Prevalence of obesity among type 2 diabetic patients in Al-khobar primary health care centers.

OBJECTIVES: This study estimates the prevalence of obesity among Type 2 diabetic patients who are followed in mini clinics (hypertension, diabetes) in Primary Health Care Centers (PHCC) in Al-Khobar.
METHODS: Retrospective study reviewing all diabetic patient files registered in PHC centers in the Al- Khobar area from May 2000 to October 2001.
RESULTS: Of the 382 diabetic patients followed in PHC, 88.7% were type 2 diabetics, and according to WHO classification of obesity 0.7% were underweight. Only 21.8% of type 2 diabetic patients were in their ideal range of body weight. While 31.2% were overweight (BMI in the range of 25.0-29.9 kg/m(2)), 39.9% of the type 2 diabetic patients were found to be obese (BMI= 30 - 39.9 kg / m(2)), and 6.3% had morbid obesity (BMI ≥ 40 kg / m(2)).
CONCLUSION: High prevalence of overweight and obesity in type 2 diabetics is associated with other serious complications. This study emphasizes the importance of training health care providers for the proper follow-up of patients.

INTRODUCTION

The risk of diabetes mellitus increases independently with increasing age, obesity, and lack of physical activity,1–6 and overall mortality rises with body mass index (BMI) level greater than 25 kg per m M21

Obesity is a complex disorder involving appetite regulation and energy metabolism, as the excess of body fat results from an imbalance of intake and expenditure.1 Obesity is considered a major risk factor for type 2 diabetes.2–4 It has been found that the incidence of diabetes increases by a factor of 2-3 fold in obese individuals when obesity is defined as 120% of ideal weight.7

Obesity is a modifiable risk factor for Type 2 diabetes. It not only interferes with effective treatment of hyperglycemia, but also hypertension, and dyslipidemia,8 cardiovascular disease, cerbrovascular disease, hyperlipidemia, increased incidence of arthritis of the hands and knees, gallbladder disease, sleep apnea. It is also related to chronic back pain and respiratory dysfunction.12 In addition to the increased risk of morbidity and mortality, obesity leads to various psychological stresses that vary from emotional distress to social stigmatization.124

Recent WHO classification of obesity is shown in Table 1, the cut-off points of 25kg/ m2 and 30kg/m2 used to define overweight and obesity respectively.910

Table 1

Classification of overweight and obesity by BMI*

This paper summarizes findings of type 2 diabetic patient files followed in the mini clinics (hypertension and diabetes) in Primary Heath Care Centers in Al-Khobar, Saudi Arabia.

METHODS

Data were collected randomly from 50% of the 10 primary health care centers (PHCC) in Al-Khobar. All the personal health files of the diabetic patients registered in these centers were studied and the required data such as weight, height BMI extracted by the investigator during an 18-month period (May 2000- October2001).

World Health Organization's criteria for diabetes classification were used to group patients as Type 1 or Type 2 diabetes mellitus.56 Experienced nurses using standard techniques, measured height and weight. Body mass index (BMI) was calculated according to person's weight in kilograms divided by the square of the person's height in meters.10 Weight was recorded by the calibrated scale in PHCC; and height was taken in the same setting. The investigator revised this randomly.

Data were entered into a personal computer using SPSS statistical package, a p-value of 0.05 or less was considered to represent statistical significance. Descriptive statistics and statistical tests were used as appropriate.

RESULTS

Ninety percent (90%) of the 382 diabetic patients registered, and followed in the randomly selected PHCC were Type 2 diabetes. Recommended data were missing in 21.2% (81) of patients’ files.

Table 2 shows the gender distribution of diabetic patients. Comparison between Types 1 and 2 diabetics showed that 88.9% of the male and 88.6% of female patients were Type 2, (p=<0.05).

Table 2

Gender distribution of the diabetic patients attending PHCC

Comparison of BMI status among type 2 and Type 1 diabetic patients attending PHCC (Table 3), showed a statistical significance (p=<0.05). Less than one percent (0.7% ) were underweight, while only 21.8% of Type 2 diabetics and 26.7% of Type 1 were in the normal range. Overweight Type 2 diabetic patients had a higher percentage (32.1%) than Type 1 diabetics (23.3%). While there was no difference between obese diabetics Type 2 and Type 1 (46.2% and 43.3% respectively).

Table 3

Status among diabetic patients attending Primary Health Care Centers (p=<0.05)

Table 4 shows the distribution of BMI among diabetics′ male and female patients (p=<0.05). More than one quarter of the male patients and 16.3% of the females were in the normal BMI range while overweight males had a higher percentage (35.2%) than females (28.7%). From the data it appears that in all obesity classes, the percentage of female patients was higher than males.

Table 4

Body Mass Index (BMI) status among male and female Type 2 diabetics (p=<0.05)

DISCUSSION

Obesity is a condition in which excess body fat may put a person's health at risk. In adults, the risk of disease increases independently with increasing BMI and excess abdominal fat. Cardiovascular and other obesity-related disease risks increase significantlywhen BMI exceeds 25.0 kg per m2. The risk increases with the extent of obesity and those with a BMI > 40 kg/m2 are at the highest risk.28

In developed countries, 85% of all diabetics are Type 2 diabetics, and almost 100% are Type 2 in developing countries. This has been explained by the changes in the life style and urbanization.39

Our study shows that of the total number of 382 diabetic patients who were followed in PHCC in the study area, 88.7% were Type 2 diabetics. Of these Type 2 diabetic patients, only 21.8% had BMI within the normal range while 32.1% were overweight; the percentage of male patients was higher (35.2%) than female patients (28.7%). Obesity was found in 39.9% of the patients (33.8% of the male patients 33.8% and 46.4% of the female patients). Extreme obesity was also higher in female patients (8.5%) than male patients (4.2%).

Different studies have documented that more than 80% of Type 2 diabetics are obese, and adult males with Type 2 diabetes are more likely to be obese than females.711

In Arab societies, it has been found that the high prevalence of Non-insulin dependent diabetes mellitus (NIDDM) is associated with high prevalence of obesity.12 In Bahrainis, the high rate of diabetes is associated with obesity, but not with overweight.13

A study done on the Saudi diabetic population, showed that only 20% of Type 2 diabetic patients had normal BMI. Similar to our finding, 37% of the male patients, and 29.7% of the females were overweight. However, 20.7% of the male, and 39.3% of the female diabetic Type 2 patients were obese.13 Another study done on the general population of the Eastern Region showed that the prevalence of overweight was higher in males (21.62%) than in females (20.45%), but the reverse was found in obesity (female have higher BMI than male).14

Results similar to ours were found in Yemeni diabetic patients, where the normal BMI was higher in female patients (22%) than in male patients (21%). However, more female patients (30%) were obese than male patients (28%).15

The rapid changes in socioeconomic life in the middle east countries not excepting Saudi Arabia with an imbalance between intake and reduced energy expenditure has brought in its wake a number of health risks.111316

It has been recommended that screening for changes in BMI is a good indicator for the development of Type 2 diabetes.17 Diabetic registration will reduce the latent complication of Diabetes. It has been documented that for most patients weight loss seems to be a desirable goal for the improvement of glycemic control, hyperlipidemia, and hypertension.1819

Public education about obesity and its consequences is strongly recommended. Ways to control, prevent obesity and overweight should be stressed and made known to people of all ages in the population. Education about diabetes mellitus and its complications could be presented in basic simple public lectures that stress the importance of the awareness of this health condition.