diabetes mellitus ( dm ) is one of the most common chronic metabolic diseases , which is on the rise globally.123 ) the dm prevalence for all age groups worldwide was estimated to be 2.8% in 2000 and projected to be 4.4% by 2030 . during this period , the total number of people with dm is expected to rise from 171 million to 366 million.4 ) several explanations have been provided for the increase in dm - prevalence , such as population growth , aging , urbanization , increasing obesity prevalence , and physical inactivity.5 ) diabetes poses a challenge not only to those living with the disease,6 ) but also to their families , communities , and the health care system.789 ) monitoring the dm prevalence and incidence trend is important for assessing the national burden of the disease to describe the impact of risk factors , develop interventions , and project needs for future health services.410 ) the states in the co - operation council for the arab states of the gulf ( gcc ) have some of the highest rates of type 2 dm in the world .
five of the international diabetes federation 's top ten countries for dm prevalence in 2011 and projected prevalence in 2030 are in this region.11 ) the recent and rapid socioeconomic development of the gcc countries has been associated with this rising prevalence.12 ) according to the international diabetes federation , the number of people with dm in its middle east - north africa region will increase to 83% by 2030.11 ) in the united arab emirates ( uae ) , the dm prevalence has reached 24% and 17.4% among citizens and expatriates,13 ) respectively . the dm prevalence in the uae was ranked to be the 2nd highest in the world ( 19.5% ) in 2007 , and the expected prevalence for 2025 is 21.9%.12 ) the uae has developed a national diabetes care continuum program with guidelines to combat this disease.13 ) based on a population study conducted in al ain , in the uae , the age - standardized prevalence rates for dm ( diagnosed and undiagnosed ) and pre - diabetes among people aged 30 - 64 years were 29.0% and 24.2% , respectively.14 ) no published data are available about the age - standardized incidence rates of dm in the uae . such data are important , because information on incidence will help plan specific preventive and control strategies , and will enhance our knowledge about the profile of this disease in the uae .
therefore , this study was conducted to determine the age and gender specific incidence rate of dm among nationals in ajman medical district in 2010 .
the total population of ajman , uae as per 2005 census was 206,997 ( men , 131,684 ; women , 75,313 ) . among this , 39,231 were emiratis ( men , 20,155 ; women , 19,076 ) and the remaining were other nationals ( 11,529 males and 56,237 females ) .
the age and gender distribution of the ajman population ( estimated for 2010 using the geometric growth method ) is shown in table 1 .
health care services for the target population were mainly provided through 5 primary healthcare centers and 2 general hospitals ( sheikh khalifa hospital and gmc hospital , ajman ) in ajman during the study period , and most of the diabetic patients were presumed to be managed at these sites .
the data were collected by using a proforma that was prepared by the team of investigators .
every copy of the research proforma was allocated a code number to identify the primary health care center . the pro forma consisted of the domains , such as socio - demographic characteristics , clinical data , biochemical parameters , and mode of management .
the emirates or health insurance identification number of the nationals and expatriates were recorded to eliminate duplication .
approval from the ethics and research committees of gulf medical university and ministry of health was obtained before commencing this study , and a prior approval was sought from the director of ajman medical district to conduct the study at primary health care centers ( phc ) .
participants were not identified by their names , and any information that could reveal the identity of the subjects was not recorded on the proforma . furthermore , confidentiality of the research data was maintained and anonymity was preserved .
confidentiality was maintained by maintaining all research documents at the statistical support facility for 3 years , and only the researchers , ethics and research committee members , and statistical support facility members had access to the data with appropriate regulatory sight .
any information that can be used to reveal the identity of a participant will not be included in any publications or presentations .
cases of dm were documented retrospectively by studying the medical records from january 1 , 2010 to december 31 , 2010 .
the cases diagnosed for the first time during the study period were included as incident cases .
the following diagnostic criteria were used : ( 1 ) diabetes was defined as a fasting plasma glucose ( fpg ) concentration of  126 mg / dl or previous first diagnosis of dm within the same time period .
impaired fasting glucose and normoglycemia were defined as a fpg concentration of 110 - 126 mg / dl and < 110 mg / dl , respectively;13 ) ( 2 ) when criterion ( 1 ) was not met , we relied on the notes written by doctors elsewhere given that the first diagnosis by the other physician was within the same time period .
2010 spreadsheet were transformed to ibm spss ver . 20.0 ( ibm co. , armonk , ny , usa ) for statistical analysis .
the incidence rate was presented for different age groups ( i.e. , 5-year intervals ) , and confidence intervals for the proportions were estimated .
the crude incidence rates were calculated by considering the population of ajman in 2010 and newly diagnosed dm cases .
the dm cases and total population were arranged into different age groups with 5-year intervals to separately calculate age specific dm incidence rates for men and women .
a total of 158 new dm cases were diagnosed during 2010 ; 102 of these cases were emiratis residents and the remaining cases were other nationalities . among the 102 emiratis cases , there was only 1 type 1 dm case , and the remaining 101 type 2 dm cases were included in the estimation of incidence rate .
the overall incidence rate of dm cases observed among those aged 20 years was 4.8/1,000 person - years ( py ) . in the present study , 35 patients ( 34.7% ) were men and 66 patients ( 65.3% ) were women , indicating female predominance .
the gender specific incidence rate was 3.3/1,000 py for men and 6.3/1,000 py for women .
the incidence rates in men and women were almost similar until the age of 39 years .
however , women who were  40 years showed a higher incidence rate than men .
the highest incidence rate for both genders ( men , 23.4/1,000 py ; women , 32.4/1,000 py ) was observed in the 55 - 59 years age group , and then a downward trend was observed .
in this study , we evaluated the incidence of dm among emirati residents because they constitute a more stable population than expatriates .
future studies involving this population will reflect changes in the epidemiology of this problem that can be linked to lifestyle , socioeconomic , or health service factors . according to the present study
, a similar type 2 dm incidence were observed both among emirati men and women in ajman , uae in the age group of 20 - 39 years , and a female preponderance in the incidence rate of dm in the later age groups .
the incidence of dm was 4.4/1,000 py in 2005 according to a study from the united kingdom ( uk).15 ) the crude incidence rate of type 2 dm was 515/100,000 ( or 5.15/1,000 py ) in 2010 based on more recent data from the uk.16 ) according to this study , the incidence of dm increased with age , and was similar among men and women up to 40 years of age . after 40 years of age , men had a higher incidence rate of dm than women .
the gender specific incidence rate for men and women was 4.86/1,000 py and 4.31/1,000 py , respectively.15 ) an overall dm incidence rate of 10/1,000 py with a male predominance was observed in a study from the united states of america ; using data from the new york city community health survey , the incidence rates were 11/1,000 py and 9/1,000 py in 2008 for men and women ,
respectively.17 ) the overall incidence of dm was 6.3/1,000 py in 2011 based on the report , " diabetes in canada , " and a male predominance was observed in the gender - specific rates ( 6.8/1,000 py in men compared to 5.7/1,000 py in women in the year 2009).18 ) a cohort study conducted over a period of 2000 - 2009 reported an overall incidence rate of dm in china was 9.5/1,000 py with a male predominance ( 11% men vs. 6.2% women).19 ) according to a previous study in the year 2000 - 2009 , the overall ( 20 - 79 years of age ) incidence rate of dm in taiwan was 11.6/1,000 py.20 ) in a report from sweden,21 ) the incidence rate ( 20 - 100 years of age ) in men and women were nearly similar ( 3.92/1,000 py and 3.64/1,000 py in men and women , respectively ) .
the comparison of crude incidence rates in different countries is provided in figure 2 . an age - wise increasing trend in the age specific rates of dm
however , only the 10-year age specific incidence rate was available , and the highest rate was observed in the 70 - 79 years age group ( 9.94/1,000 py and 7.77/1,000 py for men and women , respectively .
the age specific incidence rates of dm were 0.20 , 0.54 , 2.37 , 4.68 , and 7.46/1,000 py for men and 0.29 , 0.70 , 1.71 , 3.57 , and 6.51/1,000 py for women in the 20 - 29 , 30 - 39 , 40 - 49 , 50 - 59 , and 60 - 69 years age groups , respectively.21 ) the age specific incidence rate of dm in canada was comparable with the present findings ( figures 3 , 4 ) .
the rate of dm was almost similar at the age of 40 years in the present study .
the peak incidence rate of dm was observed in the 55 - 59 years age group and then a downward trend in the incidence rate of dm was observed . in canada , a steady increase in the incidence rate of dm was observed with increasing age , and the incidence rate in women was much higher in ajman than in canada .
a variation in the dm epidemiological pattern was observed in the available data in developing compared to developed countries . according to the present study
, dm appears to affect mostly younger participants ( range , 44 - 64 years ) , while in developing countries , the majority of diabetic patients were > 64 years of age.4 ) the higher incidence rate of dm observed among women compared to men after the age of 40 years in this study was incompatible with data from the uk . a further study is needed to investigate the possible related factors ( i.e. , hormonal , dietary , lifestyle , and social factors ) that can restrict the physical activity of older women .
both men and women have a nearly similar global prevalence of dm with slightly higher rates in men < 60 years of age and women at older age , greater than 60 years.4 ) it is worth noting that , according to the international diabetes federation,7 ) the estimated percentage of undiagnosed diabetic patients in middle - eastern high - income countries ( i.e. , uae ) was 40.6% in the year 2011 .
therefore , the actual incidence of dm is about 40% higher than what was observed in this study .
an important finding in this study was that the incidence of dm started to increase after the age of 30 years , which implies that earlier screening , rather than the currently recommended screening at 45 years of age for people without risk factors by the american diabetic association,22 ) is necessary for this disease in the uae . in this study , we have provided evidence to support recommendations by the uae national diabetes committee,13 ) which is included in the periodic health check up program23 ) to start screening for dm in all individuals in the uae at the age of 30 years .
other researchers24 ) from the uae explored the need for such a modification to the current american diabetes association guidelines based on their finding of a low prevalence rate of undiagnosed dm ( 1.5% ) among low risk individuals ( age , < 45 years ; body mass index , < 25 kg / m ) .
certainly , the final decision about the age to initiate screening for dm is affected by cost - effectiveness and health system capacity factors in addition to the incidence / prevalence of the disease.25 ) we recommend future studies to be conducted in these areas .
the incident cases of dm were collected from 5 phcs at shaikh khalifa hospital and gulf medical college hospital in ajman , uae .
it is possible that the incidence rate of dm was underestimated in this study because emirati residents at other hospitals were not considered . even with this limitation
, we can conclude that the incidence rate of dm was higher than in the uk and sweden .
the highest incidence rate of dm was observed in the 55 - 59 year age group ( men , 23.4/1,000 py ; women , 32.4/1,000 py ) .
the incidence rate among men was much lower than in women in the > 59 years age groups .
the incident cases of dm were collected from 5 phcs at shaikh khalifa hospital and gulf medical college hospital in ajman , uae .
it is possible that the incidence rate of dm was underestimated in this study because emirati residents at other hospitals were not considered .
even with this limitation , we can conclude that the incidence rate of dm was higher than in the uk and sweden .
the highest incidence rate of dm was observed in the 55 - 59 year age group ( men , 23.4/1,000 py ; women , 32.4/1,000 py ) . the incidence rate among men was much lower than in women in the > 59 years age groups .
 backgrounddiabetes mellitus ( dm ) , particularly type-2 is a major public health concern worldwide . 
 not much information is available with regard to the incidence of dm in united arab emirates ( uae ) . 
 this study aimed at determining the incidence rate of diabetes mellitus among emirati population in ajman , uae . 
 this is a retrospective cohort study.methodsthis study was conducted in all primary health care centers and shaikh khalifa and gmc hospitals , ajman , uae where the emirati population primarily go for diagnosis and treatment . 
 the incident cases of diabetes mellitus were collected during the period 2010 january to december.resultsa total of 158 cases newly detected in 2010 , 54 were among non - emiratis and one was type-1 diabetes . eliminating these , 
 the remaining 101 were included in the analysis . 
 the age of the patients ranged from 23 years to 78 years ; 35 ( 34.7% ) males and 66 ( 65.3% ) were females . 
 the overall incidence observed was 4.8/1,000 person - years ( py ) with a female predominance of 6.3/1,000 py against incidence among males of 3.3/1,000 py . with regard to age specific incidence rate among males , it increases with age till 60 years and then showed a decreasing trend . among females 
 also the same trend was observed but not as similar to males.conclusionthe highest incidence rate was observed in the 55 - 59 age group among males , 23.4/1,000 py and females , 32.4/1,000 py . among males the incidence rate was much less 
 compared to females in - the age groups older than 59 years . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
Limitations
Conclusions