Running head: [SHORTENED TITLE UP TO 50 CHARACTERS] 1

Review of Diabetes Mellitus Epidemiology Globally and in The State of Qatar

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

[SHORTENED TITLE UP TO 50 CHARACTERS] 2

Review of Diabetes Mellitus Epidemiology Globally and in The State of Qatar

Diabetes mellitus is a metabolic disorder characterized by a battery of dysfunctions

including hyperglycemia. Hyperglycemia is considered the rationale behind the resistance to

insulin action, the insufficient insulin secretion, and the enhanced disproportionate glucagon

secretion ("Standards of Medical Care in Diabetes--2014").

The clinical presentation of patients with diabetes mellitus

The classic symptoms presentation are polyuria, polydipsia, polyphagia, and loss of

weight along with the blurring of vision, a parenthesis of the lower extremities, and yeast

infections (balanitis in men). However, many patients are presented late with the complications

rather than the classic symptoms. One study conducted in the United Kingdom showed that 25%

of patients are represented with retinopathy, 9% with neuropathy and 8% with nephropathy when

they were first diagnosed with 4-7 years had been at least elapsed before being aware of their

illness (Harris, Klein, Welborn, & Knuiman, 1992).

The clinical signs are not very helpful in the early stages of the disease. However, the

clinician should concentrate on the signs of end-organ damage including fundoscopic

examination, brief vascular and neurologic examination, and assessment of the feet. The vital

signs are essential to detect associated hypertension and cardiac complications. Other systems
[SHORTENED TITLE UP TO 50 CHARACTERS] 3

are evaluated as indicated. It is worth mentioning that breathing assessment for Kussmaul

respiration should be considered to rule our the serious complication; diabetic ketoacidosis

(DKA).

Prevalence of diabetes mellitus worldwide

Diabetes mellitus has shown an increase in prevalence in a worldwide fashion to the

extent of epidemicity. Diabetes mellitus casts a great economic burden on the countries either by

direct or indirect expenses. It is a high ranked expensive disease. In 2012, the total sum expenses

in the United States, both direct and indirect, were estimated to be $245Bn. Diabetic patients’

expenditures are 2.3 times the non-diabetic patients. Moreover, diabetes mellitus patients’ visits

to the emergency department are double the visits by non-diabetic patients ("Standards of

Medical Care in Diabetes--2013").

The number of patients in developed countries is estimated to increase from 171M in

2000 to 366M in 2030 with the number doubling in developing countries (Wild, S. et al.). Type 2

diabetes mellitus prevalence is strongly associated with the lifestyle of the Western community.

The prevalence of Diabetes mellitus in the non-Western communities is less that in the Western

communities. The rationale behind such distribution is a high dietary caloric expenditure that

features the Western communities (Keeling, Ann, and Katie Dain).

Prevalence of Diabetes mellitus in the State of Qatar

The calculated prevalence of Diabetes mellitus in the State of Qatar is 17% of the overall

adults. The prevalence is subject to increase due to the high incidence of the pre-diabetics among

adults (Bener, Abdulbari et al.). The diagnosed cases are calculated to be 10.7% and the patients

that are newly diagnosed are 5.9%. Patients with impaired glucose tolerance reach 12.5% while
[SHORTENED TITLE UP TO 50 CHARACTERS] 4

patients with impaired fasting glucose reach 1.3% with a total reaching 13.8% of the total

population. The prevalence of diabetes mellitus in Qatari men, 46.8%, is lower than Qatari

Women, 53.2% (Bener, Abdulbari et al.). Some authors suggest that smoking and family history

are behind the increase of prevalence of diabetes mellitus in the State of Qatar (Bener, Abdulbari

et al.). However, others suggest that central obesity explains why the prevalence of diabetes

mellitus and impaired fasting glucose are an increase among the Qatari people of both sexes

(Bener, Abdulbari et al.).

The pathophysiology of diabetes mellitus

Two pathophysiological factor must coexist to cause diabetes mellitus; the insulin

resistance and inadequate insulin secretion. The presence of either factor alone seems not enough

to cause the disease. As a consequence, an array of devastating changes occurs including

elevation of free fatty acid levels as a result of increase fat breakdown, enhancement of

proinflammatory cytokines in plasma, and elevated production of liver glucose as a

compensatory process.

Glucagon role

The interruption of the reciprocal relationship between the insulin-secreting beta cells and

the glucagon-secreting alpha cells causes elevation of glucagon serum level irrespective of

insulin serum level. The net result is hyperglycemia (Unger, & Orci, 2010). Moreover, research

studies revealed that the volume of the pancreas decreases, pancreatic atrophy, in patients with a

median of 15-years documented the history of diabetes mellitus. (Philippe et al., 2011)
[SHORTENED TITLE UP TO 50 CHARACTERS] 5

Dysfunction of beta-cells

The spectrum of diabetes mellitus ranges from the prediabetic stage to the frank diabetes

stage. The dysfunction of the beta-cells in fatty young people develops early in the course of the

disease and need not follow the stage of insulin resistance (Michaliszyn et al., 2014).

Genomic factors

The genetic participation in diabetes mellitus has been proved. Studies of single-

nucleotide polymorphisms (SNPs) succeeded to identify that a number of genetic variants are

associated with beta cell dysfunction; more than 40 independent loci have been demonstrated to

be associated with increased risk of type 2 Diabetes mellitus (Torres, Cox, & Philipson, 2013).

Treatment of diabetes mellitus

Primary care management

The aim of the primary care facilities for the patients with diabetes mellitus is

amelioration of the symptoms and complications development either the microvascular

complications including retinopathy and nephropathy or the macrovascular complications

including the coronary heart disease, cerebrovascular disease, and peripheral vascular disease

("Standards of Medical Care in Diabetes--2010", 2009). It is better to provide the health care

services to patients with type 2 diabetes mellitus through multidisciplinary facilities and

teamwork including health professionals (Nielsen et al., 2003).

The pharmacological therapy of diabetes mellitus type 2 encompasses a long list of

medications with still more medications are added. Sulfonylurea is still on the top of the list.

Insulin therapy is resorted to for patients not responding to oral medications or those with

complications. It is a recommended practice to allow for 2-3 months to get a glycemic control by

monotherapy. Failure to achieve the goal mandates the use of multiple drug therapy; to be chosen
[SHORTENED TITLE UP TO 50 CHARACTERS] 6

according to the patient characteristics ("American Association of Clinical

Endocrinologists/American College of Endocrinology Statement on the Use of Hemoglobin A1c

for the Diagnosis of Diabetes", 2010).