Pattern of non-insulin dependent diabetes mellitus in Kuwait.

The aim of this study was to examine distinctive clinical characteristics of non-insulin dependent diabetes mellitus (NIDDM) patients in Kuwait including mode of presentation at diagnosis, family history of diabetes, therapeutic management and response to treatment. We studied 3299 Kuwaiti patients (1454 male (M) and 1845 female (F) subjects) registered in Salmiya diabetic clinic, a part of the national network of diabetes control and care programme, and located in the urban Hawally Governorate, Kuwait. The mean age of the patients was 53 years (+/- 13.9 years), and 73.8% were in the age group 45-64 years. The majority of patients (53.6%) were diagnosed as they were clinically symptomatic; in contrast a significant minority (37.8%) were diagnosed by chance mainly during investigation for unrelated events. The 8.6% of the women diagnosed during pregnancy had a high parity index 6.5 +/- 2.9. A high percentage of the diabetic patients (63%) reported a positive family history in first degree relatives. The mean duration of diabetes mellitus was 7.8 years (range 2-28 years) and 70% of the patients had diabetes mellitus for 9 years or less. The mean body mass index (BMI) was 31.8 +/- 6.3 kg/m2 and 28.5 +/- 6.3 kg/m2 in women and men, respectively. Among the diabetic women 57.7% were obese (BM > 30 kg/m2) and 30.2% were overweight (BMI 25-30 kg/m2) as compared to 33.6% and 44.3% among diabetic men, respectively. High blood pressure (> or = 160/95 mmHg) was reported in 14.9%. The main therapeutic modality in the majority of patients, (63.2%), was the administration of oral hypoglycaemic agents (OHA), while 23.7% were on a diet regimen and only 13.1% were on insulin therapy. The study throws light on the pattern of NIDDM among Kuwaiti patients. Frequent association with obesity suggests that it may be a major risk factor. The strong familial aggregation reported paves the way for future research among these families for cosegregation of a defined genetic trait with NIDDM in the Arab population subset.

Analysis of underlying and multiple-cause mortality data.

"A variety of life table models were used for the analysis of the (1984-86) Kuwaiti cause-specific mortality data. These models comprised total mortality, multiple-decrement, cause-elimination, cause-delay and disease dependency. The models were illustrated by application to a set of four chronic diseases: hypertensive, ischaemic heart, cerebrovascular and diabetes mellitus. The life table methods quantify the relative weights of different diseases as hazards to mortality after adjustment for other causes. They can also evaluate the extent of dependency between underlying cause of death and other causes mentioned on [the] death certificate using an extended underlying-cause model." (SUMMARY IN FRE AND ITA)

Reliability of death certificate diagnoses.

Consistency between death certificates and clinical records from 5 general hospitals in Kuwait was studied for 470 deaths with the following underlying or associated causes: hypertensive (HYP), ischaemic heart diseases (IHD), cerebrovascular diseases (CVD) and diabetes mellitus (DM). Direct causes were not considered since they are of little interest analytically. Only deaths with definite or most probable ascertainment were included. One cardiologist, who was provided with the WHO criteria and relevant documents on death certification, independently reviewed the records. To test the reviewer's bias and the reliability of his judgement, an adjudication process was effected by having one senior cardiologist re-review a random subsample of 140 records. The two reviewers showed good agreement. Specific diagnoses criteria for deciding the underlying cause of death in multiple morbid conditions by the reviewer were followed. Due to possible reviewer bias, we aimed at measuring the difference between initial certifiers and the reviewer rather than measuring the diagnostic accuracy of initial certifiers in reference to the reviewer. The agreement index kappa showed poor agreement between original and revised certificates. The original certificates under-estimated CVD as an underlying cause of death by 69.2%, DM by 60%, IHD by 33.5% and HYP by 31.8% in our sample. Associated causes were also consistently under-estimated by initial certifiers as compared with the reviewer. This bias calls for basing mortality statistics in Kuwait on hospital death committees' reports rather than on initial certifier death certificates, use of multiple-causes of death instead of one underlying cause and adequate training of the medical profession on the value and process of death certification.