Supplementary Data

SUPPLEMENTARY DATA

Writing group collaborators-online appendix

Global Burden of Disease Collaborators on Eastern Mediterranean Region and Diabetes:

Maziar Moradi-Lakeh, MD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US; Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran

Mohammad H Forouzanfar, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Charbel El Bcheraoui, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Farah Daoud, BS, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Raghid Charara, MD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Ashkan Afshin, ScD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Ibrahim Abdel-Messih Khalil, MD, MPH, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Marie Ng, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Danny Colombara, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Sarah Wulf Hanson, MPH, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Kalkidan Hassen Abate, MS, Jimma University, Jimma, Ethiopia

Mohamed Magdy Abd El Razek, MBBCh, Ophthalmology resident in Aswan University Hospital, Aswan, Egypt

Foad Abd-Allah, MD, Department of Neurology, Cairo University, Cairo, Egypt

Mahmud A Abdallat, MPH, Royal Jordanian Medical Services, Amman, Jordan

Laith J Abu-Raddad, PhD, Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar

Niveen M E Abu-Rmeileh, PhD, Institute of Community and Public Health, Birzeit University, Ramallah, Palestine

Aliasghar Ahmad Kiadaliri, PhD, Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences-Lund, Lund University, Lund, Sweden; Kerman University of Medical Sciences, Kerman, Iran

Nadia Akseer, PhD Candidate, Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Zulfa A Al Rayess, MD, The Saudi Center for Evidence Based Healthcare, Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia

Ziyad Al-Aly, MD, Washington University in Saint Louis, Saint Louis, MO, US

Khurshid Alam, PhD, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia; The University of Sydney, Sydney, NSW, Australia

Deena Alasfoor, MSc, Ministry of Health, Al Khuwair, Oman

Raghib Ali, FRCP, University of Oxford, Oxford, UK

Ala’a Alkerwi, PhD, Luxembourg Institute of Health, Strassen, Luxembourg

Mohammad AbdulAziz AlMazroa, MD, Saudi Ministry of Health, Riyadh, Saudi Arabia

Abdulwahab A Al-Nehmi, MD, Ministry of Health, Sana’a, Yemen

Mahmoud A Alomari, PhD, Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan

Rajaa Mohammad Salem Al-Raddadi, PhD, Ministry of Health, Jeddah, Saudi Arabia

Shirina Alsowaidi, MD, United Arab Emirates University, Al Ain, UAE

Khalid A Altirkawi, MD, King Saud University, Riyadh, Saudi Arabia

Walid Ammar, PhD, Ministry of Public Health, Beirut, Lebanon

Stephen Marc Amrock, MD, Oregon Health & Science University, Portland, OR, US

Hamid Asayesh, PhD, Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran

Rana Jawad Asghar, MD, South Asian Public Health Forum, Islamabad, Pakistan

Reza Assadi, PhD, Mashhad University of Medical Sciences, Mashhad, Iran

Suleman Atique, MS, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan

Umar Bacha, PhD, School of Health Sciences, University of Management and Technology, Lahore, Pakistan

Alaa Badawi, PhD, Public Health Agency of Canada, Toronto, ON, Canada

Aleksandra Barac, PhD, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Shahrzad Bazargan-Hejazi, PhD, Charles R. Drew University of Medicine and Science, Los Angeles, CA, US

Neeraj Bedi, MD, College of Public Health and Tropical Medicine, Jazan, Saudi Arabia

Adugnaw Berhane, PhD, College of Health Sciences, Debre Berhane University, Debre Berhan, Ethiopia

Balem Demtsu Betsu, MS, Mekelle Uniersity, Mekelle, Ethiopia

Sibhatu Biadgilign, MPH, Independent Public Health Consultants, Addis Ababa, Ethiopia

Ismael Ricardo Campos-Nonato, PhD, National Institute of Public Health, Cuernavaca, Mexico; T.H. Chan School of Public Health, Harvard University, Boston, MA, US

David O Carpenter, MD, University at Albany, Rensselaer, NY, US

Ferran Catala-Lopez, PhD, Department of Medicine, INCLIVA Health Research Institute and CIBERSAM, University of Valencia, Valencia, Spain; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

Rajiv Chowdhury, PhD, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

Hadi Danawi, PhD, Walden University, Minneapolis, MN, US

Amare Deribew, MD, PhD, Nuffield Department of Medicine, Oxford University, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; St. Paul Millennium Medical College, Addis Ababa, Ethiopia

Samath D Dharmaratne, MD, Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

Eric L Ding, ScD, T.H. Chan School of Public Health, Harvard University, Boston, MA, US

Bruce B Duncan, PhD, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; University of North Carolina, Chapel Hill, NC, US

Babak Eshrati, PhD, Ministry of Health and Medical Education, Tehran, Iran; Arak University of Medical Sciences, Arak, Iran

Alireza Esteghamati, MD, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran

Talha A Farid, MD, University of Louisville, Louisville, KY, US

Maryam S Farvid, PhD, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, US; Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, US

Seyed-Mohammad Fereshtehnejad, MD, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden

João C Fernandes, PhD, Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK

Florian Fischer, MPH, Bielefeld University, Bielefeld, Germany

Alemseged Aregay Gebru, MPH, Mekelle University, Mekelle, Ethiopia; Kilte Awlaelo-Health and Demographic Surveillance System, Mekelle University, Mekelle, Ethiopia

Melkamu Dedefo Gishu, MS, Haramaya University, Dire Dawa, Ethiopia; Kersa Health and Demographic Surveillance System, Harar, Ethiopia

Philimon Gona, PhD, University of Massachusetts Boston, Boston, MA, US

Sameer Vali Gopalani, MPH, Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia

Atsushi Goto, MD, Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan

Rahul Gupta, MD, West Virginia Bureau for Public Health, Charleston, WV, US

Vipin Gupta, PhD, University of Delhi, Delhi, India

Nima Hafezi-Nejad, MD, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran

Randah Ribhi Hamadeh, DPhil, Arabian Gulf University, Manama, Bahrain

Samer Hamidi, PhD, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates

Graeme J Hankey, MD, School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Nedlands, WA, Australia; Western Australian Neuroscience Research Institute, Nedlands, WA, Australia

Hilda L Harb, MPH, Ministry of Public Health, Beirut, Lebanon

Ileana Beatriz Heredia-Pi, PhD, National Institute of Public Health, Cuernavaca, Mexico

Masako Horino, MPH, Nevada Division of Behavior and Public Health, Carson City, NV, US; Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, US

Mohamed Hsairi, MD, National Institute of Public Health, Tunis, Tunisia

Abdullatif Husseini, PhD, Institute of Community and Public Health, Birzeit University, Birzeit, Palestine

Inge Huybrechts, PhD, International Agency for Research on Cancer, Lyon, France; Ghent University, Ghent, Belgium

Mihajlo B Jakovljevic, PhD, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

Jost B Jonas, MD, Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls- University Heidelberg, Mannheim, Germany

Edmond Kato Kabagambe, PhD, Vanderbilt University, Nashville, TN, US

Amir Kasaeian, PhD, Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran

Yousef Saleh Khader, ScD, Jordan University of Science and Technology, Irbid, Jordan

Abdul Sattar Khan, MD, Family & Community Medicine Department, College of Medicine, King Faisal University, Alhafof, Saudi Arabia

Abdur Rahman Khan, MD, University of Louisville, Louisville, KY, US

Ejaz Ahmad Khan, MPH, Health Services Academy, Islamabad, Pakistan; Expanded Programme on Immunization, Islamabad, Pakistan

Tawfik Ahmed Muthafer Khoja, FRCP, Executive Board of the Health Ministers’ Council for Cooperation Council States, Riyadh, Saudi Arabia

Daniel Kim, DrPH, Department of Health Sciences, Northeastern University, Boston, MA, US

Yun Jin Kim, PhD, Southern University College, Skudai, Malaysia

Yohannes Kinfu, PhD, University of Canberra, Canberra, ACT, Australia

Yoshihiro Kokubo, PhD, Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan

Dhaval Kolte, MD, Brown University/Rhode Island Hospital, Providence, RI, US

Georgios A Kotsakis, DDS, School of Dentistry, University of Washington, Seattle, WA, US

Ai Koyanagi, MD, Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain

Asma Abdul Latif, PhD, Department of Zoology, Lahore College for Women University, Lahore, Pakistan

Raimundas Lunevicius, PhD, Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK

Azeem Majeed, MD, Imperial College London, London, UK

Reza Malekzadeh, MD, Digestive Disease Research Institute, Tehran Universities of Medical Sciences, Tehran, Iran

Peter A Meaney, MD, Pereleman School of Medicine, University of Pennsylvania, Philadelphia, PA, US; Children’s Hospital of Philadelphia, Philadelphia, PA, US

Alem Mehari, MD, College of Medicine, Howard University, Washington, DC, US

Alemayehu B Mekonnen, MS, University of Gondar, Gondar, Ethiopia; The University of Sydney, Sydney, NSW, Australia

Yohannes Adama Melaku, MPH, School of Public Health, Mekelle University, Mekelle, Ethiopia; School of Medicine, The University of Adelaide, Adelaide, SA, Australia

Ziad A Memish, MD, Saudi Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

Walter Mendoza, MD, United Nations Population Fund, Lima, Peru

Ted R Miller, PhD, Pacific Institute for Research & Evaluation, Calverton, MD, US; Curtin University Centre for Population Health, Perth, WA, Australia

Mojde Mirarefin, MPH, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Layla Abdalla Ibrahim Mohamed, MPH, Federal Ministry of Health, Khartoum, Sudan

Alireza Mohammadi, PhD, Neuroscience Research Center, Baqiyatallah University of Medical Science, Tehran, Iran

Shafiu Mohammed, PhD, Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria; Institute of Public Health, Heidelberg University, Heidelberg, Germany

Dariush Mozaffarian, MD, DrPH, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, US

Ulrich O Mueller, PhD, Competence Center Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany

Chakib Nejjari, PhD, Université Sidi Mohamed Ben Abdellah, Fès, Morocco

Muhammad Imran Nisar, MSc, Aga Khan University, Karachi, Pakistan

Erika Ota, PhD, St. Luke’s International University, Tokyo, Japan

Max Petzold, PhD, Health Metrics Unit, University of Gothenburg, Gothenburg, Sweden; University of the Witwatersrand, Johannesburg, South Africa

Farshad Pourmalek, PhD, University of British Columbia, Vancouver, BC, Canada

Mostafa Qorbani, PhD, Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

Anwar Rafay, MS, Contech School of Public Health, Lahore, Pakistan

Kazem Rahimi, DM, University of Oxford, Oxford, UK

Mahfuzar Rahman, PhD, Research and Evaluation Division, BRAC, Dhaka, Bangladesh

Mohammad Hifz Ur Rahman, MPhil, International Institute for Population Sciences, Mumbai, India

Sajjad Ur Rahman, FCPS, FRCPHC, Neonatal Intensive Care Unit, Sweidi Hospital, Riyadh, Saudi Arabia

Rajesh Kumar Rai, MPH, Society for Health and Demographic Surveillance, Suri, India

Saleem M Rana, PhD, Contech School of Public Health, Lahore, Pakistan; Contech International Health Consultants, Lahore, Pakistan

Amany H Refaat, PhD, Walden University, Minneapolis, MN, US, Suez Canal University, Ismailia, Egypt

Serge Resnikoff, MD, Brien Holden Vision Institute, Sydney, NSW, Australia; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia

Gholamreza Roshandel, PhD, Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran; Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Shadi Saleh, PhD, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon

Juan R Sanabria, MD, MSc, Case Western Reserve University, Cleveland, OH, US; Marshall University School of Medicine, Huntington, WV, US

Itamar S Santos, PhD, Internal Medicine Department, University of São Paulo, São Paulo, Brazil

Benn Sartorius, PhD, University of KwaZulu-Natal, Durban, South Africa

Monika Sawhney, PhD, Marshall University, Huntington, WV, US

Maria Inês Schmidt, MD, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

Ben Schöttker, MPH, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Institute of Health Care and Social Sciences, FOM University, Essen, Germany

Sadaf G Sepanlou, PhD, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Sara Sheikhbahaei, MD, Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran

Kawkab Shishani, PhD, Washington State University, Spokane, WA, US

Abla Mehio Sibai, PhD, Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

Dayane Gabriele Alves Silveira, MD, Department of Health Science, Brasília University, Brasília, Brazil

Karen Sliwa, PhD, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa

Rafael Tabarés-Seisdedos, PhD, Department of Medicine, University of Valencia INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain

Karen M Tabb, PhD, School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, US

Mohammad Tavakkoli, MD, Westchester Medical Center, New York Medical College, Valhalla, NY, US

Marcello Tonelli, MD, University of Calgary, Calgary, AB, Canada

Roman Topor-Madry, PhD, Institute of Public Health, Jagiellonian University, Krakow, Poland; Casimir the Great Foundation of Innovation and Development, Krakow, Poland

Jaako Tuomilehto, MD, University of Helsinki Department of Public Health, Finland

Stefanos Tyrovolas, PhD, Parc Sanitari Sant Joan de Déu, Fundacio Sant Joan de Déu, Universitat de Barcelona, San Boi, Barcelona, Spain

Kingsley N Ukwaja, MD, Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria

Olalekan A Uthman, PhD, Warwick Medical School, University of Warwick, Coventry, UK

Andrea Werdecker, PhD, Competence Center Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany

Yuichiro Yano, MD, Department of Preventive Medicine, Northwestern University, Chicago, IL, US

Naohiro Yonemoto, MPH, Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan

Mustafa Z Younis, DrPH, Jackson State University, Jackson, MS, US

Zoubida Zaidi, PhD, University Hospital, Setif, Algeria

Maysaa El Sayed Zaki, PhD, Mansoura Faculty of Medicine, Mansoura, Egypt

Zulfiqar A Bhutta, PhD, Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan

Abdullah A. Al-Rabeeah, MBBS, Saudi Ministry of Health, Riyadh, Saudi Arabia

Haidong Wang, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Theo Vos, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Mohsen Naghavi, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Alan D Lopez, PhD, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Christopher J L Murray, DPhil, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Ali H Mokdad, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, US

Supplementary Table 1. Age-sex-specific death rates of diabetes mellitus (per 100,000 population) in the Eastern Mediterranean region, 1990 and 2013

Male Female Both sexes Age group 1990 2013 1990 2013 1990 2013

95% UI Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Rate Under 5 2.0 1.6 2.5 1.5 1.2 1.9 1.6 0.9 2.5 0.9 0.5 1.4 1.8 1.4 2.3 1.2 0.9 1.5 5 to 9 0.4 0.3 0.5 0.3 0.2 0.4 0.4 0.2 0.6 0.2 0.1 0.4 0.4 0.3 0.5 0.3 0.2 0.4 10 to 14 0.4 0.3 0.6 0.4 0.3 0.5 0.7 0.4 1.1 0.5 0.3 0.9 0.5 0.4 0.8 0.4 0.3 0.6 15 to 19 0.6 0.5 0.8 0.5 0.4 0.7 0.9 0.5 1.6 0.8 0.4 1.3 0.8 0.6 1.1 0.6 0.5 0.9 20 to 24 1.5 1.1 1.9 1.7 1.1 2.6 1.6 0.9 2.5 1.4 0.7 2.3 1.5 1.1 2.0 1.6 1.1 2.2 25 to 29 1.5 1.3 1.8 1.4 1.1 1.8 1.8 1.4 2.2 1.9 1.3 2.6 1.7 1.4 1.9 1.6 1.3 2.1 30 to 34 2.6 2.1 3.2 2.8 2.0 4.0 2.5 1.9 3.0 2.7 1.9 3.6 2.5 2.2 2.9 2.8 2.2 3.5 35 to 39 4.0 3.3 4.9 4.6 3.3 6.5 3.8 3.0 4.7 4.2 3.0 5.6 3.9 3.4 4.5 4.4 3.5 5.6 40 to 44 6.9 5.7 8.6 8.2 6.0 11.0 6.6 5.4 8.0 7.3 5.5 9.5 6.8 5.9 7.9 7.8 6.3 9.6 45 to 49 13.3 10.9 16.3 16.4 12.6 22.0 13.5 11.1 16.4 14.6 11.2 19.2 13.4 11.6 15.6 15.6 12.8 19.0 50 to 54 23.7 19.8 28.4 30.4 24.0 38.0 26.0 21.5 31.5 29.0 22.5 37.0 24.8 21.7 28.3 29.7 24.7 35.5 55 to 59 41.3 34.0 50.4 54.5 43.3 69.6 43.5 35.7 52.0 51.6 41.3 64.0 42.3 36.7 49.1 53.0 45.1 63.3 60 to 64 69.4 57.6 82.5 93.0 75.0 116.4 81.8 67.7 98.8 93.3 74.1 117.0 75.5 65.4 87.3 93.1 79.8 108.9 65 to 69 107.0 88.8 131.9 148.7 118.6 185.3 126.6 106.0 151.6 152.1 121.9 191.7 116.8 102.7 134.8 150.5 127.5 176.7 70 to 74 167.3 136.9 202.5 236.8 186.0 302.2 184.5 153.9 225.7 238.3 191.2 301.1 176.0 153.6 203.1 237.5 199.6 280.7 75 to 79 248.5 203.8 302.0 352.9 285.8 430.2 261.2 219.8 314.7 359.9 292.1 438.0 255.0 223.8 295.7 356.6 308.4 408.0 80 plus 415.0 339.3 518.2 613.6 501.1 741.1 423.3 351.8 512.5 695.5 551.4 841.9 419.5 366.5 490.6 658.4 572.6 754.9 All ages 11.3 10.1 12.6 18.1 15.5 20.8 13.0 11.7 14.7 20.9 18.1 24.1 12.1 11.2 13.2 19.5 17.4 21.5 Age- 30.0 26.9 33.9 41.8 35.7 48.0 32.3 28.8 36.6 43.5 37.4 50.2 31.2 28.9 34.0 42.7 38.3 47.1 standardized

Supplementary Table 2. Age-specific disability-adjusted life year (DALY) rates of diabetes mellitus in the Eastern Mediterranean region compared to global estimates, 1990 and 2013

1990 2013 Age group Global EMR Global EMR Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Under 5 115.7 95.9 143.8 164.6 131.2 207.6 67.4 55.5 82.7 115.0 90.9 143.7 5 to 9 39.5 30.1 50.6 59.9 45.9 77.2 39.1 28.3 53.8 59.0 42.3 79.9 10 to 14 60.8 45.6 79.6 88.4 66.7 115.5 66.1 47.3 90.3 94.2 67.0 127.7 15 to 19 93.6 70.3 122.5 124.5 93.9 163.1 107.1 77.7 144.5 138.4 97.8 186.4 20 to 24 155.3 121.6 197.0 209.8 161.9 267.2 185.9 141.6 240.6 245.9 183.0 320.5 25 to 29 213.6 168.1 270.4 284.8 218.8 361.0 265.4 202.2 343.6 336.0 248.7 440.9 30 to 34 309.2 243.9 387.7 417.9 324.2 532.1 380.1 294.6 483.2 514.8 382.5 668.0 35 to 39 434.1 344.5 542.5 612.4 473.7 776.1 538.7 414.3 682.5 767.1 573.3 992.6 40 to 44 628.5 505.4 788.0 948.1 744.8 1,194.5 783.8 611.2 991.1 1,190.2 910.5 1,531.3 45 to 49 966.8 783.0 1,171.9 1,529.5 1,215.6 1,891.7 1,184.5 928.5 1,476.1 1,918.6 1,484.1 2,434.4 50 to 54 1,326.3 1,101.2 1,600.2 2,112.7 1,689.1 2,591.2 1,622.3 1,305.7 1,980.4 2,713.5 2,140.9 3,358.9 55 to 59 1,708.6 1,458.5 1,996.6 2,625.7 2,154.3 3,161.1 2,054.2 1,693.7 2,469.7 3,423.7 2,782.5 4,129.8 60 to 64 2,144.3 1,857.2 2,457.7 3,302.7 2,785.9 3,857.5 2,455.3 2,061.7 2,885.1 4,211.7 3,499.1 4,964.9 65 to 69 2,545.2 2,227.1 2,877.7 3,847.7 3,300.6 4,476.9 3,013.7 2,582.9 3,470.3 4,950.4 4,215.7 5,756.4 70 to 74 2,842.1 2,523.0 3,202.5 4,374.0 3,781.9 5,072.4 3,308.8 2,860.1 3,802.1 5,788.4 4,923.5 6,782.7 75 to 79 2,883.3 2,558.9 3,234.2 4,663.6 4,088.0 5,366.2 3,536.9 3,105.5 4,040.5 6,314.5 5,493.7 7,228.3 80 plus 2,319.6 2,060.9 2,631.3 4,022.2 3,522.1 4,651.8 3,012.5 2,640.7 3,438.0 5,823.4 5,098.3 6,601.3 All ages 532.0 453.4 622.8 589.9 498.0 698.0 779.2 647.2 932.4 883.5 732.2 1,051.5 Age-standardized 706.3 602.1 821.2 1,086.7 927.9 1,273.3 844.8 703.7 1,005.8 1,397.6 1,179.6 1,639.3

Supplementary Table 3. All-age and age-standardized death and disability-adjusted life year (DALY) rates of diabetes mellitus in the Eastern Mediterranean countries, 2013

All ages Age-standardized Location Sex DALYs per 1,000 Deaths per 100,000 DALYs per 1,000 Deaths per 100,000 YLL/DALY Rate 95% UI Rate 95% UI Rate 95% UI Rate 95% UI Male 7.9 5.6 10.5 19.4 12.7 27.1 71% 19.5 13.8 25.9 69.7 47.2 93.4 Afghanistan Female 10.4 7.3 14.6 31.6 21.2 46.0 84% 24.1 17.1 33.7 97.2 67.3 138.8 Male 14.1 10.6 18.2 19.4 15.0 25.0 34% 23.3 18.3 29.2 76.6 60.7 98.7 Bahrain Female 14.7 10.9 19.3 24.4 18.7 31.3 34% 24.3 18.7 30.5 75.1 58.5 94.5 Male 5.9 4.4 8.6 18.9 13.7 28.4 78% 11.0 8.2 15.9 47.9 36.1 69.4 Djibouti Female 5.4 3.7 7.7 19.1 11.9 29.0 76% 9.8 6.7 13.9 43.9 27.6 64.9 Male 9.9 7.9 12.5 22.5 19.4 26.1 53% 14.1 11.4 17.4 42.0 36.2 48.7 Egypt Female 11.6 9.3 14.6 27.8 23.1 32.8 48% 15.0 12.1 18.7 41.7 34.5 49.2 Male 5.1 3.7 6.7 8.6 6.9 10.4 35% 6.7 4.9 8.8 14.7 12.0 17.8 Iran Female 7.2 5.1 9.8 9.4 7.2 11.7 25% 9.1 6.6 12.3 16.5 12.7 20.3 Male 8.7 6.6 11.4 16.2 11.6 22.5 50% 17.5 13.1 23.0 48.3 34.8 66.9 Iraq Female 10.9 8.2 13.9 25.8 17.9 33.5 56% 20.1 15.2 25.3 62.6 44.1 80.2 Male 11.0 8.3 14.5 15.1 12.1 19.1 30% 19.1 14.5 24.4 44.0 35.3 54.8 Jordan Female 11.3 8.3 15.2 16.2 12.5 19.6 27% 19.8 14.8 26.1 48.1 37.2 58.6 Male 12.3 8.5 16.3 6.4 5.5 7.3 10% 17.9 13.1 23.6 24.9 21.2 29.2 Kuwait Female 8.5 6.0 11.6 6.9 5.9 8.2 17% 15.0 11.0 19.7 31.2 26.1 36.9 Male 13.2 9.7 17.5 22.0 15.9 29.8 30% 13.5 9.9 17.8 27.0 19.7 36.3 Lebanon Female 10.5 7.6 13.8 18.9 13.9 25.3 30% 11.4 8.3 15.1 21.9 16.1 29.2 Male 11.5 8.0 15.5 16.7 11.2 22.8 31% 16.5 11.8 22.0 34.7 23.1 47.7 Libya Female 13.8 10.2 18.4 21.2 15.2 28.3 29% 19.4 14.4 25.2 40.1 28.5 54.0 Male 12.8 10.3 16.3 38.9 31.4 49.0 58% 19.5 16.1 23.9 87.7 71.4 109.0 Morocco Female 15.3 11.8 19.5 63.9 50.2 82.3 65% 21.3 16.7 26.8 112.3 88.6 144.3 Male 9.8 7.5 12.7 22.3 16.1 27.5 48% 24.8 19.5 30.8 87.8 64.4 106.2 Oman Female 10.9 8.1 14.0 25.8 18.5 33.4 47% 21.7 16.4 27.8 68.4 49.4 87.5

Male 9.4 6.9 12.1 24.3 15.1 31.6 59% 15.1 10.8 19.1 53.1 33.2 69.5 Pakistan Female 7.9 5.8 10.4 19.6 12.6 28.1 57% 12.5 9.0 16.4 42.6 27.3 61.6 Male 7.7 5.9 10.2 10.3 7.6 13.9 42% 14.7 11.0 19.8 30.6 22.5 41.3 Palestine Female 8.9 6.2 12.1 9.5 7.1 13.0 27% 16.6 11.6 22.4 28.3 21.2 39.2 Male 10.0 6.6 14.2 6.3 5.1 7.6 15% 19.3 14.9 25.0 68.2 56.0 80.6 Qatar Female 10.3 7.3 13.9 12.6 9.8 15.4 21% 22.2 16.9 28.2 82.7 65.8 99.6 Saudi Male 14.7 10.3 20.6 7.3 5.8 9.2 10% 20.6 14.9 27.9 23.5 18.8 29.8 Arabia Female 14.3 10.1 19.3 7.7 6.4 9.5 8% 22.1 15.7 29.2 18.7 15.6 22.9 Male 4.2 3.0 6.2 12.8 8.6 19.7 80% 10.1 7.1 14.8 42.4 29.0 63.7 Somalia Female 3.1 2.1 4.3 9.8 5.9 14.6 72% 7.2 4.9 9.9 26.7 18.0 43.0 Male 5.1 3.8 6.7 10.9 7.8 15.6 52% 10.3 7.8 13.7 32.9 23.8 46.8 Sudan Female 5.9 4.2 7.8 14.1 9.6 21.1 54% 11.4 8.2 15.7 38.6 26.4 58.5 Male 6.7 4.5 9.3 4.9 3.6 6.0 16% 10.7 7.3 14.8 11.7 8.5 14.5 Syria Female 7.6 5.1 10.7 5.0 3.4 6.6 13% 11.8 8.0 16.3 11.3 7.8 15.0 Male 8.8 6.2 12.2 18.2 12.1 27.4 38% 10.1 7.1 13.7 26.3 17.4 39.5 Tunisia Female 9.6 6.9 13.1 21.0 14.6 32.6 35% 10.2 7.4 14.0 26.6 18.5 41.2 Male 6.7 4.5 9.4 3.7 2.5 5.2 19% 15.9 11.6 20.3 40.6 28.8 54.0 UAE Female 7.0 4.8 9.9 4.1 2.4 6.8 18% 17.8 13.0 24.5 43.3 26.2 71.6 Male 3.0 2.0 4.4 9.2 5.4 14.7 76% 7.3 4.7 10.7 31.2 19.2 47.7 Yemen Female 6.3 4.1 9.2 18.5 10.1 28.2 70% 14.0 9.0 20.2 55.4 31.8 81.6 Male 8.6 7.0 10.4 18.1 15.5 20.8 48% 13.8 11.6 16.3 41.8 35.7 48.0 EMR Female 9.1 7.4 11.0 20.9 18.1 24.1 48% 14.1 11.7 16.8 43.5 37.4 50.2

Supplementary Table 4. Attributable diabetes burden to each risk factor of diabetes and ranking of risk factors in the Eastern Mediterranean region (EMR) and countries of the region compared to the global level, 2013

Diet high in High body-mass index Diet low in whole grains Low physical activity Location processed meat Rank Rate 95% UI Rank Rate 95% UI Rank Rate 95% UI Rank Rate 95% UI Global 1 387 307 480 2 163 115 214 3 114 76 161 4 68 45 100 EMR 1 579 461 706 2 185 130 245 3 146 98 202 8 20 7 42 Bahrain 1 1,139 864 1,472 2 371 244 521 3 258 167 370 8 31 6 79 Egypt 1 798 632 990 2 259 178 348 3 188 125 263 9 8 1 27 Iran 1 411 296 542 2 148 97 212 3 101 64 150 7 7 1 21 Iraq 1 694 540 872 2 221 149 308 3 160 105 226 8 6 1 22 Jordan 1 818 607 1,082 2 279 183 395 3 199 127 291 8 9 1 32 Kuwait 1 914 641 1,229 2 303 189 431 3 203 126 299 8 34 9 83 Lebanon 1 844 629 1,103 2 277 183 395 3 217 139 319 8 14 3 41 Libya 1 950 693 1,242 2 297 189 424 3 227 146 330 8 17 3 49 Morocco 1 919 729 1,159 2 294 204 402 3 254 174 356 9 8 1 29 Palestine 1 538 393 711 2 177 113 252 3 125 80 181 8 4 0 16 Oman 1 668 506 858 2 242 163 340 3 184 120 265 8 20 5 52 Qatar 1 843 582 1,175 2 281 167 421 3 173 105 266 8 47 13 109 Saudi Arabia 1 1,145 804 1,554 2 391 244 566 3 310 193 457 8 28 5 75 Syria 1 522 355 726 2 174 108 260 3 124 74 189 9 5 1 18 Tunisia 1 521 375 706 2 208 134 305 3 131 82 198 8 8 1 28 UAE 1 508 358 688 2 205 126 301 3 135 83 205 8 27 7 65 Yemen 1 279 183 417 2 101 61 160 3 81 48 128 8 2 0 8 Sudan 1 324 237 421 2 123 81 173 3 108 72 155 9 3 0 10 Afghanistan 1 525 385 695 2 206 138 295 3 154 99 236 8 3 0 13 Pakistan 1 491 375 620 2 126 78 183 3 119 77 174 7 47 18 89 Djibouti 1 340 236 499 2 54 30 94 3 54 32 86 8 13 4 33 Somalia 1 180 120 267 2 60 34 100 3 33 19 54 7 9 2 22 Rate: DALYs per 100,000 persons of all ages; UI: Uncertainty Interval; EMR: The Eastern Mediterranean region; UAE: United Arab Emirates

Supplementary Table 5. Attributable diabetes burden to each risk factor of diabetes and ranking of risk factors in the Eastern Mediterranean region (EMR) and countries of the region compared to the global level, 2013, continued.

Diet high in sugar Diet low in nuts Smoking Diet high in red meat Alcohol use Location sweetened beverages and seeds Rank Rate 95% UI Rank Rate 95% UI Rank Rate 95% UI Rank Rate 95% UI Rank Rate 95% UI Global 5 67 51 88 6 53 33 75 7 48 14 84 8 44 34 56 9 4 -5 12 EMR 5 57 36 85 6 53 32 79 7 47 12 85 4 58 45 73 9 4 2 6 Bahrain 4 172 89 277 7 78 38 134 6 85 23 160 5 97 50 160 9 3 -11 26 Egypt 6 64 32 108 4 99 63 143 7 63 16 117 5 67 46 92 8 9 5 14 Iran 8 7 2 16 6 19 8 33 5 25 7 48 4 41 27 60 9 1 -2 6 Iraq 4 63 33 105 7 46 22 76 6 53 15 97 5 57 31 96 9 2 -1 6 Jordan 4 113 61 190 6 79 43 123 5 91 27 164 7 72 46 106 9 2 -3 9 Kuwait 4 129 68 222 7 75 38 121 6 78 19 151 5 116 71 174 9 2 -2 8 Lebanon 4 142 89 213 7 23 9 44 6 97 30 176 5 111 69 169 9 1 -14 23 Libya 4 92 43 155 6 62 30 103 7 61 15 121 5 74 48 109 9 4 0 9 Morocco 4 91 48 150 5 81 45 122 7 56 14 108 6 66 45 93 8 11 5 17 Palestine 6 43 18 75 7 38 18 66 4 52 14 94 5 48 24 82 9 2 0 5 Oman 4 79 41 133 6 53 27 87 7 29 7 59 5 62 33 104 9 4 -2 12 Qatar 4 123 63 220 7 58 25 102 6 59 13 121 5 73 28 138 9 2 -8 16 Saudi Arabia 5 125 59 217 4 144 80 221 7 67 17 138 6 102 61 157 9 2 -5 9 Syria 4 50 24 85 7 16 6 30 6 37 11 73 5 47 29 72 8 6 2 12 Tunisia 5 63 30 111 7 39 20 65 4 71 20 134 6 41 25 62 9 5 -2 14 UAE 5 94 33 186 6 39 17 67 7 33 8 69 4 99 58 154 9 11 -3 31 Yemen 5 25 11 45 4 41 23 68 7 16 5 32 6 22 13 33 9 1 0 3 Sudan 4 31 16 53 6 27 14 45 7 5 1 11 5 31 16 52 8 5 -1 12 Afghanistan 6 39 19 68 5 49 25 82 7 34 9 66 4 56 29 94 9 2 -2 5 Pakistan 5 63 33 104 8 45 24 71 6 56 16 105 4 67 43 93 9 2 1 4 Djibouti 6 32 17 58 5 44 26 74 4 44 13 82 7 25 15 38 9 -4 -8 0 Somalia 5 21 9 37 4 28 15 48 6 16 4 33 8 7 3 13 9 -1 -3 1 Rate: DALYs per 100,000 persons of all ages; UI: Uncertainty Interval; EMR: The Eastern Mediterranean region; UAE: United Arab Emirates

Supplementary Table 6. Population attributable fraction of deaths and disability-adjusted life years (DALYs) of diabetes to different risk factors for diabetes in the Eastern Mediterranean Region, 2013

Population attributable fraction Attributable diabetes burden (rate per 100,000) Rate of Rate of Risk factors PAF 95% UI (PAF PAF 95% UI (PAF 95% UI DALY 95% UI diabetes Diabetes DALYs DALYs) deaths deaths) rate Death Rate DALYs deaths High fasting 100% - - 100% - - 883.5 732.2 1051.5 19.5 17.4 21.5 plasma glucose High body mass 65.5% 60.2% 70.0% 55.6% 49.0% 62.0% 578.8 461.0 705.7 10.8 9.1 12.6 index Low whole 20.9% 16.4% 25.4% 16.6% 12.6% 20.5% 184.9 129.6 244.8 3.2 2.4 4.1 grains Physical 16.5% 11.8% 21.5% 18.3% 13.1% 23.9% 145.5 97.6 202.0 3.6 2.6 4.8 inactivity High sweetened 6.6% 5.7% 7.5% 5.1% 4.3% 6.0% 58.3 44.9 73.3 1.0 0.8 1.2 beverages Low nuts and 6.4% 4.4% 8.7% 3.7% 2.4% 5.4% 56.7 36.5 84.7 0.7 0.5 1.1 seeds High red meat 6.0% 4.0% 8.3% 5.1% 3.4% 7.0% 53.5 32.1 78.6 1.0 0.6 1.4

Smoking 5.3% 1.4% 9.4% 5.3% 1.5% 9.6% 46.5 12.4 85.4 1.0 0.3 1.9 High processed 2.3% 0.9% 4.5% 1.7% 0.6% 3.6% 20.1 7.4 42.2 0.3 0.1 0.7 meat

Alcohol use 0.4% 0.2% 0.6% 0.5% 0.3% 0.7% 3.6 1.9 5.6 0.1 0.1 0.1

PAF: Population Attributable Fraction

Supplementary Table 7. Decomposition analysis of the change in total disability-adjusted life years (DALYs) from 1990 to 2013 into total population growth, population aging, and changes in age-sex-specific DALY rates of diabetes for the Eastern Mediterranean Region

95% Uncertainty Value interval 1990 total DALYs* (thousands) 222.1 187.5 262.8 Total DALYs expected with 2013 population, 1990 population age structure, 1990 DALY rates 361.9 305.5 428.2 (thousands) Total DALYs expected with 2013 population, 2013 population age structure, 1990 DALY rates 432.2 364.9 511.4 (thousands)

2013 total DALYs (thousands) 551.4 457.0 656.2

Median percent change of DALYs during 1990 to 2013 due to population growth 62.9% 61.5% 64.8%

Median percent change of DALYs during 1990 to 2013 due to population aging 31.8% 30.5% 33.6%

Median percent change of DALYs during 1990 to 2013 due to change in DALY rates 53.9% 52.0% 56.0%

Median percent change of DALYs during 1990 to 2013 (Total) 148.2% 146.3% 150.7%

*All DALYs in this table reflect diabetes burden