, 95% CI 28.7-65.8] and females [26.3, 95% CI 14.8-37.8] at p = 0.05 and a significant trend for an increase in prevalence of type 2 diabetes with age [p = 0.026]. The overall age-adjusted prevalence rate in the 2002 Kuwaiti population was 33.2 [95% CI 26.6-39.9], 41.6 [95% CI 31.2-52.0] in male and 24.6 [95% CI 16.4-32.7] in female children; the difference was significant at p = 0.013. There was no significant difference in prevalence between regions. Children with type 2 diabetes had a significantly higher frequency [51.1%] of a positive family history of diabetes than children of a similar age without type 2 diabetes [22.2%] [p = 0.004]. The prevalence of type 2 diabetes in adult Kuwaitis is spreading to children and adolescents, making it an emergency public health problem. Efforts need to be initiated to address prevention strategies of type 2 diabetes in youth

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, [h and ling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected st and ard, 3 = At expected st and ard, 4 = Above expected st and ard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31.8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%] A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Prevalence of type 1 diabetes among 6- to 18- year- old Kuwaiti children

To determine the prevalence of type 1 diabetes among 6- to 18-year-old Kuwaiti children according to gender, age, and region. Subjects and Children with type 1 diabetes aged 6-18 years were identified at 182 schools [50 primary, 63 intermediate, and 69 secondary] in Kuwait during the study period October 2000 to September 2002. Schools were randomly selected using the 2000/01 educational districts' registers as sampling frame proportional to the number of schools in each district. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 1 diabetes was based on the World Health Organization, and the American Diabetes Association criteria. Prevalence of type 1 diabetes was 269.9 per 100,000 [95% confidence interval, CI 241.6-298.3]. There was no significant difference in prevalence between male [247.6, 95% CI 205.2-290.0] and female [285.5, 95% CI 247.5-323.5]. Type 1 diabetes was more prevalent in the age group 10-13 years [347.3], and lowest in the age group 6-9 years [182.6] per 100,000; the difference was significant at p < 0.001. The overall age-adjusted prevalence rate was 252.9 [95% CI 234.6-271.2], 229.1 [95% CI 204.6-253.6] in male and 277.4 [95% CI 250.0-304.7] in female children in the 2002 Kuwaiti population. The mean age at onset was 9.2, and 8.1 years in male and female children, respectively [p = 0.018]. There was no significant difference in prevalence between regions. Type 1 diabetes is a common chronic disease in Kuwaiti children

Tight glycemic control and new modalities in the treatment of diabetes mellitus

There has been evidence for the effect of tight glycemic control on diabetes-related complications, in particular microvascular complications. Two large prospective studies, the Diabetes Control Complications Trial and the United Kingdom Prospective Diabetes Study, have shown in large cohorts of Type 1 and Type 2 diabetic patients the beneficial effects of tight control on microvascular complications. The development of newer agents like insulin analogues and, in the near future, inhaled insulin as well as new oral compounds groups with longer actions, meal oriented short lived effects and insulin sensitizers will contribute to achieving better diabetic control. The new evolving treatment paradigm may well be to initiate combination therapy right from the onset of diabetes to address the pathogenetic defects and to promptly add supplemental insulin therapy if glycemic goals are not achieved