Diabetes in the UAE Population - Essay Example

Aim: To study the prevalence of Type 2 Diabetes Mellitus (T2DM) in UAE population through creating an Emirates Family Registry where researchers can collect data from patients with Diabetes Mellitus and assess features that may contribute to disease progression. Methods: Major hospitals and diabetes centres in the United Arab Emirates had been contacted to establish an Emirates Family Registry (EFR). Through this collaboration, demographic data of DM patients was evaluated and tabulated in an organised professional database for further studies which included sampling of blood for Biochemical profiling (Glucose, Lipids, HbA1c. etc) and genotyping. Results: The Emirates Family Registry recruited 23,064 adults’ volunteers from three major hospitals and nine primary care centres. 88.3% of the total adult in the EFR were diagnosed with DM. Almost 59% of T2DM patients were between the ages 40-59 years old.UAE nationals occupied 29.9% of the database of which 20.6% were diagnosed with DM. However the percentage of adults with DM was higher in other group effecting to almost 44% of the Indian population who lives in UAE. Through this network, total of 1,766 UAE Nationals with T2DM consented to DNA profiling of blood for future genotyping studies. Conclusion: This study confirmed the previously reported high prevalence of Diabetes Mellitus in the UAE. Lack of genome wide association studies leaves very little to be discussed regarding the genetic prevalence of diabetes in the Arab countries. Therefore, there is a pending need for the development of genome wide association studies that would pertain to the population of the UAE and other Arab nations. The increased understanding of the disease with its genetic association in UAE population may improve management and lead to effective treatment and prevention of T2DM. Background Diabetes mellitus is a group of metabolic diseases characterized by hyperglycaemia resulting from absolute or relative deficiency of insulin. The chronic hyperglycaemia of diabetes is associated with long-term dysfunction, damage and eventually failure of various organs. These changes mainly occur due to micro and macro vascular complications. Several physiological processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action. Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy leading to chronic kidney disease; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction. Patients with diabetes have an increased incidence of atherosclerotic cardiovascular, peripheral arterial and cerebrovascular disease. Increased incidence of Hypertension and abnormalities of lipoprotein metabolism are often found in people with diabetes (1). The vast majority of cases of diabetes fall into two broad etiopathogenetic categories: Type 1 caused by an absolute deficiency of insulin secretion, and Type 2 caused by a combination of resistance to insulin action and an inadequate compensatory insulin secretory response. Type 2 diabetes accounts for ~ 90-95% of those with diabetes and was previously referred to as non-insulin dependent diabetes or adult onset diabetes. It encompasses individuals who have insulin resistance, relative insulin deficiency, and usually need insulin treatment mainly later in the course of disease (2, 3). The United Arab Emirates has a cosmopolitan population of about 4.75 million and exhibits a unique demographic structure as UAE nationals only make 17% of the total population (4). Type 2 diabetes has become a major public health problem in the UAE. A survey completed by the Ministry of Health in UAE reported that the overall percentage of people with diabetes was 19.6% among UAE citizen group. Furthermore, recent studies estimated that 25% of adult Arabs now suffer from diabetes; mainly type 2; and the prevalence of the disease is increasing (5). Two unpublished UAE studies were recently reviewed by Reed in 2005 (Centre for Arab Genomic Studies (CAGS: cags@emirates.net.ae ): The first study was a national survey conducted jointly by WHO and UAE Ministry of Health between 1998 and 2000, on 2363 nationals and 4246 expatriates. They reported a prevalence of T2D to be 24% in nationals and 17.4% in expatriates. The second study by Dun et al (1997-1999) on a random sample of UAE citizens over the age of 30 living in Al-Ain reported 20% prevalence of T2D (25.4% urban to 14.1% rural). However, the methodology used may have resulted in underestimation of prevalence by as much as 20%. Recent studies reported by CAGS indicated that the prevalence of T2DM in UAE rises with increasing age reaching 40% in people over 60 years. These observations emphasize the necessity of considering prevention for diabetes in the UAE. Tools and resources developed in the genomic era are now assisting in deciphering the complexity of diseases in humans (6). The requirement is now to establish registries with well defined description of the disease (i.e. the phenotype) as well as the genetic background of populations of interest (i.e. the genotype). This resource is currently not available for the ethnic groups of the Arab world. Therefore “Emirates Family Register” was developed to address this deficiency. The “Emirate Family Registry” is a register containing information on the local ethnic population of the region designed specifically to study the genetic factors that are unique to this region which will lead to better patient care, disease management and improved quality of life.“Emirates Family Registry” can be used by local research groups to systematically study common diseases throughout the Middle East region. It also will be used to develop regional and international collaborations in biomedical science. “Emirates Family Registry” will increase the understanding of the disease may improve management and lead to effective treatment and prevention of diseases. Methods Emirates Family Registry Three major hospitals and nine primary care centres in the United Arab Emirates were contacted to establish Emirates Family Registry. Through this collaboration, data of type 2 diabetes patients, after consent, was evaluated and tabulated in a well organised professional registry for further studies. The procedure for collecting the data is illustrated in Figure1.The database registry was built by an IT Specialist using visual studio 2006 and it consists of two components: (1) a DNA and bio specimen repository and (2) a computer database documenting the details of participants of the registry. The Patient data include: patient demographic data, biochemical results such as haemoglobin A1c (HbA1C), fasting blood glucose, impaired glucose tolerance (IGT), lifestyle variables such as diet, exercise, smoking, quality of life and disease complications such as neuropathy, nephropathy, retinopathy and family history. Biochemistry Profile Peripheral 2-5ml of blood was drawn and collected in EDTA, Heparin and fluoride tube. The EDTA tube used to measure the A1C in the blood whereas the heparin tube was used to measure the cholesterol, triglycerides, urea and creatinine. Finally the fluoride tube was used to measure plasma glucose concentration. Biochemical test have been performed on 766 individuals’ both diabetic and non diabetic. Heparin and Fluoride tubes were centrifuged at 3,000 rpm for 5 minute and serum was separated to measure fasting glucose cholesterol, triglycerides, urea and creatinine level. A 25µl of blood from EDTA tube used to measure A1c (HbA1c). All the biochemical tests were performed Albaraha Hospital using the Cobas Integra 800 clinical chemistry system (Roche Diagnostics, Indianapolis, IN) An individual was classified as diabetic if the subject (1) had a physician diagnosed diabetes, (2) was on drug treatment for diabetes and (3) met the criteria laid by the World Health Organization consultation group report that is fasting plasma glucose of at least 126mg/dl. Impaired glucose tolerance was diagnosed if the 2 hour post glucose was at least 140mg/dl and less than 200mg/dl and normal glucose tolerance was determined if 2 hours post glucose was less than 140mg/dl. Genomic DNA Peripheral blood 2-5ml was drawn and collected in EDTA tubes from 1766 diabetic and non diabetic individuals. The DNA was then extracted using the High Pure Viral Nucleic Acid Kit (Roche Applied Science, Indianapolis, IN, USA) according to the package insert. Specifically, 300μl of whole blood from each sample was mixed with 200μl of lysis buffer (50mM Tris, pH 8.0, 100mM EDTA, 100mM NACL, 1%SDS) to lyse the cell wall and to release the DNA. The procedure also included the addition of 40μl of Proteinase K. 100μl of isoproponal was subsequently added to remove residual amounts of protein. 500μl of Inhibitor Removal Buffer (5M guanidine-HCl, 20mM Tris-HCl, pH 6.6) was then added. The DNA was washed with a buffer (20mM NaCl; 2mM Tris-HCl; pH 7.5) and centrifuged twice at 2,000 rpm. The DNA was washed using cold 70% ethanol, centrifuged at 3,000 rpm and the supernatant was discarded, leaving purified template DNA that was diluted in 200 μl TE Buffer (1mM EDTA; 10mM Tris-HCl, pH 7.5). The quantity and purity with of the DNA samples a ratios of (A260:A280) of 1.9 were determined by absorbance measurements using a NanoDrop ND-1000 Spectrophotometer (NanoDrop Technologies, Inc, Wilmington, DL, USA). All DNA samples were stored at -20°C for future studies. Informed consent was obtained from all individual before initiation of study procedures. The study was approved by the UAE Ministry of Health and Dubai Police Head Quarter. Results Having a registry with genomic data is essential towards better understanding of disease mechanisms in the local ethnic groups of the Middle-East. The “Emirates Family Registry” consists of genomic samples (blood, DNA, biopsies, etc) linked to a database which is stored. Recording of demographic data including race and family relationships, Phenotype information including diagnostic indicators and DNA polymorphism database. Figure 1 demonstrates the procedure for collecting the data in three major hospitals and nine primary care centres in the UAE. This registry is leading to several outcomes, such as; 1) categorizing patients and their families based on disease complications which may imply different pathophysiology and therefore different susceptibility genes 2) Studying lifestyle variables and other exposures that may be related to the development of type 2 Diabetes 3) Evaluating patient awareness about the disease and developing new trends in disease management. So far the registry contains 20,374 diabetic patients and 2,690 non diabetic. Table1 depicts a summary of the current status of the registry. A total of 1766 DNA samples (diabetic and non diabetic) have been collected for genome scan studies in the future. Epidemiological studies to elucidate the factors that contribute to disease require high quality phenotype (disease marker) and genotype (polymorphisms) data. Risks of type 2 diabetes increases as an individual grow older, especially after an age of 45 years. It is estimated that one out of five people aged 20 to 79 lives with this disease. Part of the reason is that as people grow older they tend to become less physically active, and they gradually lose muscle mass and gain weight. Recent years, however have seen a dramatic rise in type 2 diabetes among people in their 30s and 40s. In addition, more children and teenagers are being diagnosed with type 2 diabetes. The registry allowed us to estimate the percentage of Burden with diabetes by age group (figure 2). UAE has been the centre of trade and commerce in the present day world for the last four decades. People from every part of the world arrive here in search of labour, job, trade and business. Expatriates tend to use health care facilities in the UAE. Table 2 shows the culture diversity in the United Arab Emirates. It is important thus to observe trends in the rise of such non communicable diseases and also review the predisposing factors leading to the same. References 1. Malecki MT, Klupa T. Type 2 diabetes mellitus: from genes to disease. Pharmacol Rep. 2005;57 Suppl:20-32. 2. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, General Information and National Estimates on Diabetes in the United States. Atlanta, U.S. : Department of Health and Human Services, Centers for Disease Control and Prevention; 2007. 3. Centers for Disease Control and Prevention Coordinating Center for Health Promotion. Diabetes: Successes and Opportunities for Population-Based Prevention and Control At-A-Glance; 2009. 4. El-Sharkawy T. Diabetes in the United Arab Emirates and Other Arab Countries: need for Epidemiological and Genetic Studies. Genetic Disorders in the Arab World. Dubai: Centre for Arab Genomic Studies; 2004. p. 57. 5. Malik M, Bakir A, Saab BA, King H. Glucose intolerance and associated factors in the multi-ethnic population of the United Arab Emirates: results of a national survey. Diabetes Res Clin Pract. 2005 Aug;69(2):188-95. 6. Niazi TN, Cannon-Albright LA, Couldwell WT. Utah Population Database: a tool to study the hereditary element of nonsyndromic neurosurgical diseases. Neurosurg Focus. Jan;28(1):E1. 7. de Costa CM. Consanguineous marriage and its relevance to obstetric practice. Obstet Gynecol Surv. 2002 Aug;57(8):530-6. Read More