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Title: Prevalence and risk factors of diabetes and insulin resistance in patients attending a health care centre in Kuwait, and the accuracy of a point of care device to measure glycated haemoglobin to monitor patients with diabetes
Author: Almotawa, A. A.
ISNI:       0000 0004 7428 6275
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Background: Globally, 422 million adults have type 2 diabetes mellitus (T2DM), causing 1.5 million deaths per year. Kuwait has one of the highest T2DM prevalence in the world and determining the proportion of patients and relatives who have pre-diabetes (PDM), insulin resistance (IR) and T2DM is crucial to inform preventive activities and curative services. Study objectives: The study describes the prevalence and risk factors of PDM, IR and T2DM, in adult patients attending a primary health care facility in Kuwait and the prevalence and risk factors of the same conditions among the patients’ first-degree relatives. The study also describes the degree of glycaemic control achieved by patients with T2DM and risk factors for poor glycaemic control. Finally, we assessed the agreement of a point of care (POC) device to measure glycated haemoglobin (HbA1c) to monitor T2DM control. Methods We conducted cross-sectional surveys of patients and first-degree relatives attending Nuzha health care facility in Kuwait and case-control studies of participants attending Nuzha’s diabetic clinic. Diabetic participants were consecutively tested by the Quo-test (POC) device to compare its agreement with a reference test. Results The prevalence of T2DM, IR and PDM among patients attending the clinics were 29.6% (95% CI: 25.1%-34.1%), 34.6% (95% CI: 29.1%-40.2%) and 26.0% (95% CI: 21.6%-30.4%), respectively. The proportion of patients with T2DM increased with age (AOR=5.4), with the highest prevalence occurring at 60-69 years of age. T2DM was associated with hypertension (AOR=1.95) and being a widow (AOR=6.11). IR was associated with low HDL (AOR=1.96), overweight (OR=8.25), obesity (OR=18.33) and increased waist circumference (OR= 5.5). Sugar-sweetened beverages were associated with IR. The prevalence of T2DM, IR and PDM among first-degree relatives of T2DM patients were 29.1% (95%CI: 23.7%-34.5%), 32.8% (95%CI: 26.2%-39.4%), 20.4% (95%CI: 15.6%-25.2%). The risk factors for T2DM were similar among patients and first-degree relatives, but IR was associated with manual labour occupations (AOR=3.6). Only 30% of T2DM patients achieved good glycaemic. Poor control was associated with high triglycerides (AOR=2.2), smoking (AOR=4.1) and the number of years since diagnosis (AOR=4). The Quo-Test had comparable performance to the reference test, with a Coefficient of Variation of 2.1% (r2 = 935, Kappa 90% and 87% at HbA1c cut-offs of 7.0 and 9.0% respectively). The POC and the reference tests performed poorly in patients with haemoglobinopathies. Conclusion This study demonstrates that a high proportion of patients and first-degree relatives attending one of the main primary health care centres in Kuwait have T2DM. Many patients and relatives were unaware of their condition. There was also a very high prevalence of IR and PDM suggesting the burden of T2DM will increase further in the future. Major efforts are needed to upscale detection, and preventive programmes for IR, PDM and T2DM and the quality of T2DM management needs to improve. The POC device tested could provide timely information for the management of T2DM.
Supervisor: Cuevas, Luis ; Dacombe, Russell Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral