Exploring Type Two Diabetes Mellitus in the Kingdom of Saudi Arabia: Studying the Socio-economic Environment

Abstract

Type two diabetes mellitus (T2DM) is a global public health challenge, yet the socio-economic factors that contribute to this remain largely unexplored. This high burden of T2DM has profound economic and societal impact, particularly in the Gulf Cooperation Council (GCC) countries, where the oil-boom in the Arabic Gulf region has led to unprecedented growth and urbanisation. Saudi Arabia stands out as one of the countries with the highest prevalence of T2DM worldwide. Rapid socio-economic development in the Kingdom has resulted in lifestyle changes and concomitant changes in non-communicable disease epidemiology. Despite this, there are few national studies exploring the relationship between socio-economic factors and T2DM in Saudi Arabia. In this thesis I address this deficit by investigating the association between education level and the prevalence, diagnosis, and control of T2DM in Saudi Arabia. I explore and evaluate the impact of demography and geographical location together with socio-economic, lifestyle, healthcare access and behavioural factors such as self-care on T2DM outcomes.
I first explore the association between education level and T2DM prevalence in Saudi Arabia and show an inverse association. The prevalence of T2DM is elevated among groups with low education level, together with those who are older, obese, and lived in Southern region. Additionally, the findings support projections in which the prevalence of T2DM continues to increase up to 2030. I then investigate individuals with diagnosed T2DM and analyse the association between education level and other risk factors on the diagnosis of T2DM. These analyses confirm that age and low household income are highly associated with achieving diagnosis of T2DM. Based on these findings, I then develop two prediction models for undiagnosed diabetes and pre-diabetes by considering education level and socio-economic factors. Development of the prediction models established that age, administrative region, and body mass index are the three main predictors of undiagnosed diabetes, although gender and hypertension also emerged as predictors for the compound outcome of undiagnosed diabetes or pre-diabetes.
In the final analysis, I investigate whether education level is associated with achieving control of diabetes through interaction with health-care access and self-care factors. Administrative region, prescribed diet and adherence to medication emerged as key predictors of controlled diabetes. The association with administrative region reflected differences in patterns of T2DM management relating to medication and behavioural modification interventions. My findings indicate that T2DM management forms vary between regions and that the success of lifestyle management approaches is influenced by patients' socio-economic characteristics. The work described in this thesis establishes that education level is associated with the prevalence of diagnosed T2DM.
However, among other socio-economic factors, administrative region stands out as a significant predictor of diagnosed T2DM, undiagnosed T2DM and achieving effective control of T2DM. These findings have important implications for primary prevention of T2DM in Saudi Arabia through population approaches, especially in poorer or more deprived groups. They inform strategies to improve the early diagnosis of T2DM in such groups and suggest approaches to gain better glycaemic control in individuals with diagnosed disease. A combination of these two approaches will prevent complications and improve the quality of life for patients with T2DM.

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ORCID for Amos Channon: orcid.org/0000-0003-4855-0418

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