A study of diabetes complications in an endogamous population: an emerging public health burden.

AIM: The aims of this study were to determine the prevalence of diabetic complications namely neuropathy, nephropathy, and retinopathy among Qatari's DM patients; and to find associations between these complications and socio-demographic and clinical characteristics in a highly consanguineous population.

DESIGN: It is an observational cohort study.

SETTING: The survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar.

SUBJECTS: The study was conducted from May 2011 to January 2013 among Qatari nationals above 20 years of age. Of the 2346 registered with diagnosed diabetes attending Hamad General Hospital and PHC centers, 1633 (69.3%) agreed and gave their consent to take part in this study.

METHODS: Questionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed.

RESULTS: Out of 1633 diabetic patients, 842 (51.6%) were males. The prevalence of diabetic nephropathy 12.4% and retinopathy was 12.5% followed by neuropathy 9.5% among diabetic population. The proportion of diabetic neuropathy and nephropathy were significantly higher among diabetic patients with age 60 years and above as compared to younger age groups (p=0.010). Nephropathy was significantly higher among male diabetic (p=0.014) and smokers (p<0.001) while diabetic neuropathy was more common among diabetic hypertensive patients (p=0.028). Multivariate logistic regression showed that Age (p=0.025), being male (p=0.045), and having high blood pressure (p=0.006) were significant predictors of diabetic neuropathy. For diabetic retinopathy, family history of DM (p<0.001), consanguinity (p=0.010), having high blood pressure (p=0.042) and physical activity (p<0.001) were significant predictors of diabetic retinopathy. Meanwhile, for diabetic nephropathy, age (p<0.001), smoking (p=0.045), physical activity (p<0.001) hypertension (p<0.001) and gender (p=0.012) were the significant predictors.

CONCLUSION: Diabetes exerts a significant burden in Qatar, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high morbidity and mortality and prevalence of complications observed. The significant interactions between diabetes and associated complications highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.