Background  
The rising incidence of diabetes mellites is a growing health concern in Kuwait, placing an overwhelming burden on the healthcare system. The overall prevalence of diabetes was estimated to be 19.1% according to last published data in 2020. As a result, the Kuwait National Diabetes Registry (KNDR) was established in the year 2018 by the Ministry of Health in collaboration with the Dasman Diabetes Institute to provide insight on the nature of the disease in this population.

Aim  
The aim of establishing the national web-based registry is to provide a sound database to investigate disease diagnosis, management, and outcomes and enable evaluation of clinical improvement focusing on identifying risk factors, treatment interventions and disease complications and assess morbidity in the adult and pediatric population.

Method  
Patients of all ages and nationalities residing in Kuwait diagnosed with any form of diabetes (type 1, type 2, gestational and atypical) were included in the KNDR. Data sources include electronic health records from primary healthcare centers (PHC), hospital outpatient clinics, Kuwait Diabetes Society (KDS) and patient self-register on the webpage. The register includes data on demographics, diabetes type, comorbidities, smoking habits, treatment modality, blood pressure, weight, height, and blood profile including glucose status, renal and lipid profile. Patient data was collected from one governorate as a pilot phase before extending the platform to other regions in Kuwait. Descriptive analysis was performed.

Results  
A sample of 36,447 patients with diabetes from PHCs in one Kuwaiti governorate, Al-Farwaniyah, collected from September 2019 to March 2020 (pre-SARS-CoV-2 pandemic) was studied. The median age was 54 years, most were men (63.4%), 33.4% were Kuwaiti and 11.3 % were smokers. The majority had type 2 diabetes (82.3%) and hypertension and dyslipidemia were found in 20.2% and 22.2% of the population, respectively. Over half the population (56.4%) with type 2 diabetes were on oral medication only, 3.7% on insulin only, 21.8% on oral and insulin medication and 18.1% were not on any medication and were recommended lifestyle modifications. Of the patients on insulin 60% were using long acting and 30% were using mixed insulin. In the registry, only 20% of those who have diabetes have a recorded HbA1c.

Discussion  
Creating a diabetes registry gathers invaluable information, aids as an essential tool for monitoring patients with diabetes and supports planning better healthcare services. However, the high missing data requires increased physician data entry training and improved and incorporated hospital information systems into the registry to ensure high ascertainment. The registry can be utilized to estimate incidence and prevalence, to translate into policy and improve standard of care.



The Kuwait National Diabetes Registry (KDNR): Methodology and Pilot Results