Diabetes Mellitus among School Age Children in Dubai

Published by: Statistical Analysis SectionIssue: 6Apr - Jun 2006The Departmentof Health andMedical Servicesstrives to become aprominent health institution caringfor the human being throughout thelife. As statistics is needed as aunifying voice for DOHMS activitiesand advocacy, The Sixth Issue ofStatistical News (April - June 2006)reflects the role of DOHMS incollecting and analyzing data fromall health sectors in Dubai. Itfeatures diabetes mellitus amongschool age children in Dubai andmalignant neoplasm’s of breast inDOHMS.From theHope the newsletter provesbeneficial with regards to yourprofession. Your comments arewelcomed.Diiabetes Melllliitus among Schooll AgeChiilldren iin DubaiiDiabetes is one of the most common Non -communicable disease in children andadolescents. When diabetes strikes during childhood, it is routinely assumed to be type 1, orjuvenile-onset diabetes. However, the end of the 20th century witnessed a dramatic rise in theincidence of type 2 diabetes in children. Although considered uncommon a few decades ago,type 2 diabetes in adolescents now represents one of the most rapidly growing forms ofdiabetes worldwide .Not surprisingly, the incidence of type 2 diabetes in adolescents hasparalleled the epidemic of childhood obesity now occurring in Westernized societies. It isbelieved that the genetic and lifestyle factors that increase the risk of developing type 2diabetes in adolescents and adults are similar. Children and adolescents diagnosed with type 2diabetes are generally between 10 and 19 years old, obese, have a strong family history fortype 2 diabetes, and have insulin resistance. Generally, children and adolescents with type 2diabetes have poor glycemic control. It is hard to detect type 2 diabetes in children because itcan go undiagnosed for a long time; children may have no symptoms or mild symptoms; andbecause blood tests are needed for diagnosis. It is difficult to be sure it is type 2, becausecriteria for differentiating between types of diabetes in children are confusing; that is, childrenwith type 2 can develop ketoacidosis; children with type 1 can be overweight; and because theoverall prevalence of the disease may still be low (1) . Diabetes mellitus is a significant causeof morbidity and mortality in UAE. Deaths attributed to DM accounted for 2.1-3.1% of alldeaths in the last ten years (2) .Inside this issue:Diabetes Mellitus among School AgeChildren in DubaiMalignant Neoplasms of Breast infemale, DubaiStatistical Analysis SectionPlanning & Statistics DepartmentDepartment of Health & Medical ServicesDubai - United Arab EmiratesThere was 304 persons withdiabetes mellitus among theschool age group (4-19 years)diagnosed by specialist clinicsin DOHMS in 2005, 229(75.3%) Emirates and 24.7%Expatriates. Among Emiratechildren, females amounted to46.7% of the cases, (Figure1). Type1 diabetes mellitusconstituted 91.2% of Emiratesdiabetic cases, (Figure 2).Studying the distribution bylevel of education, thepercentage in kindergartenwas 7.4%, 41.0% wereamong primary, 21.0% amongpreparatory and 70 cases(30.6%) were amongsecondary school children.Studying the distribution oftype1 diabetes mellitus byage, there was a peak at 11years old.Figure (1) Distribution of Emirate Diabetic CasesDiagnosed in Specialist Clinics in DOHMS by Sex ,Dubai 200547%MalesFemales53%Figure (2) Distribution of Emirate Diabetic CasesDiagnosed in Specialist Clinics in DOHMS byType ,Dubai 20059%91%Type 1Type2Issue 6Statistical News1

In Dubai, Diabetes mellitus amounted for 1.9 % of all admissionsin DOHMS in 2005. It constituted 2.6% of all admitted cases inthe school age group 4-19 years in DOHMS in 2005. There were18 cases, 86 (72.9%) Emirates and 27.1% expatriates. Studyingthe distribution of diabetes mellitus among Emirates, there were51 (59.3%) males and 35 (40.7%) females. Type 1 diabetesamounted to 93.02% of the cases. Studying the distribution oftype 1, diabetes by age, there is a peak at 11-12 years. As forcomplications of type 1 diabetes, keloacidosis constituted 38.8%;other complications 16.2% and 45% of the diabetic childrenwere not complicated, (Figure 3). The distribution was nearly thesame in both males and females, but ketoacidosis was more inmales (41.3%).Figure (3) Distribution of Type 1 Diabetes MellitusComplications among School Age Children in DOHMS,Dubai 200545%16%There were 597 diabetic persons below 25 years reported by theprivate health sector in Dubai in 2005, 55.9% were males and44.1% females. Only 27 cases (4.5%) were below 15 years.Type 1 diabetes amounted to 43.6% of the cases and Type 2diabetes 56.4%. Emirates amounted to 14.1% of the cases.Comments and Recommendation:39%Ketoacidosis Other & Multiple Complications No ComplicationType 2 diabetes mellitus is a new morbidity in children andadolescents. For pediatric patients, it heralds earlier onset ofcardiovascular disease, retinopathy, nephropathy, andneuropathy, with risk of impaired quality of life and prematuredeath. The emergence of type 2 diabetes mellitus in youngpeople is believed to be associated with changes in physicalactivity and nutrition that are ubiquitous in modern society (3) .Prevention must take highest priority and should focus ondecreasing the risk, incidence, and consequences of type 2diabetes mellitus among children. Primary prevention efforts byprimary health care professionals are recommended in twoarenas: general community health promotion and healtheducation and clinically based activities. Clinically based healthpromotion activities should not duplicate community-wide healthpromotion but instead should offer additive benefits. Theprinciples of managing children with type 2 diabetes includediabetes self-management education, nutrition management,exercise prescription, pharmacological management andpsychosocial considerations (4.5.6) .As in adults with type 2 diabetes, adolescents may be able toeffectively manage this condition with lifestyle adjustmentsfocused on choice and amount of foods ingested combined withincreased physical activity. One major therapeutic goal shouldbe maintenance of a desirable body weight. As in adults, minorreductions in weight can have dramatic results on glucosetolerance. This underscores the value of frequent access to adiabetes team that can assess, prescribe, and assist in theimplementation of these children's care plans. Smokingcessation is essential since tobacco use magnifies the risk forlong-term micro- and macro vascular complications andaggravates co-morbid problems (e.g., hypertension) (6.7) .Adolescence is well known to be characterized by diminishedadherence to medical regimens and increases in risk-takingbehaviors. This problem is compounded by the focus on shorttermrather than long-term goals typical of many adolescents.Parents may be reluctant to comply with insulin therapy. Propereducation of the family is essential to maximizing adherence tothe medical regimen (4.6) .Most overweight children with type 2 diabetes have diminishedexercise tolerance. A contributing factor is the lack of physicaleducation in schools. Getting adolescents to engage in physicalactivity takes an understanding of what each child considers"acceptable." An overly ambitious exercise prescription can resultin poor adherence and frustrate teens and their families (4.8) .For most inactive teens, walking is a good start. If there is anactivity a child enjoys, such as team sport, this can also be used.Exercise must be started slowly (3 times a week) and for shortperiods of time (15–20 minutes) to build tolerance. The goal isto develop a healthy pattern of regular physical activity, not acompetitive athlete. Parents or other family members should beencouraged to participate. This will help the entire family adopta healthier lifestyle and improve adherence in most cases. Thekey to a successful exercise program for children, as for adults,is to engage in an enjoyable activity. As children develop greaterexercise tolerance, encourage increasing the duration andintensity of their physician activity (8) .Nutritional education is a cornerstone of therapy for childrenwith type 2 diabetes. Often, these children come from a homeenvironment with a poor understanding of healthy eating habits.Adolescents and their families must be encouraged toconsistently make better food choices. This begins by teachingparents what foods to bring home and how to plan meals andsnacks (9) .Recommendation:1. More elaborate data and precise indicators are required toassess the magnitude of the problem of diabetes mellitus inDubai in preparation for the development of a plan for theprevention and management of the disease in Dubai.2. A Task Force Group should be developed from DOHMS andMinistry of Education for studying the nature of diabetesmellitus among school children in Dubai and developing aprogram for managing and controlling the disease. TheDepartment of Planning and Statistics should be engaged inthat activity. A proposed protocol for studying diabetesmellitus among school children in Dubai was prepared bythe Department.3. The Research and Diabetes committees in DOHMS and incollaboration of the Department of Planning & Statistics andDepartment of Primary Health Care should design andimplant a study for studying diabetes mellitus amongEmirate Population 18 years and above in Dubai. Asuggested protocol is prepared by the Department.References:1. Epidemiology of type1 and type2 diabetes mellitus among North American children &adolescents available from CDC (home page on the internet).http://www.cdc.gov/diabetes/projects/cda2.htm2. Annual report 2004. Preventive Medicine Section, Ministry of Health - U.A.E.3. Internal diabetes federal (homepage on the internet) type2 diabetes in the young,available form http://www.eatlas.idf.org/Prevalence/Type_2_in_the_young4. Guidelines for school health programs to promote life long healthy eating MMWR June 14,1996 145 (RR-9), 34-41. available form.5. Medicine net com. (obesity double kid’s diabetes risk), available formhttp://www.medicinenet.com/script/main/art.asp?articlekey=577276. Risk reduction for type 2 diabetes in Aboriginal children in Canada, Pediatrics & ChildHealth 2005; 10(1): 49-52, available fromhttp://www.cps.ca/English/statements/II/FNIH05-01.htm7. Obesity Doubles Kids' Diabetes Risk Available fromhttp://www.medicinenet.com/script/main/art.asp?articlekey=57728. Diabetes Spectrum. Type2 Diabetes Mellitus in Teens Volume 13 Number2, 2000, Page95,available http://journal.diabetes.org/diabetesspectrum/00v13n2/pg95.htm9. Simple Steps to Preventing Diabetes Available fromhttp://journal.diabetes.org/diabetesspectrum/00v13n2/pg95.htmIssue 6 Statistical News2

Malliignantt Neeopllassm’’ss off Brreeasstt iinDOHMS, , DubaiiWith one million new cases in the world each year, breastcancer is the commonest malignancy in women and comprises18% of all female cancers and is the single commonest cause ofdeath among women aged 40-50, accounting for about a fifth ofall deaths in this age group. For so many women, there is nomore dreaded disease than breast cancer. Breast cancer elicitsfears related to loss of body image and sexuality, surgery, anddeath. As is the case for most cancers, the exact cause of breastcancer is not clearly known. Furthermore, there is currently nocure for advanced disease, and there is no definitive way ofpreventing it (1) .The incidence of breast cancer increases with age, doublingabout every 10 years until the menopause, when the rate ofincrease slows dramatically. In some countries there is aflattening of the age-incidence curve after the menopause. Theincidence of breast cancer is greater in women of higher socioeconomicbackground. The relationship of breast cancer riskwith socio-economic factors is most likely related to the lifestyle, differences like age at first childbirth and number ofpregnancies (1.2) .Data of the national cancer registry in UAE shows that cancerbreast was the most common cancer (27.2%) of all cancersamong females and accounted for 9.3% of all deaths amongfemales in 2003 (3) . Cancer is the second leading cause of deathis Dubai (14.8%) following cardiovascular diseases thataccounted for 22.8 % of all deaths (4) . Information of malignantneoplasm’s of Breast (C50) diagnosed in DOHMS hospitals wascollected from the electronic network of health informationsystem in DOHMS. Retrospective case series of cancerdischarged during the period 2004- 2005 were reviewed. Basicdata were age, sex, nationality, diagnosis and outcome atdischarge.There were 254 malignant neoplasms of breast (249 femalesand 5 males) admitted in DOHMS in 2004-2005. Breast cancerwas the most prevalent neoplasm (34.5%) in females. Emiratesamounted for 30.1% of cases and Expatriates 69.9.8%, (Table1). The mean age of the studied cases was 47.86 ± 13.33 years.It was 49.2 ± 15.30 for Emirates and 47.28 ± 12.99 forExpatriates. This difference is not significant. As for the age ofdistribution, 14.9% was below 35 years, 29.7% were 35-44years, 28.1% of cases were in the age group 45-54 years and27.3% were 55 years and above, (Table 1 & Figure 1). Theaverage length of stay in hospital was 3.37± 6.63 days. It was5.34 ± 10.02 for Emirate females and 2.43 ± 3.8 forexpatriates. This difference is significant (P = 0.001). The casefatality rate was 9.2%. It was 13.33% among Emirate femalesand 7.47% among Expatriates. This difference is not significant.Table (1) Summary characteristics of MalignantNeoplasm’s of Breast among Inpatients in DOHMS,Dubai 2004-2005VariableValue% Among Female Cancer 34.5Nationality (%)Emirates 30.1Expatriates 69.9Age (%)