Background and aims: Diabetes mellitus constitutes one of the most important public health burdens in Kuwait, but the percent of adults with diabetes who are unaware of their illness is unknown. The objective of this study was to determine the prevalence of unawareness of diabetes in Kuwaiti adults in 2014.
Methods: A random sample of Kuwaiti adults aged 18-69 years were surveyed in 2014 (n=3918) using the WHO Instrument for Chronic Disease Risk Factor Surveillance comprising demographics, clinical history, physical measurements, and blood biochemistry. A subset of 2561 individuals had both fasting plasma glucose (FG) and HbA1c analysed. Diabetes was defined as a self-reported history of diabetes, FG≥7 mmol/L, or HbA1c ≥6.5%. “Unawareness” of diabetes was defined as having a FBG ≥ 7.0 or Hba1c ≥ 6.5% among those reporting that they do not have a previous diagnosis of diabetes. Survey sampling weights were taken into account to provide estimates generalizable to the Kuwaiti population. A multivariate logistic regression model including age group, sex, and body mass index (BMI) category was used to estimate adjusted odds ratios (AOR) for associations with diabetes unawareness.
Results: The overall prevalence of diabetes was 18.8% (n=494) The prevalence among men was 20.4% and among women, 17.4% (p=0.03). The overall percent unawareness among the diabetic individuals was 41.5% [95% Confidence Interval, 37.3%, 45.8%]. Unawareness was marginally higher in men (45.3%) than women (37.4%; p=0.07). Unawareness was strongly associated with age group: 18-29 years (63.5%), 30-44 years (59.1%), 45-59 years (32.4%), and 60-69 years (23.0%; p<0.001). However, unawareness was not significantly associated with BMI category: <25 kg/m2 (47.2%), 25-29 kg/m2 (48.9%), 30-34 kg/m2 (34.0%), and ≥35 kg/m2 (41.1%). After adjustment, unawareness was associated strongly with age group (Reference: 18-29 years), with AOR’s for successively older age groups, 0.9 (p=0.70); 0.3 (p<0.001); and 0.2 (p<0.001). The AOR for female sex was 0.8 [0.6, 1.3; p=0.41]. After adjustment, unawareness was not associated with BMI group.
Discussion: More than one in three Kuwaiti adults with diabetes are unaware of their disease. This percentage is similar in men and women, but is much higher in those younger than 44 years, and lower in the older age groups. Given the very high prevalence of diabetes in Kuwaiti adults and a high level of unawareness, an assessment of the cost-effectiveness of a screening program for diabetes in Kuwaiti adults should be conducted.

High level of unawareness of diabetes in the Kuwaiti population