A landmark cross-sectional survey uncovered one of the highest diabetes rates in the world, with surprising ethnic disparities and lasting public health implications.
Imagine a nation where nearly one in three adults suffers from the same preventable metabolic condition. Picture doctors discovering that some population groups have double the risk of developing this disease compared to their neighbors. This isn't a hypothetical scenario—this was the reality uncovered in Bahrain in the mid-1990s, when a landmark cross-sectional survey revealed one of the highest diabetes rates in the world, intertwined with alarming rates of heart disease.
For decades, medical professionals in the Arabian Peninsula suspected that coronary heart disease (CHD) and non-insulin-dependent diabetes (now known as type 2 diabetes) were becoming increasingly common, but reliable data was scarce. The 1995 Bahraini study changed this, providing startling evidence of a growing public health crisis that would set the stage for decades of research and intervention.
What researchers discovered not only documented a serious national health issue but also revealed unexpected connections between ethnicity, cholesterol, and diabetes that challenged conventional medical understanding.
When the survey results were analyzed, they painted a startling picture of the metabolic health of adult Bahrainis. The overall prevalence rate of diabetes was approximately 30%—an astonishingly high figure that placed Bahrain among the countries most affected by this condition worldwide 1 .
Diabetes prevalence
Diabetes prevalence
The situation was particularly concerning for middle-aged and older adults. In the 50-59 years age group, the prevalence was 29% in men and 35% in women 1 . These numbers revealed not just a health issue, but a widespread epidemic that would have significant implications for the country's healthcare system, economy, and quality of life for its citizens.
What puzzled researchers was that the high rates of diabetes couldn't be fully explained by traditional risk factors like obesity and physical inactivity alone. There was something distinctive about the Bahraini population that made them particularly susceptible—a combination of genetic predisposition and environmental factors that would become clearer as the data was analyzed more deeply 1 5 .
The 1995 survey represented a massive scientific undertaking designed to provide reliable, comprehensive data on the health of the Bahraini population. The researchers employed a systematic random sample of 2,128 Bahraini natives, including 1,245 men aged 40-59 years and 883 women aged 50-69 years 1 .
2,128
Adult Bahrainis1,245 men / 883 women
Physical exams & ECG
Blood samples & glucose tests
Each participant underwent a comprehensive assessment:
Covering medical history, lifestyle factors, and family history.
Including measurements of weight, height, and waist circumference.
To detect heart abnormalities.
Including venous blood samples taken both fasting and 2 hours after a 75g oral glucose load 1 .
This rigorous methodology allowed researchers to not only identify cases of diabetes and heart disease but also to examine the relationships between these conditions and various biological, social, and lifestyle factors. The use of multiple assessment tools—from questionnaires to advanced laboratory tests—provided a holistic picture of the nation's health that had never been available before.
Overall Diabetes Prevalence
Women 50-59 with Diabetes
Men with ECG Abnormalities
The study revealed that the average body mass index (BMI) was 27.3 kg/m² in men and 28 kg/m² in women, indicating a trend toward overweight in the population 1 . Perhaps more concerning was the finding that only 13% of men and 1% of women walked at least 4 kilometers per day, revealing strikingly low physical activity levels that undoubtedly contributed to the high metabolic disease rates 1 .
Among participants with a BMI ≥30 kg/m² (classified as obese), only 42% rated themselves as overweight 5 .
of obese individuals self-identified as overweight
The electrocardiogram results provided concrete evidence of heart disease in the population. The prevalence of major Q waves (indicating possible previous heart attacks) on ECG was 2.8% in men aged 40-59 years 1 . These cardiac abnormalities were associated with smoking, hypertension, and positive family history of CHD.
Interestingly, the study found that coronary heart disease was not significantly associated with diabetes or plasma lipids in this cross-sectional analysis, though the researchers noted this might be a limitation of the study design rather than a true absence of relationship 1 .
One of the most intriguing findings from the study was the consistent association between diabetes and raised plasma cholesterol—a relationship that isn't typically emphasized in standard medical literature. The research showed that mean plasma cholesterol was 0.5 mmol/L higher in diabetic participants compared to those with normal blood sugar 5 .
Higher in diabetic participants
After adjusting for obesity
Even after adjusting for obesity, plasma cholesterol remained 0.4 mmol/L higher in diabetic individuals 1 . This suggested that the connection between cholesterol metabolism and diabetes in this population might be more than coincidental, possibly pointing toward a shared underlying metabolic disorder affecting both glucose and lipid regulation.
The researchers concluded that the high prevalence of diabetes in Bahrainis and other Arabian Peninsula populations appeared to be part of a familial syndrome that included raised plasma cholesterol levels 5 . This novel insight proposed that in this specific population, diabetes and cholesterol abnormalities might share common genetic roots.
One of the most surprising findings was the stark difference in diabetes prevalence between ethnic groups. The age-standardized prevalence of diabetes was 25% in Jaafari Arabs, 48% in Sunni Arabs, and 23% in Iranians 5 . Even after adjusting for other risk factors, this ethnic disparity persisted, suggesting a strong genetic component to diabetes susceptibility in these populations.
Diabetes prevalence
Diabetes prevalence
Diabetes prevalence
The odds ratio for diabetes in Shi'ite versus Sunni Arabs was 0.48 in men and 0.22 in women, meaning Shi'ite Arabs had less than half the risk of developing diabetes compared to their Sunni counterparts 1 . This represented one of the most significant ethnic variations in diabetes risk ever documented in a single nation.
Odds ratio (Shi'ite vs Sunni)
Shi'ite men had 52% lower riskOdds ratio (Shi'ite vs Sunni)
Shi'ite women had 78% lower riskThe 1995 survey served as a wake-up call for the Bahraini healthcare system and provided a scientific foundation for public health interventions. The researchers recommended measures to prevent and control both diabetes and coronary heart disease, including:
Decades later, the insights from this study remain relevant. A 2023 study conducted in Bahraini primary healthcare centers found that only 39.3% of patients with diabetes had controlled blood sugar levels, and just 41.3% had controlled blood pressure 3 . The struggle continues, with young, obese, and non-Bahraini residents showing particularly poor glycemic control 3 .
of patients with controlled blood sugar
of patients with controlled blood pressure
Recent research has also expanded our understanding of prediabetes—the intermediate stage between normal blood sugar and diabetes. A 2022 survey of primary care physicians in Bahrain revealed significant gaps in knowledge about prediabetes risk factors and diagnostic criteria, highlighting the need for continued medical education 9 .
The 1995 cross-sectional survey of diabetes and heart health in Bahrain provided an invaluable snapshot of a nation at a critical juncture in its health transition. The findings revealed not just statistical trends, but human stories—of genetic predisposition, changing lifestyles, and the complex interplay between culture and health.
Decades later, the study remains a foundational reference for understanding the evolution of metabolic diseases in the Gulf region. Its most enduring lesson may be that addressing complex health challenges requires both scientific rigor and cultural sensitivity—understanding not just the biological mechanisms of disease, but the human contexts in which they unfold.
The journey from discovery to solution continues, but it began in earnest with those first stark numbers that forced a nation to confront its health reality and start building a healthier future.