title: Prevalence, correlates and management of type 2 diabetes mellitus in Lebanon: findings from a national population-based study.
abstract: OBJECTIVE
  This study aims to examine the prevalence, associated risk factors and complications of diabetes, as well management and preventive care in Lebanon, a small, middle-income country of the Mediterranean region.
  
  
  METHODS
  Using a comprehensive multi-dimensional questionnaire, a cross-sectional national survey of 2195 Lebanese adults aged ≥25 years was conducted based on the WHO STEPwise guidelines. The outcome variable, diabetes, was self-reported. Measures for diabetes management included frequency of blood glucose testing and regular eye and foot exams. Macrovascular and microvascular complications were also recorded.
  
  
  RESULTS
  The prevalence of type 2 diabetes was 8.5% (95%CI=7.3-9.7). Factors associated with an increased risk of having diabetes were: being divorced or widowed (OR=2.56; 95%CI=1.07-5.42) compared to single, being obese (OR=1.50, 95%CI=1.00-2.57), and having a family history of diabetes (OR=3.40;95%CI=2.48-5.19). Vigorous physical activity significantly decreased the odds of diabetes (OR=0.42; 95%CI=0.24-0.72). Diabetes management and self-care goals were as follows: 82% were not measuring their blood sugar via dextro on a daily basis, 64.2% did not have a foot exam within the past year, and 52.4% did not obtain the recommended yearly eye exam. The most common complications included heart disease (27.8%) and retinopathy (16.6%).
  
  
  CONCLUSIONS
  Prevalence of diabetes in Lebanon was comparable to that found in the West, yet remained lower than estimates in other resource-rich neighboring countries. Adherence to management and self-care measures was sub-optimal resulting in high complication rates. Contextual factors play a role in increasing diabetes risk. Population-based interventions to enhance and promote self-management behaviors are essential to improve complication rates.
authors.affiliation: Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Electronic address: christycostanian@gmail.com.
authors.forename: Christy
authors.initials: C
authors.lastname: Costanian
authors.affiliation: Department of Pharmacology and Therapeutics, Trinity Centre of Health Sciences, St James's Hospital, Dublin 8, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon; Member of the Public Health and Nutrition (PHAN) Research Group at the American University of Beirut, Lebanon.
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
authors.affiliation: Lebanese University, Faculty of Sciences, Beirut, Lebanon.
authors.forename: Shafika
authors.initials: S
authors.lastname: Assaad
authors.affiliation: Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; Member of the Public Health and Nutrition (PHAN) Research Group at the American University of Beirut, Lebanon. Electronic address: am00@aub.edu.lb.
authors.forename: Abla M
authors.initials: AM
authors.lastname: Sibai
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D003935:Diagnostic Techniques, Cardiovascular; D003941:Diagnostic Techniques, Ophthalmological; D019468:Disease Management; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity; D015995:Prevalence; D065840:Protective Factors; D012307:Risk Factors; D012648:Self Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Complications; Lebanon; Management; Prevalence; Type 2 diabetes mellitus