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Diabetes mellitus (DM) is a prominent public health problem in Qatar with one of the highest prevalence in the Gulf Cooperation Council region. Obesity continues to be a challenging public health problem in Qatar along with other social determinants contributing to the high DM prevalence.
This paper examines the data from Qatar National STEPS survey (2012) to determine diabetes prevalence among Qatari adults and identify the effect of both generalized and central obesity on it. The article also describes the contribution of selected social and demographic factors on diabetes prevalence in Qatar.
Secondary data analysis of 1471 Qatari adults (18-64 years) from STEP 3 component of the 2012 STEPS Survey was executed. Multivariate binary logistic regression analysis was carried out to assess the role of social and biomedical factors in the prevalence of DM.
Among participants, 18.97% (279/1471) of the study population had DM. Both generalized (OR 1.8, P=.005) and central obesity (OR 1.9, P<.001) were significantly associated with DM when adjusted for various respondent characteristics. Older age (P<.001), marital status of ever married (P<.001), and lower educational status (P=.01) were associated with DM. Hypertension (OR 1.5, P=.003 total cholesterol level ≥190 mg/dL (OR 2.2, P<.001) and triglyceride level ≥150 mg/dL (OR 3.6, P<.001) were significantly associated with DM among the study participants. Although family history of DM was significantly associated with development of DM (OR 1.7, P=.01), parental consanguinity was not associated with DM (OR 0.96, P=.80).
The DM prevalence in Qatar seems to be highly associated with obesity; however, various additional population characteristics and comorbidity factors should also require attention and should be incorporated while developing intervention strategies.
Diabetes mellitus (DM) is one of the most costly preventable public health condition causing mortality and morbidity in millions of people globally [
According to the World Health Organization (WHO) estimates, in 2014 the global prevalence of DM in adults was 8.5%, and in 2012, mortality due to DM was 1.5 million worldwide [
The World Health Survey (WHS) in 2006 revealed that about 8% of Qatar population was diabetic which was higher than the worldwide diabetes prevalence of 5.1% [
This study examines the data from Qatar National STEPwise Survey (2012) to determine DM prevalence among Qatari adults and identify the effect of both generalized and central obesity on it. The STEPS survey is a standardized approach to collect population level data pertaining to the NCD including DM and the related risk factors [
The secondary data from WHO-based Qatar National STEPwise Survey for chronic diseases and risk factors were utilized for this particular study [
The DM status by obesity and sociodemographic factors was examined among 1471 Qatari adults aged 18-64 years and who participated in the STEP 3 survey tool. The response rate for STEP 3 component was about 60% [
Data to assess obesity in STEP 3 participants were analyzed using the STEPS methodology [
Cutoff values for FBG, lipid profile, and BP were determined in accordance with the WHO STEPS Guidelines, that is ≥190 mg/dL of total cholesterol, ≥150 mg/dL triglyceride level, <40 mg/dL and <50 mg/dL of high-density lipoproteins (HDL) in men and women, respectively, and ≥110 mg/dL of FBG were considered unfavorable [
Statistical analysis was performed using IBM SPSS statistics version 20.0 for Windows. All categorical variables were presented as frequencies and percentages. Study outcomes were assessed using Fisher exact test or chi-square test with Yates correction for discrete variables appropriately. The Kolmogorov-Smirnov test was used for checking normality. Continuous variable such as FBG, BMI, WC were presented as geometric mean and 95% CI. Independent sample
The female-to-male ratio among the total surveyed population (N=1471) was 1.7 (62.5% women and 37.5% men). The overall mean age of participants was 38.5 years with higher mean age (45.8 years) for diabetics (
Study participants' characteristics by diabetes status. Geometric means are presented with 95% CI. Age is presented with SD. Pregnant women are excluded from the BMI and WC calculations.
Parameters | Categories | Total, |
Diabetic, |
Normal, |
|||||||||||
Overall sample | N | 1471 (100.0) | 279 (19.0) | 1192 (81.0) | |||||||||||
Mean (SD) | 38.5 (12.2) | 45.8 (11.7) | 36.7 (11.7) | <.001 | |||||||||||
Age | 18-44 years | 1008 (68.5) | 121 (43.4) | 887 (74.4) | <.001 | ||||||||||
45-64 years | 463 (31.5) | 158 (56.6) | 305 (25.6) | ||||||||||||
Gender | Male | 552 (37.5) | 111 (39.8) | 441 (37.0) | .38 | ||||||||||
Female | 919 (62.5) | 168 (60.2) | 751 (63.0) | ||||||||||||
BMI (kg/m2) | Mean (95% CI) | 29.4 (29.0-29.8) | 31.8 (30.9-32.7) | 28.8 (28.4-29.3) | <.001 | ||||||||||
Lean | 39 (2.7) | 1 (0.4) | 38 (3.3) | <.001 | |||||||||||
Normal | 315 (22.2) | 34 (12.5) | 281 (24.4) | ||||||||||||
Overweight | 403 (28.3) | 75 (27.6) | 328 (28.5) | ||||||||||||
Obese | 665 (46.8) | 162 (59.6) | 503 (43.7) | ||||||||||||
Male | Mean (95% CI) | 102.2 (100.0-104.5) | 108.0 (103.1-113.2) | 100.8 (98.3-103.3) | .01 | ||||||||||
Central obesity (WC ≥102 cm) | 268 (49.3) | 71 (64.5) | 197 (45.4) | <.001 | |||||||||||
Normal (WC <102 cm) | 276 (50.7) | 39 (35.5) | 237 (54.6) | ||||||||||||
Female | Mean (95% CI) | 97.8 (94.7-100.8) | 102.1 (98.1-106.1) | 96.8 (93.3-100.5) | .20 | ||||||||||
Central obesity (WC ≥88 cm) | 509 (60.0) | 127 (79.9) | 382 (55.4) | <.001 | |||||||||||
Normal (WC <88 cm) | 340 (40.0) | 32 (20.1) | 308 (44.6) | ||||||||||||
Education level | Secondary or less/no formal education | 957 (65.1) | 200 (71.7) | 757 (63.6) | .01 | ||||||||||
College/university/PG | 513 (34.9) | 79 (28.3) | 434 (36.4) | ||||||||||||
Marital status | Ever married | 1182 (80.4) | 256 (91.8) | 926 (77.7) | <.001 | ||||||||||
Never married | 289 (19.6) | 23 (8.2) | 266 (22.3) | ||||||||||||
Parental consanguinity | Yes | 528 (35.9) | 97 (34.8) | 431 (36.2) | .66 | ||||||||||
No | 943 (64.1) | 182 (65.2) | 761 (63.8) | ||||||||||||
Family history of DM | Yes | 1017 (69.1) | 208 (74.6) | 809 (67.9) | .03 | ||||||||||
No | 454 (30.9) | 71 (25.4) | 383 (32.1) | ||||||||||||
Mean fasting blood glucose (95% CI) | Overall | 90.3 (88.8-92.0) | 149.2 (143.5-155.1) | 80.3 (79.6-81.0) | <.001 | ||||||||||
Men | 90.2 (87.8-92.7) | 148.8 (140.1-158.2) | 79.6 (78.3-80.8) | <.001 | |||||||||||
Women | 90.3 (88.5-92.1) | 149.4 (142.0-157.1) | 80.7 (79.8-81.6) | <.001 | |||||||||||
Current smoker | Yes | 197 (13.4) | 35 (12.5) | 162 (13.6) | .64 | ||||||||||
No | 1274 (86.6) | 244 (87.5) | 1030 (86.4) | ||||||||||||
Smoking status | Daily | 179 (12.2) | 31 (11.1) | 148 (12.4) | .82 | ||||||||||
Nondaily | 18 (1.2) | 4 (1.4) | 14 (1.2) | ||||||||||||
Past smoker | 53 (3.6) | 12 (4.3) | 41 (3.4) | ||||||||||||
Never smoker | 1221 (83.0) | 232 (83.2) | 989 (83.0) | ||||||||||||
Hypertension | Mean systolic blood pressure (SBP), mmHg (95% CI) | 118.3 (117.4-119.2) | 127.4 (125.1-129.8) | 116.2 (115.3-117.1) | <.001 | ||||||||||
Mean diastolic blood pressure (DBP), mmHg | 79.0 (78.4-79.5) | 83.0 (81.8-84.2) | 78.0 (77.4-78.6) | <.001 | |||||||||||
SBP ≥140/DBP ≥90 mmHg |
540 (37.0) | 150 (54.0) | 390 (33.1) | <.001 | |||||||||||
Normal | 918 (63.0) | 128 (46.0) | 790 (66.9) | ||||||||||||
Total cholesterol (mg/dL) | Mean (95% CI) | 160.4 (158.6-162.2) | 166.6 (161.8-171.4) | 159.0 (157.0-160.9) | <.01 |
||||||||||
≥190 mg/dL | 381 (26.0) | 124 (44.6) | 257 (21.7) | <.001 | |||||||||||
<190 mg/dL | 1083 (74.0) | 154 (55.4) | 929 (78.3) | ||||||||||||
Male | Mean (95% CI) | 39.7 (38.5-40.9) | 38.8 (36.4-41.4) | 39.9 (38.5-41.3) | .47 | ||||||||||
<40 (mg/dL) | 264 (47.8) | 59 (53.2) | 205 (46.5) | .21 | |||||||||||
≥40 (mg/dL) | 288 (52.2) | 52 (46.8) | 236 (53.5) | ||||||||||||
Female | Mean (95% CI) | 54.5 (53.4-55.6) | 52.0 (49.4-54.8) | 55.1 (53.8-56.4) | .04 | ||||||||||
<50 (mg/dL) | 341 (37.4) | 73 (43.7) | 268 (36.0) | .06 | |||||||||||
≥50 (mg/dL) | 571 (62.6) | 94 (56.3) | 477 (64.0) | ||||||||||||
Triglyceride (mg/dL) | Mean (95% CI) | 96.1 (93.8-98.5) | 122.9 (115.7-130.7) | 90.7 (88.4-93.1) | <.001 | ||||||||||
≥150 (mg/dL) | 257 (17.7) | 103 (37.2) | 154 (13.1) | <.001 | |||||||||||
<150 (mg/dL) | 1197 (82.3) | 174 (62.8) | 1023 (86.9) | ||||||||||||
LDL (mg/dL) | Mean (95% CI) | 89.1 (87.6-90.5) | 89.5 (86.1-93.1) | 88.9 (87.3-90.5) | .75 | ||||||||||
≥130 (mg/dL) | 144 (10.8) | 34 (12.8) | 110 (10.3) | .24 | |||||||||||
<130 (mg/dL) | 1188 (89.2) | 232 (87.2) | 956 (89.7) |
Crude analysis showed that the older age group (45-64) had 3.8 time odds of having DM compared with younger age (18-44) group (95% CI 2.9-4.9,
Relationship (crude) of diabetes between participant parameters and categories. Odds ratios (OR) and 95% CI were estimated using logistic regression models. Model 0: crude odds ratio.
Parameters | Categories | Crude OR (95% CI) | ||||||||
Predictors | OR (95% CI) | |||||||||
Age | 18-44 | Reference | ||||||||
45-64 | 3.8 (2.9-4.9) | <.001 | ||||||||
Gender | Male | 1.1 (0.86-1.5) | .38 | |||||||
Female | Reference | |||||||||
Marital status | Ever married | 3.2 (2.0-5.0) | <.001 | |||||||
Never married | Reference | |||||||||
Highest level of education | Secondary or less/no formal education | 1.45 (1.09-1.9) | .01 | |||||||
College/University/PG | Reference | |||||||||
Parental consanguinity | Yes | 0.94 (0.72-1.2) | .66 | |||||||
No | Reference | |||||||||
Family history of DM | Yes | 1.4 (1.03-1.8) | .03 | |||||||
No | Reference | |||||||||
Smoking status | Daily | 0.89 (0.59-1.3) | .59 | |||||||
Nondaily | 1.22 (0.39-3.7) | .73 | ||||||||
Past smoker | 1.24 (0.64-2.4) | .51 | ||||||||
Never smoker | Reference | |||||||||
BMI (kg/m2) | Lean | 0.21 (0.03-1.6) | .14 | |||||||
Normal | Reference | |||||||||
Overweight | 1.9 (1.2-2.9) | .004 | ||||||||
Obese | 2.6 (1.8-3.9) | <.001 | ||||||||
Male | ≥102 cm | 2.2 (1.4-3.4) | <.001 | |||||||
<102 cm | Reference | |||||||||
Female | ≥88 cm | 3.2 (2.1-4.8) | <.001 | |||||||
<88 cm | Reference | |||||||||
Blood pressure (BP, mmHg) | Raised BP or currently on medication | 2.3 (1.8-3.1) | <.001 | |||||||
Normal | Reference | |||||||||
Total cholesterol (mg/dL) | ≥190 mg/dL | 2.9 (2.2-3.8) | <.001 | |||||||
<190 mg/dL | Reference | |||||||||
Male | <40 (mg/dL) | 1.3 (0.86-1.9) | .21 | |||||||
≥40 (mg/dL) | Reference | |||||||||
Female | <50 (mg/dL) | 1.4 (0.98-1.9) | .06 | |||||||
≥50 (mg/dL) | Reference | |||||||||
Triglyceride (mg/dL) | ≥150 (mg/dL) | 3.9 (2.9-5.3) | <.001 | |||||||
<150 (mg/dL) | Reference | |||||||||
LDL (mg/dL) | ≥130 (mg/dL) | 1.3 (0.84-1.9) | .25 | |||||||
<130 (mg/dL) | Reference |
Multivariate logistic regression analysis revealed that generalized obesity was significantly associated with DM (OR 1.8, 95% CI 1.2-2.8,
Family history of DM was significantly associated with DM (OR 1.7, 95% CI 1.2-2.3,
Including obesity parameters in the relationship between consanguinity and family history with obesity, respectively (not shown in the table), showed that the family history of DM in presence of generalized obesity was not statistically significant (OR 1.3, 95% CI 0.95-1.7,
Relationship of diabetes between participant parameters and categories, multivariate logistics regression models. Odds ratios (95% CI) were estimated using multivariate logistic regression models.
Parameters | Categories | Multivariate models | ||||||
Model 1a | Model 2b | Model 3c | ||||||
Predictors | OR (95% CI) | OR (95% CI) | OR (95% CI) | |||||
BMI (kg/m2) |
Lean | 0.29 (0.04-2.2) | .23 | 0.35 (0.04-2.6) | .31 | 0.36 (0.04-2.7) | .33 | |
Normal | Reference | Reference | Reference | |||||
Over weight | 1.5 (0.97-2.4) | .06 | 1.4 (0.92-2.3) | .1 | 1.4 (0.91-2.3) | .12 | ||
Obese | 2.1 (1.4-3.2) | <.001 | 1.9 (1.2-2.9) | .002 | 1.8 (1.2-2.8) | .005 | ||
Male | ≥102 cm | 2.0 (1.3-3.2) | .002 | 1.9 (1.2-2.9) | .006 | 1.8 (1.1-2.9) | .007 | |
<102 cm | Reference | Reference | Reference | |||||
Female | ≥88 cm | 2.3 (1.5-3.5) | <.001 | 2.1 (1.3-3.2) | .002 | 2.0 (1.2-3.1) | .003 | |
<88 cm | Reference | Reference | Reference | |||||
Blood pressure (BP, mmHg) | Raised BP or currently on medication | 1.7 (1.3-2.2) | <.001 | 1.6 (1.2-2.1) | .001 | 1.5 (1.1-2.0) | .003 | |
Normal | Reference | Reference | Reference | |||||
Total cholesterol (mg/dL) | ≥190 mg/dL | 2.3 (1.8-3.2) | <.001 | 2.3 (1.7-3.1) | <.001 | 2.2 (1.6-3.0) | <.001 | |
<190 mg/dL | Reference | Reference | Reference | |||||
Male | <40 (mg/dL) | 1.3 (0.87-2.1) | .18 | 1.32 (0.85-2.1) | .21 | 1.28 (0.82-2.0) | .27 | |
≥40 (mg/dL) | Reference | Reference | Reference | |||||
Female | <50 (mg/dL) | 1.3 (0.93-1.9) | .11 | 1.29 (0.91-1.8) | .15 | 1.3 (0.89-1.8) | .16 | |
≥50 (mg/dL) | Reference | Reference | Reference | |||||
Triglyceride (mg/dL) | ≥150 (mg/dL) | 3.9 (2.8-5.3) | <.01 | 3.7 (2.7-5.1) | <.01 | 3.6 (2.6-4.9) | <.001 | |
<150 (mg/dL) | Reference | Reference | Reference | |||||
LDL (mg/dL) | ≥130 (mg/dL) | 1.1 (0.75-1.7) | .54 | 1.1 (0.73-1.7) | .6 | 1.1 (0.71-1.7) | .66 | |
<130 (mg/dL) | Reference | Reference | Reference | |||||
Family history of DM | Yes | 1.6 (1.1-2.1) | .004 | 1.7 (1.2-2.3) | .001 | |||
No | Reference | Reference | ||||||
Parental consanguinity | Yes | 0.97 (0.73-1.3) | .86 | 0.96 (0.72-1.3) | .77 | |||
No | Reference | Reference |
aModel 1: adjusted for age and gender.
bModel 2: adjusted for age, gender, sociodemographic indicators (marital status, education, smoking status).
cModel 3: adjusted for age, gender, sociodemographic indicators, family history, and consanguinity.
Using family history as a screening tool, the family history of DM identified 74.6% of participants who had DM. For obesity (generalized), 59.6% of participants were identified to have DM. Family history and obesity together identified 46% diabetics. This means that family history is a better indicator of DM among participants compared with obesity or other combinations including consanguinity (
Sensitivity, specificity, positive and negative predictive values of family history of diabetes, consanguinity, obesity and all their possible combinations.
Selected social characteristics | Sensitivity |
Specificity |
Positive predictive value |
Negative predictive value |
Family history of DM | 74.6 (69.0-79.6) | 32.1 (29.5-34.9) | 20.4 (19.2-21.7) | 84.4 (81.3-87.0) |
Consanguinity | 34.8 (29.2-40.7) | 63.8 (61.0-66.6) | 18.3 (15.8-21.2) | 80.7 (79.2-82.1) |
Obesity | 59.6 (53.5-65.4) | 56.3 (53.4-59.1) | 24.4 (22.2-26.6) | 85.5 (83.6-87.3) |
Family history of DM with obesity | 46.0 (39.9-52.1) | 68.6 (65.8-71.3) | 25.7 (22.9-28.8) | 84.3 (82.7-85.8) |
Consanguinity with obesity | 20.2 (15.6-25.5) | 84.6 (82.4-86.6) | 23.7 (19.1-28.9) | 81.8 (80.8-82.7) |
Consanguinity with family history of DM | 26.5 (21.4-32.1) | 75.1 (72.5-77.5) | 19.9 (16.7-23.7) | 81.4 (80.2-82.5) |
Consanguinity and family history of DM with Obesity. | 16.2 (12.0-21.1) | 88.6 (86.6-90.4) | 25.1 (19.7-31.5) | 81.7 (80.9-82.5) |
In summary, the results of this study support the fact that the family history of DM, older age, high WC, high BMI, hypertension, dyslipidemia, lower educational status, and marital status (ever married) have significant relationship with DM and are consistent with the findings from other studies [
DM prevalence is a result of complex interaction between personal, social, economic, and environmental factors in a geographical region. This study demonstrates DM as an important public health challenge in Qatar somewhat similar to the other countries in the region [
While examining the impact of obesity on DM, both generalized and central types obesity were found to be significantly associated with DM in this study. Central obesity among females had slightly higher odds (OR 2.0) of having DM versus males (OR 1.8; Table.3). According to the 2001 Korea National Health and Nutrition Examination Survey (KNHANES), WC and BMI both were identified as a risk factor for DM in females and WC was also associated with DM in males [
In this study, the family history of DM was found among about 70% of STEP 3 survey participants. The data also showed that around 20% of survey participants who had family history of DM also had DM which constitutes 74.6% of identified 279 diabetics in the sample of this study (
In this study, using data from a national population based survey was a main strength [
According to this study, the central and generalized obesity both have an impact on the DM prevalence among Qatari adults. Furthermore, social and behavioral factors seem to have an influence on DM prevalence. In general, DM and obesity together are a major problem in the State of Qatar that requires evidence-based strategies to reduce associated morbidity and premature death. The results of this study might help public health and medical professionals in planning and implementing effective and sustainable interventions.
Body mass index
Blood pressure
Diabetes mellitus
Fasting blood glucose
Noncommunicable diseases
Primary sampling units
STEPwise survey
Waist circumference
World Health Organization
World health survey
No funding was received for this study. Work in this study was supported by the Ministry of Public Health, Qatar. The authors would like to thank Ministry of Development and Planning, Qatar for their support during implementation of National STEPS Survey 2012.
None declared.