Trends in diabetes mellitus prevalence and gender disparities in Jazan, Saudi Arabia

ABSTRACT

Objectives:

To analyze the prevalence of DM focusing on demographic trends, gender disparities, and age distribution. Additionally, it evaluates diabetes control rates.

Methods:

A retrospective cross-sectional study examined DM trends (2021–2023). It included patients with type 1 or type 2 DM from various healthcare settings.

Results:

The number overall number of diabetes cases has grown from 41,876 in 2021 to 46,889 in 2023, reflecting an annual rise of 5.7% (2022) and 6% (2023). The majority of cases (85.1%) were observed in individuals aged 40 and above, having the greatest prevalence in the 50–59 age group (25.3%). A significant gender disparity was found, with 54.4% of cases occurring in males and 45.6% in females (χ²=355.539, degrees of freedom=1, p<0.001), indicating a statistically significant association between gender and diabetes prevalence. The proportion of controlled diabetes cases fluctuated, accounting for 44.1% in 2021, 42% in 2022, and 44% in 2023.

Conclusion:

The findings indicate a steady increase in DM prevalence in Jazan, with significant age and gender disparities. The study underscores the need for early screening programs, targeted lifestyle interventions, and improved diabetes management strategies to address the growing burden of the disease.

Diabetes mellitus (DM) is a common chronic illness that presents a major global health concern. According to the International Diabetes Federation, an estimated 537 million adults globally have DM, with projections indicating this number will rise to 783 million by 2045.¹ Diabetes mellitus is characterized by persistent hyperglycemia, resulting from insulin resistance, insufficient insulin production, or both. The condition is associated with severe complications, including cardiovascular disease, kidney failure, neuropathy, and vision impairment.² Approximately 23.7% of adults in Saudi Arabia have DM, making it one of the countries with the highest prevalence rates in the world.³ This increasing burden is mainly driven by lifestyle changes, rising obesity rates, genetic predisposition, and dietary patterns.⁴ In particular, the southwestern region, including Jazan, has seen a steady rise in DM cases, necessitating focused research to identify risk factors and implement targeted interventions.⁵ The Kingdom of Saudi Arabia has undergone rapid lifestyle changes over the past few decades, primarily due to urbanization, economic growth, and technological advancements. Type 2 DM (T2DM) is largely caused by these changes, which have resulted in decreased physical activity, greater intake of processed foods, and a higher prevalence of obesity.⁶ In Jazan, an area located in the southern part of Saudi Arabia, there has been a notable rise in DM prevalence, particularly among individuals aged 40 and above.⁷ Several studies have highlighted that DM rates in Jazan are higher compared to other regions, likely due to dietary habits, limited healthcare access, and potential genetic factors.⁸ Understanding the demographic and regional variations in DM prevalence is crucial for designing effective prevention and management strategies. Addressing these challenges requires a comprehensive approach that includes preventive screenings, community-based awareness programs, and improved healthcare infrastructure.² The purpose of the study is to analyze the prevalence and distribution of DM in Jazan, focusing on assessing trends in DM prevalence over a 3-year period (2021–2023). It also investigates gender-based differences in DM prevalence and evaluates the effectiveness of DM management, including controlled versus uncontrolled cases. This study is vital for understanding the epidemiological patterns of DM in Jazan and will contribute to guiding future healthcare policies.

Methods

In Jazan, Saudi Arabia, this cross-sectional, retrospective study was carried out from January 2021 to December 2023. The study included patients diagnosed with type 1 DM (T1DM) and T2DM who received treatment at primary healthcare centers (PHCs), public and private hospitals, DM clinics, and endocrinology centers. Existing medical records from healthcare facilities in the region were assessed for trends in DM prevalence and management. The inclusion criteria included patients diagnosed with T1DM or T2DM based on the American Diabetes Association (ADA) diagnostic criteria, with a verified diagnosis in Jazan Province between January 2021 and December 2023. Eligible participants had available glycemic control data at the time of diagnosis. The exclusion criteria encompassed patients with gestational DM (GDM) and those diagnosed with secondary DM due to pancreatic diseases, steroid use, or endocrine disorders. Additionally, patients with incomplete or missing critical medical records, as well as non-residents of Jazan or those receiving DM treatment outside the province, were excluded from the study.

Statistical analysis

The data was organized and presented in tabular format. Means and frequency tables were calculated as part of the descriptive analysis. The data was analyzed using SPSS version 26.0 software (IBM Corp., Armonk, NY, USA). Univariate analysis was used to investigate individual variables, with statistical tests such as the chi-squared test for categorical variables, ANOVA and t-tests for age-related variations in DM prevalence, and logistic regression analysis to look at associations between DM control rates and demographic factors. Data visualization and graphical representation of trends were performed using Microsoft Excel. The study was approved by the Saudi Arabian Health Ethics Committee in Jazan (Approval No. 2520). The privacy of the collected data was rigorously preserved. The research followed the Helsinki Declaration’s ethical principles as well as the specific guidelines established by Saudi Arabia’s National Committee of Bioethics. As part of standard clinical processes, data were extracted from patient charts and/or laboratory databases. Personal information and identifiable details on participants were excluded from the study.

Results

During the study period from 2021 to 2023, a total of 46,889 individuals were diagnosed with DM in the Jazan region. The annual trend of DM cases showed a consistent increase over the years. In 2021, the total number of recorded DM cases was 41,876, which rose to 44,274 in 2022, reflecting an annual growth of 5.7%. By 2023, the number of cases further escalated to 46,889, marking a 6% increase compared to the previous year. The upward trajectory of DM cases over the three-year period highlights a concerning trend of increasing DM prevalence in the region, warranting closer examination of contributing factors such as lifestyle, genetic predisposition, and healthcare interventions (Figure 1). The proportion of controlled DM cases as a percentage of total DM cases in the Jazan region is illustrated in Figure 2. The trends observed indicate that despite the rising prevalence of DM, the proportion of controlled cases has shown variability over the years, emphasizing the need for enhanced disease management strategies and healthcare interventions. Gender distribution analysis revealed that among the 46,889 diagnosed individuals, 54.4% were male and 45.6% were female, indicating a slight male predominance in DM cases. Specifically, 54.5% of male patients and 45.5% of female patients comprised the study population. A Chi-square test confirmed a statistically significant association between gender and DM incidence (χ²=355.539, degrees of freedom [df]=1, p<0.001), suggesting a potential influence of gender on DM occurrence (Figure 3). Age distribution analysis, as presented in Table 1, revealed that the largest affected age group was “50 - 59” years, accounting for 25.3% of DM patients, followed closely by the “60-69” age group at 24.6%. Notably, 85.1% of patients were aged 40 and above, underscoring the higher prevalence of DM among older individuals. A Chi-square test of homogeneity confirmed a statistically significant age-related distribution of DM cases (p<0.05), further emphasizing the impact of aging on DM susceptibility. Table 2 presents the distribution of DM types by gender. In T1DM, there were 2,144 males and 1,689 females, accounting for 4.4% of the total DM population among males and 3.5% among females. Type 2 DM exhibited a much higher prevalence, with 24,287 males and 20,408 females, comprising 50% of the total cases among males and 42.1% among females. Type 2 DM exhibited a much higher prevalence, with 24,287 males and 20,408 females, making up 50% and 42.1% of the total cases,. These findings indicate that T2DM is significantly more prevalent than T1DM in both genders. The overall prevalence of DM in the study population was 92.1%, with 7.9% of cases found in males and 3.5% in females. The odds ratio (OR) comparing T1DM and T2DM across genders was 1.067 (95% confidence interval [CI]: 0.998-1.140), suggesting a slight, though statistically nonsignificant, increase in the odds of having T1DM among males. The Chi-square test showed borderline significance (χ²=3.625, df=1, p=0.057), suggesting a possible but inconclusive link between gender and DM type, requiring additional investigation.

Figure 1.

- Distribution of the number of diabetes mellitus cases among the population in the Jazan Region of Saudi Arabia for the years 2021, 2022, and 2023.

Figure 2.

- Distribution of controlled diabetes mellitus (DM) as a percentage of total DM cases in the Jazan Region of Saudi Arabia for the years 2021, 2022, and 2023.

Figure 3.

- Distribution of type 1 and type 2 diabetes mellitus by gender in the Jazan, Region, Saudi Arabia.

Table 1.

- Distribution of patients by age group with chi-square test of homogeneity and percentage of patients aged.

Age (years)	Frequency	%	Cumulative %	% of 40 and above	Chi-square test of homogeneity
Less than 19	1119	2.4	2.4	14.9%	24919.82*
20 - 29	1458	3.1	5.5
30 - 39	4423	9.4	14.9
40 - 49	9950	21.2	36.1	85.1%
50 - 59	11872	25.3	61.4
60 - 69	11565	24.6	86.1
70 - 79	4578	9.8	95.8
80 and above	1962	4.2	100.0

The distribution of patients by age group, along with their corresponding frequencies, percentages (%), and cumulative percentages. It also highlights the percentage (%) of patients aged 40 and above, which comprises 85.1% of the total population. A Chi-square test of homogeneity was conducted to assess the significance of the age-related distribution, with a

^*p-value of <0.05, indicating a statistically significant association between age and diabetes prevalence.

Table 2.

- Cross-tabulation of gender and diabetes mellitus type with odds ratios and confidence intervals (CI).

DM*	Gender n (%)		Total	Odds ratio (95 CI%)
	Male	Female
DM1	2144 (4.4%)	1689 (3.5%)	3833 (7.9%)	1.067 (95% CI: 0.998-1.140)
DM2	24287 (50.0%)	20408 (42.1%)	44695 (92.1%)	0.938 (95% CI: 0.877-1.001)

The distribution of male and female patients diagnosed with type 1 (DM1) and type 2 (DM2) diabetes mellitus, along with the corresponding odds ratios and 95% CI. The Chi-square test value (*χ²= 3.625, p=0.057) indicates borderline relevance in gender distribution across diabetes types.

Discussion

This study provides important insights into the distribution and trends of DM in the Jazan region of Saudi Arabia, focusing on the years 2021 to 2023. The increasing prevalence of DM observed in Jazan, with an annual growth rate of 5.73% in 2022 and 6.03% in 2023, reflects a broader global pattern of rising DM rates. Our findings demonstrate that the DM burden in Jazan is a growing public health concern, similar to trends seen globally in both developed and developing nations.^1,9,10 In Saudi Arabia, the rise in DM prevalence is particularly alarming. According to the International Diabetes Federation, approximately 18.3% of the adult population in Saudi Arabia was living with DM in 2021, making it one of the highest rates globally.¹ In comparison, studies conducted in other regions of Saudi Arabia report varying prevalence rates, reflecting regional disparities. For example, a study conducted in Riyadh, the capital city, found that the prevalence of DM was slightly higher at 19.4% in 2021 while in Jeddah, a large urban city, the prevalence was around 17.2%.^11,12 These findings suggest that while the Jazan region has a high burden of DM, it is not an isolated case, as other major cities in Saudi Arabia also report substantial prevalence rates. A similar trend is observed in other cities like Dammam and Khobar in the Eastern Province, where the increase in sedentary behaviors and fast food consumption has also led to a rise in obesity and DM prevalence. In Dammam, for example, a study conducted in 2022 revealed a 7.5% annual increase in DM cases, reflecting similar trends to those observed in Jazan.¹³ The gender distribution in this study revealed that approximately 54.4% of the patients diagnosed with DM were male, with females representing approximately 45.6%. This aligns with findings from other studies in Saudi Arabia, which also suggest a higher prevalence of DM among males compared to females.¹⁴ In Riyadh, research suggest that men are also at a higher risk of acquiring DM, with 55% of confirmed cases being male.¹⁵ However, some regions like Mecca show a slightly different pattern, where the gender distribution is more balanced, with females making up around 52% of the cases.¹⁶ These gender differences may be influenced by various social and behavioral factors, such as diet, physical activity, and healthcare-seeking behavior. In addition, the high prevalence of DM among individuals aged 40 and above, as found in this study, is consistent with global trends, where the majority of DM cases occur in middle-aged and older adults.¹⁷ Studies conducted in other regions, including Riyadh and Jeddah, have similarly found that the majority of diagnosed cases are in the 40 and above age group, reflecting the aging population across Saudi Arabia.^18,19 The trends observed in our country mirror the DM prevalence patterns seen in other regions, particularly in developed countries like the United States (U.S.) and Europe. In the U.S., the CDC reports that nearly 11.3% of adults had diagnosed DM in 2020, with T2DM accounting for the majority of cases.²⁰ In Europe, the European Association for the Study of DM reports that approximately 8.5% of adults were living with DM in 2021, with T2DM predominating in most countries.²¹ Similarly, the Gulf Cooperation Council (GCC) countries, such as the UAE and Qatar, have some of the highest DM rates globally. In Qatar, studies show that nearly 17% of the adult population has DM, while the UAE has an estimated 16.3% prevalence rate.^22,23 These findings reinforce the notion that DM is a widespread public health challenge across the region. Furthermore, in Asia, countries like China and India are also experiencing a rapid increase in DM prevalence, with China having an estimated 116 million individuals with DM in 2021.²⁴ The rising prevalence of DM in Jazan and across the globe highlights the urgent need for effective public health interventions. In Saudi Arabia, national strategies should focus on promoting healthier lifestyles, including improving dietary habits, increasing physical activity, and addressing obesity. Given the aging population in Jazan and Saudi Arabia, there is also a growing need for targeted interventions for older adults, who are at a higher risk for developing T2DM.²⁵ Early screening and management of DM are crucial to preventing complications such as cardiovascular disease, kidney failure, and neuropathy, which are common in patients with uncontrolled DM.^13,26

One of the key recommendations for managing DM at the national level is to implement comprehensive public health policies that target both prevention and management. The (WHO) emphasizes the importance of strategies that promote lifestyle changes, including healthier diets, increased physical activity, and smoking cessation. These strategies should be tailored to the local context, considering cultural preferences, socioeconomic factors, and the specific DM-related challenges of the population.² In regions like the U.S. and Europe, several successful programs have demonstrated the effectiveness of integrated care models that combine education, early detection, and management. For example, the National Diabetes Prevention Program (NDPP) in the U.S. has been successful in reducing the risk of T2DM through lifestyle intervention programs aimed at individuals at high risk. This model, which includes a combination of nutrition counseling, physical activity support, and behavioral strategies, could be adapted to Saudi Arabia, particularly in Jazan, where rising obesity rates and sedentary lifestyles contribute significantly to the DM burden.²⁰ Targeted interventions for older adults in Jazan, a group at higher risk for developing T2DM, should also be prioritized. As the population ages, it is critical to design interventions specifically addressing this demographic. For example, the Diabetes Care Program for Seniors in the United Kingdom has been successful in providing tailored care plans for older adults, including medication management, physical activity programs, and dietary guidance, to prevent the complications of DM.¹⁸

Study limitations

This study has several limitations that should be acknowledged. First, as a regional study conducted in Jazan, its findings may not be fully generalizable to other regions of Saudi Arabia. Additionally, potential biases in data collection may have arisen due to variations in record-keeping practices across different healthcare facilities. Differences in data completeness, diagnostic criteria, and patient management strategies could have influenced the reported trends. Second, the retrospective cross-sectional design of this study limits the ability to establish causal relationships between identified factors and DM prevalence. While statistical associations were examined, a prospective cohort study would provide a stronger framework for assessing causal relationships and long-term disease progression. Future research should incorporate longitudinal study designs to explore these trends more comprehensively. Third, this study did not include data on key socioeconomic factors, dietary habits, and comorbidities, all of which could provide deeper insights into diabetes trends in Jazan. Socioeconomic status influences access to healthcare and adherence to treatment, while dietary patterns and lifestyle choices significantly impact diabetes prevalence and management. Including these variables in future studies would allow for a more nuanced understanding of diabetes risk factors in the region. Despite these limitations, the study provides valuable insights into the rising prevalence of diabetes in Jazan and highlights the need for targeted healthcare interventions and improved diabetes management strategies.

In conclusion, this study highlights the rising prevalence of DM in the Jazan region, with a steady annual increase in diagnosed cases from 2021 to 2023. The findings indicate a growing public health concern, reflecting similar trends observed in other major cities across Saudi Arabia and the Gulf region. Given the high burden of DM, particularly among middle-aged and older adults, there is a critical need for comprehensive public health policies focusing on lifestyle changes (diet, physical activity, and smoking cessation). National screening programs for early DM detection, especially for people over 40. Public health education campaigns about DM prevention and self-management (such as lifestyle modifications). Integration of telemedicine for remote monitoring and consultations, especially in rural or underserved regions.