High prevalence of diabetes among migrants in the United Arab Emirates using a cross-sectional survey

www.nature.com/scientificreports OPEN Received: 6 July 2017 Accepted: 27 March 2018 Published: xx xx xxxx High prevalence of diabetes among migrants in the United Arab Emirates using a cross-sectional survey Nabil Sulaiman1, Salah Albadawi3, Salah Abusnana1, Maisoon Mairghani1, Amal Hussein1, Fatheya Al Awadi2, Abdulrazak Madani3, Paul Zimmet4 & Jonathan Shaw4 In 2011, the United Arab Emirates (UAE) had the 10th highest diabetes prevalence globally, but this was based on data that excluded migrants who comprise 80% of the population. This study assessed diabetes prevalence across the UAE population. A random sample of migrants was recruited from the visa renewal centers. Data were collected using interviews, anthropometric measurements and fasting blood for glucose, lipids and genetic analyses. 2724 adults completed the questionnaires and blood tests. Of these, 81% were males, 65% were ≤40 years old and 3% were above 60 years. Diabetes, based on self-report or fasting plasma glucose ≥7.0 mmol/l, showed a crude prevalence of 15.5%, of whom 64.2% were newly diagnosed. Overall age- and sex-adjusted diabetes prevalence, according to the world mid-year population of 2013, was 19.1%. The highest prevalence was in Asians (16.4%) and non-Emirati Arabs (15.2%) and lowest in Africans and Europeans (11.9%). It increased with age: 6.3% in 18–30 years and 39.7% in 51 to 60 years. Lower education, obesity, positive family history, hypertension, dyslipidemia, snoring, and low HDL levels, all showed significant associations with diabetes. The high diabetes prevalence among migrants in the UAE, 64% of which was undiagnosed, necessitates urgent diabetes prevention and control programs for the entire UAE population. The Middle East and North Africa (MENA) region has a high prevalence of diabetes mellitus (DM) in adults (10.9%), with particularly high rates reported in the Gulf States. The International Diabetes Federation (IDF) estimated in 2011 that the United Arab Emirates (UAE) had the 10th highest prevalence of diabetes in the world (18.8%), and this was projected to rise to 21.6% by the year 20301. A 1990 study estimated a prevalence of 6% in UAE Emiratis of Bedouin origin (30–64 age group) in which the diagnosis was based on a random capillary blood glucose2. A cardiovascular screening program of UAE Emiratis in Abu Dhabi also revealed a high age-standardized prevalence of diabetes (25%) and pre diabetes (30%) defined as fasting blood glucose (FBG) (5.6–6.9 mmol/l) or 2 h post OGTT (7.8–11 mmol/l)3. A survey conducted in both UAE Emiratis and migrants between the years 1999 and 2000 reported a prevalence of 20% (20–64 age group) using the oral glucose tolerance test (OGTT)2. A more recent study on 599 migrant women in Al-Ain found that the prevalence of pre diabetes and diabetes was 18.6% and 10.7% respectively, based on HbA1C levels, and that the longer the expats resided in the UAE the more likely they were to develop diabetes4. A later survey of adult Emirati citizens living in Al Ain in 2007 reported age-standardized rates among 30–64 year old, of 29.0% for both diagnosed and undiagnosed DM and 24.2% for pre-diabetes5. Most countries of the MENA region, in particular countries of the Gulf Cooperative Countries (GCC), have had rapid socioeconomic development and urbanization over the last century following the discovery of oil, leading to epidemiologic and nutritional transition6. The economic boom has led to decreased levels of physical activity, increased sedentary behavior and high rates of obesity hence leading to this increasing prevalence of diabetes4,7, and its major public health impact on the UAE Emirati and Migrant communities2. The UAE has a large and young immigrant workforce, but the burden of diabetes is poorly described in this population group, thus impeding appropriate resource allocation. Although a number of studies have aimed to determine the prevalence of DM in the UAE, the selection of participants has almost always focused on UAE Emiratis. One study focused on both UAE Emiratis and migrants and was conducted more than 15 years ago in 1999 and used the OGTT in reporting 1 Department of Family and Community Medicine, College of Medicine, University of Sharjah, Sharjah, UAE. 2Dubai Health Authority, Dubai, UAE. 3Dubai Hospital, Dubai, UAE. 4Baker/IDI, Melbourne, Victoria, 3004, Australia. Correspondence and requests for materials should be addressed to N.S. (email: ) SCiENtiFiC REPortS | (2018) 8:6862 | DOI:10.1038/s41598-018-24312-3 1 www.nature.com/scientificreports/ T2DM2. To our knowledge, there has been no recent study on the prevalence of DM in the Emirati and Migrant population across different emirates of the UAE. As a result, the UAE National Diabetes and Lifestyle (UAEDIAB) study was conducted to estimate the prevalence of, and risk factors for, type 2 DM. The first phase of this study, concerning the UAE multi-ethnic migrant population, was undertaken during 2013/14. This paper reports results of the first phase of this study. Methods The UAE National Diabetes and Lifestyle Study is a cross-sectional survey designed to investigate the prevalence of diabetes and associated risk factors in UAE Emiratis and Migrants who have been living in the UAE for at least four years. Phase 1 of the study was conducted during 2013 in Dubai, Sharjah and the Northern Emirates. The methods are described in detail elsewhere8. Ethical approval for this study was obtained from UAE Ministry of Health on March 14th, 2012 and the University of Sharjah ethics committee on 23rd of June, 2010. Every participant read a detailed information sheet and signed an informed consent form to give information as well as blood samples before the interview. Briefly, the recruitment methods for phase 1 were based on the legal requirement for all UAE migrants to have a medical assessment for visa renewal every 2–3 years at designated Preventive Medicine Departments (PMD). A sample of PMDs was drawn by the UAE National Bureau of Statistics based on size, demographic representation of catchment population, location and numbers of migrants visiting each PMD for visa renewal the year before the survey. A systematic random sample of every 10th PMD attendee was then invited to participate in the study. Assessments included a face-to-face interview to collect demographic data using a general questionnaire. Participants were asked to report their gender, nationality (based on country of origin), date of birth, marital status, residence, highest educational level achieved, family history of diabetes in first degree relatives and lifestyle habits. In addition, they were asked to report their health-related knowledge, attitudes and practices. Following the interview, measurements of weight, height, waist and hip circumference and systolic and diastolic blood pressure were done. In addition, a fasting blood sample was collected after participants’ confirmation that they had been fasting fo (...truncated)