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

BACKGROUND: Diabetes 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 country's 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. METHODS: A 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$ (1 USD = 3.68 AED). RESULTS: The total annual direct treatment costs of DM among patients without complications in Al Ain-UAE, was US $1,605 (SD = 1,206) which is 3.2 times higher than the per capita expenditure for health care in the UAE (US$ 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. CONCLUSIONS: DM 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: Microalbuminuria (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). METHODS: The 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. RESULTS: MA 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. CONCLUSION: The 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).

Clinical diagnostic tools for vitamin D assessment.

Vitamin D deficiency has been implicated in a plethora of diseases including rheumatoid arthritis, Parkinson's disease, Alzheimer's disease, and osteoporosis. Deficiency of this vitamin is a global epidemic affecting both developing and developed nations. Within a clinical context, the qualitative and quantitative analysis of vitamin D is therefore vital. The main metabolic markers for assessing vitamin D status in humans are the hydroxylated forms of vitamin D, 25OHD3 and 25OHD2 on account of their long half-lives within the body and excellent stability. An adequate level for healthy individuals of these hydroxylated forms is estimated to be around 20-40ng/ml of blood. There are three main analytical techniques for determining the levels of 25OHD3 and 25OHD2. The first technique is immunoassay-based and can be performed in a rapid, high throughput, automated manner, allowing as many as 240 tests per hour with the duration of each assay as little as 18min. Furthermore, it offers excellent sensitivity with a detection range of 3.4-156ng/ml. A major downside of immunoassays is that they are unable to distinguish between the various forms of vitamin D. While HPLC is a highthroughput low cost instrument it is not a very sensitive technique and cannot quantify the down stream metabolites of vitamin D. The third technique, namely liquid chromatography-mass spectrometry (LC-MS/), provides excellent sensitivity with a wide dynamic range from 0.068pg/ml to 100ng/ml. Additionally, it offers a high level of separation and permits identification of vitamin D-related metabolites. However, a huge limitation with LC/MS/MS is their poor throughput for sample analyses. As yet, there is no analytical technique which combines the fine detection capabilities of LC/MS/MS and the rapid, automated format of immunoassay, for vitamin D analyses. Future attention therefore needs to be given to this area if the current clinical diagnostic tools for vitamin D analysis are to be further improved.

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

BACKGROUND: Diabetes Mellitus (DM) is a major public health problem in the UAE with a prevalence rate reaching 24% in national citizens and 17.4% in expatriates. The aim of this study was to determine the prevalence and risk factors of macrovascular complications among diabetic patients in the Al-Ain district of the United Arab Emirates (UAE). METHODS: The study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes (DM) complications 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 including measurement of height, weight, blood pressure and examination for evidence of macrovascular complications. A standard ECG was recorded and blood samples were taken to document fasting blood sugar, glycosylated haemoglobin (HbA1C) and lipid profile. RESULTS: A sample of 513 diabetic patients was selected with a mean age of 53 years (SD +/- 13.01). Overall, 29.5% of DM patients had evidence of macrovascular complications: 11.6% (95% CI: 8.8-14.4) of patients had peripheral vascular disease (PVD), 14.4% (95% CI: 11.3-17.5) had a history of coronary artery disease (CAD) and 3.5% (95% CI: 1.9-5.1%) had cerebrovascular disease (CVD). Of the total population surveyed 35% (95%CI: 30.8-39) had hypertension. The analysis showed that macrovascular complications in diabetic patients were more common among males, increased with age, were more common among hypertensive patients and its prevalence increased steadily with duration of DM. CONCLUSION: Our data revealed a significant association between hypertension and presence of macrovascular disease among diabetic patients. However, the risk of CAD in the UAE was relatively low compared to that seen in patients in other geographical settings. In addition, a lack of correlation between macrovascular disease and glycemic control among patients with DM was observed.

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

BACKGROUND: Diabetic 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). METHODS: The 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. RESULTS: A 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. CONCLUSION: The 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.

Prevalence of risk factors for diabetic foot complications.

BACKGROUND: Foot 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). METHODS: The 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). RESULTS: Forty 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). CONCLUSION: Despite the low prevalence of foot ulceration and amputation among the study population, nevertheless, a substantial proportion had potential risk factors for foot complications.

Road traffic accidents in the United Arab Emirates: trends of morbidity and mortality during 1977-1998.

High rates of serious road traffic accidents (RTAs) have been reported for several Arabian Gulf countries, including the United Arab Emirates (UAE). in recent years. This study aims to describe quantitatively the morbidity and mortality from RTAs in the UAE, to identify their trends during the period 1977-1998, to compare the results with those of developed countries, and to evaluate the information available on possible causes with a view to identifying the most useful direction for future research. Data were obtained from UAE's police and health sources and, for international comparison, from WHO Statistics reports and the published literature. Overall and cause-specific fatality and injury rates of RTAs were calculated. Estimates of trends were achieved by using linear regression. The characteristics of road users injured or killed were also analysed. The results revealed that during the period 1977-1998, the rates of RTAs per 100,000 population and per 100,000 motor vehicles declined in the UAE by a trend component of -56.3 (P < 0.001: R2 = 0.69) and -521.8 (P<0.001; R2=0.92), respectively. RTA fatality and injury rates based on the same denominators also declined by -1.1 (P<0.001; R2 = 0.56) and -13.3 (P < 0.001; R2 = 0.47); and by -3.8 (P < 0.02; R2 = 0.23) and - 90.0 (P < 0.001; R2 = 0.59), respectively. Paradoxically, however, except for a short period (1977-1985), a steady increase in the risk of injury and death in each RTA accompanied these declines. Between 1985 and 1998 the severity rate (the ratio of fatalities and injuries per 1,000 RTAs) more than tripled in the UAE. The UAE's rates were high when compared with a number of selected countries. The cause for the increasing severity of RTAs is not clear but the most likely cause could lie in speeding, careless driving, the changing vehicle mix on the roads and the standard of immediate care available for victims. Further investigation is essential and will require close collaboration between police and health authorities.

Evaluation of effectiveness of safety seatbelt legislation in the United Arab Emirates.

Seatbelt legalisation was implemented in the United Arab Emirates (UAE) in January 1999. This provided the opportunity to evaluate the effectiveness of the legislation in the Eastern District of Abu Dhabi Emirate in the UAE by establishing levels of injury severity from motor vehicle crashes (MVC) before and after the legislation and the rate of compliance with the legislation. Data were obtained from a major hospital in the Eastern District of Abu Dhabi Emirate, UAE. Subjects were a systematic sample of MVC victims who arrived alive at hospital in either the pre-implementation period (January-June 1998) or the post-implementation period (February-August 2000). The main measures of outcome were injury severity codes, numbers of hospital bed days and rates of admission and discharge at hospital. The analysis of injury severity from MVCs, from the pre- to the post-implementation period, revealed a significant declining trend (chi-square = 77.68, P < 0.001). While the proportion of minor injuries increased from 42% (95% CI: 36-48%) in the pre-implementation period to 77% (95% CI: 71-83%) in the post-implementation period, the proportion of "moderate to fatal injuries" declined from 54% (95% CI: 48-60%) to 17% (P = 0.001) and the median number of hospital bed days declined from 5 days (25% = 2; 75% = 8 ) to 3 days (25% = 1; 75% = 4 ). The rate of seatbelt compliance reported by occupants involved in MVCs in the post-implementation period was 59% (95% CI: 52-67%). The implementation of the seatbelt legislation in the Eastern District of Abu Dhabi Emirate was associated with statistically significant reduction in morbidity in those arriving alive at hospital following MVC, including reduced severity of injury, admission rate to hospital and the duration of hospital stay. More active implementation of seatbelt law would most likely further reduce severity of MVC injuries and fatalities in the Eastern District of Abu Dhabi Emirate, UAE.

Prevalence and issues in non-use of safety belts and child restraints in a high-income developing country: lessons for the future.

OBJECTIVE: In United Arab Emirates (UAE), a high-income developing country, safety belt (SB) legislation was implemented in 1998, covering only front-seated adults on highways outside cities. We assessed wearing of SBs after 5 years, together with use of safety restraints by rear passengers and children, perceptions about SBs, and use of tinted glass. METHODS: A cross-sectional survey in 2003-2004 in Al Ain, population 400,000 and the main desert city of UAE, used random sampling of petrol stations; about 80% of UAE's population is non-citizens. Five of 30 stations were selected, including 3 different speed zones; vehicles with children were over-sampled. Drivers were interviewed by questionnaire. Use of safety restraints and presence of tinted glass were verified by observation. Confounding and correlation were assessed by stratification and logistic regression. RESULTS: The sample included 500 vehicles, containing 959 adults and 876 children; 382 vehicles had children. SBs were used by 29% of drivers, 14% of front-seat and 2% of rear-seat adult passengers. 23% of children were in front; only 4% in front and 1% in the rear were restrained. SBs were worn by only 11% of UAE-citizen drivers and 10% of off-duty police and military. Odds ratio for non-use by citizens was 3.55 (95% CI 1.96-6.42). Use was greater among older drivers (p < 0.0005, X(2) trend). Reasons for non-use of SBs included discomfort 42%, forgetfulness 25%, uselessness 17%, carelessness 13%, and dangerous 3%. Among citizens, 15% believed SBs are dangerous. Tinted glass was present in 68% of vehicles. CONCLUSIONS: SB legislation failed to protect the population, with low use of restraints by citizens, military, and police, and virtually none among children and rear passengers. Lessons include the necessity of drafting laws that provide comprehensive and effective protection, study of cultural constraints to compliance with injury prevention measures, and locally effective interventions to prepare citizens and enforcers for the expected new behaviour. Highly tinted glass is widespread and poses a barrier to enforcement.