Diabetes epidemic sweeping the Arab world

Table 1 Prevalence of type-2 diabetes mellitus in adult Arab population

Ref.	Country	Year	Sample size	Main findings	Diagnostic technique
Bacchus et al[8]	Saudi Arabia	1982	1385	Prevalence of diabetes: 2.4%	WHO criteria
Fatani et al[9]	Saudi Arabia	1987	5222	Prevalence of diabetes: 4.3%	Random capillary blood glucose
Al-Nuaim et al[28]	Saudi Arabia	1997	13177	Prevalence of diabetes in urban males and females: 12%, 14%	Random plasma glucose
				Prevalence of diabetes in rural males and females: 7%, 7.7%
Rahman Al-Nuaim et al[47]	Saudi Arabia	1997	2059	Prevalence of T2DM in obese males: 26.0%	OGTT
				Prevalence of T2DM in non-obese males: 8.6% (P < 0.001)
				Prevalence of T2DM in obese females: 23.5%
				Prevalence of T2DM in non-obese females: 4.4% (P < 0.0001)
el-Hazmi et al[48]	Saudi Arabia	2000	14660	Prevalence of obesity in males: 13.05%	FBG
				Prevalence of obesity in females: 20.26%
				Prevalence of obesity in diabetics: 29.98%
				Prevalence of obesity in non-diabetics: 15.87% (P < 0.0001)
Al-Nozha et al[49]	Saudi Arabia	2004	16917	Prevalence of diabetes: 23.7%	FPG
Almajwal et al[50]	Saudi Arabia	2009	195851	Prevalence of diabetes: 17.2%	FBG
Al-Rubeaan et al[10]	Saudi Arabia	2014	18034	Prevalence of diabetes: 25.4%	FPG
Al-Rubeaan et al[51]	Saudi Arabia	2014	53370	Prevalence of abnormal glucose metabolism: 34.5%	FPG
El Bcheraoui et al[52]	Saudi Arabia	2014	10735	Prevalence of diabetes: 13.4%	FPG
Abdella et al[53]	Kuwait	1996	8336	Prevalence of diabetes: 7.6%	Medical chart review
Al Khalaf et al[54]	Kuwait	2010	560	Prevalence of diabetes: 21.4%	FBG
Alarouj et al[20]	Kuwait	2013	1970	Prevalence of diabetes: 17.9%	FPG
Al Zurba et al[55]	Bahrain	1996	498	Prevalence of diabetes: 25.5%	FPG
Malik et al[56]	UAE	2005	5758	Prevalence of T2DM: 20.2%	FPG
Saadi et al[57]	UAE	2007	2455	Prevalence of diagnosed T2DM: 10.5%	FBG
				Prevalence of undiagnosed T2DM: 6.6%
Mansour et al[58]	Iraq	2007	13730	Incidence of T2DM: 6.8%	FPG
Mansour et al[59]	Iraq	2014	5445	Prevalence of T2DM: 19.7%	FPG
Al-Moosa et al[21]	Oman	2006	5840	Prevalence of T2DM: 11.6%	FPG
Al-Lawati et al[60]	Oman	2015	NA	Age-adjusted prevalence of T2DM: 10.4% to 21.1%	FPG and OGTT
Musaiger et al[61]	Qatar	2005	535	Prevalence of T2DM among obese females ≥ 50 yr: 51.4%	Self-reported diabetes
Bener et al[22]	Qatar	2009	1117	Prevalence of T2DM: 16.7%	FBG and OGTT
Al-Habori et al[62]	Yemen	2004	498	Prevalence of T2DM: 7.4%	FPG
Gunaid et al[63]	Yemen	2008	250	Prevalence of T2DM: 10.4%	FPG and OGTT
Abdul-Rahim et al[23]	Palestine	2001	302	Prevalence of T2DM: 12%	OGTT
Ajlouni et al[64]	Jordan	2008	1121	Prevalence of T2DM: 17.4%	FPG
Albache et al[65]	Syria	2010	806	Prevalence of T2DM: 15.6%	FPG
Hirbli et al[66]	Lebanon	2005	3000	Prevalence of T2DM: 15.6%	FPG
Herman et al[67]	Egypt	1998	1451	Prevalence of T2DM: 9.3%	OGTT
Abolfotouh et al[68]	Egypt	2008	1800	Prevalence of T2DM: 3.7%	FBG
Elbagir et al[25]	Sudan	1996	1284	Prevalence of T2DM: 3.4%	OGTT
Noor et al[69]	Sudan	2015	1111	Prevalence of T2DM: 1.3%	FBG
				Prevalence of undiagnosed T2DM: 2.6%
Bouguerra et al[26]	Tunisia	2007	3729	Prevalence of T2DM: 9.9%	FPG
Ben Romdhane et al[70]	Tunisia	2014	7700	Prevalence of T2DM: 15.1%	FPG
Kadiki et al[71]	Libya	2001	868	Prevalence of T2DM: 14.1%	OGTT
Rguibi et al[72]	Morocco	2006	249	Prevalence of undiagnosed T2DM: 6.4%	FPG
Bos et al[29]	North Africa	2013	NA	Prevalence of diabetes: Range from 2.6% in rural Sudan to 20.0% in urban Egypt	NA
				Prevalence of diabetes significantly higher in urban than rural areas
				Significantly higher prevalence of overweight/obesity in females than males in Algeria, Egypt, Morocco, Tunisia and Sudan
Jaber et al[73]	United States (Arab-Americans)	2003	542	Prevalence of T2DM in males: 22.0%	OGTT
				Prevalence T2DM in females: 18.0%
Rissel et al[74]	Australia (Arab immigrants)	1998	528	Prevalence of overweight or obesity in males: 73%	NA
				Prevalence of overweight or obesity in females: 36%
Thow et al[75]	Australia (people born in Middle East and North Africa)	2005	NA	Highest prevalence and incidence of T2DM	NA
				Second highest ratio of hospitalization and mortality
				Standard prevalence ratio for diabetes among Arabic-speaking subjects significantly 3.6 times higher than English-only speaking subjects

WHO: World Health Organization; OGTT: Oral glucose tolerance test; FBG: Fasting blood glucose; FPG: Fasting plasma glucose; UAE: United Arab Emirates; NA: Data not available; T2DM: Type-2 diabetes mellitus.

Table 2 Prevalence of type-2 diabetes mellitus in Arab podiatric and children

Ref.	Country	Year	Sample size	Main findings	Diagnostic technique	Notes
Punnose et al[76]	UAE	2005	96	11 children diagnosed with T2DM	FPG	(8-18 years old)
				9/11 children were Arab origin		Case series
				8/11 children were overweight or obese
				10/11 children were female
Moussa et al[6]	Kuwait	2008	128918	T2DM found in 45 children	NA	(6-18 years old)
				Prevalence of T2DM in male children: 47.3/10000		Medical record review
				Prevalence of T2DM in female children: 26.3/10000 (P = 0.05)
Al-Agha et al[77]	Saudi Arabia	2012	387	Prevalence of T2DM: 9.04%	NA	(2-18 years old)
						Retrospective cross-sectional study
Al-Rubeaan et al[7]	Saudi Arabia	2015	23523	Age adjusted Prevalence of T2DM: 1/1000	FPG	≤ 18 yr
Ali et al[78]	Egypt	2013	210	28 out of 210 children with diabetes diagnosed with T2DM	Fasting serum C-peptide levels	(1-18 years old)
				64.3% of T2DM children were female (P = 0.04)
Osman et al[79]	Sudan	2013	958	38/985 children identified with T2DM	NA	(11-18 years old)
				32/38 of cases were from tribes of Arab origin		Retrospective cross sectional
Ehtisham et al[80]	United Kingdom	2000	8	First 8 cases reported with T2DM in United Kingdom	NA	(9-16 years old)
				All cases were overweight and originated from India, Pakistan and Arab countries		Retrospective cross sectional

UAE: United Arab Emirates; FPG: Fasting plasma glucose; NA: Data not available; T2DM: Type-2 diabetes mellitus.

Table 3 Diabetes complications in the Arab world

Country	Year	Sample size	Prevalence of complication	Ref.
Saudi Arabia	2015	50464	Retinopathy: 19.7%	[81]
	2015	3800	Blindness: 33%	[82]
	2014	54670	Nephropathy: 10.8%	[83]
	2015	62681	Diabetic foot: 3.3%	[84]
			Foot ulcer: 2.05%
			Gangrene: 0.19%
			Amputation: 1.06%
	2014	552	Peripheral neuropathy: 19.9%	[85]
Kuwait	2007	165	Retinopathy: 40%	[86]
Emirates	2007	513	Retinopathy: 19%	[87]
	2007	2455	Retinopathy: 54.2%	[57]
			Nephropathy: 40.8%
			Neuropathy: 34.7%
			Peripheral vascular disease: 11.1%
Bahrain	2009	712	Microalbuminuria: 27.9%	[88]
	2007	1477	Neuropathy: 36.6%	[89]
			Foot ulcer: 5.9%
			Peripheral vascular disease: 11.8%
Qatar	2011	540	Retinopathy: 23.5%	[90]
	2014	1633	Retinopathy: 12.5%	[91]
			Nephropathy: 12.4%
			Neuropathy: 9.5%
Oman	2003	2249	Retinopathy: 14.9%	[92]
	2009	418	Retinopathy: 7.9%	[93]
	2012	2551	Microalbuminuria: 37%	[94]
			Nephropathy: 5%
	2012	699	Nephropathy: 42.5%	[95]
Yemen	2011	694	Blindness: 15.7%	[96]
	2009	350	Retinopathy: 55%	[97]
	1997	1095	Peripheral neuropathy: 40.7%	[98]
	2010	311	Peripheral vascular disease: 9.1%	[99]
Jordan	2015	3638	Blindness: 1.3%	[100]
			Severe visual impairment: 1.82%
			Correctable visual impairment: 9.49%
	2008	986	Retinopathy: 64.1%	[101]
	2005	986	Blindness: 7.4%	[102]
	2003	1142	Microalbuminuria: 33%	[103]
			Ulceration: 4%
			Amputation: 5%
Egypt	2011	1325	Retinopathy: 20.5%	[104]
	2015	2000	Neuropathy: 29.3%	[105]
			Peripheral vascular disease: 11%
	1998	4600	Retinopathy: 42%	[67]
			Blindness: 5%
			Nephropathy: 7%
			Neuropathy: 22%
			Foot ulcer: 1%
Tunisia	2014	2320	Retinopathy: 26.3%	[106]
Libya	2012	260	Retinopathy: 16.2%	[107]
			Nephropathy: 1.5%
			Neuropathy: 11.2%