PREVELANCE OF COMPLICATIONS OF DIABETES MELLITUS IN EGYPT Prof Morsi Arab University of Alexandria

Total (n) 2000 > < 20Age /y 940 (100%) 5.5%77.8%12.6 %4.1 %M (100%) 4.1%80.0%12.3 %3.6%F. Age and Sex ( percent )

16.6 %Type %Type %IGT 0.6 %GDM 3.0 %? Not well defined Type of Diabetes

Over 30 (very obese) Over 27 ( Obese) Over 24 (overweight) BMI 38.5 %62.6 %81.2 %Male 60.5 %77.5 %90%Female BMI Increased BMI and Gender

Comparative prevalences of overweight among diabetic patients at urban and rural Governorates: B.M.I. > % 87.2 % 78.3 % Governorates A Alexandria & Cairo B Lower Egypt C Upper Egypt

Fasting Hyperglycemia - Controlled (< 120 mg/dl ) = 19.8 % -Uncontrolled = 80.2 % Hyperglycemic mg/dl = 15.6 % Marked hyperglycemia -200 = 31.3 % Severe hyperglycemia -220 = 12.5 % Very severe hyperglycemia > 220 = 20.8 %

120 mg/dl Hyperglycemia Fasting

Post Prandial Hyperglycemia - Controlled < 160 mg/dl = 13.5 % - Accepted mg/dl = 7.9 % Total = 21.4 % - Uncontrolled (>180 mg/dl ) = 78.6 % * Moderate -220 mg/dl = 17.4 % * Severe mg/dl = 16.0 % * Very Severe > 260 mg/dl = 45.2 %

180 mg/dl Hyperglycemia

Total> < 80Diast. B.P. mm Hg (n) 100% (64.6 %) % ( 35.4 % ) Uncontrolled ”Diastolic” Hypertension ( > 80 mmHg)

Diastolic Blood Pressure 80 mm Hg

Total> < 130Syst. B.p. Hg (n) 100 % % ( 46.3 ) % ( 53.7) % Uncontrolled “Systolic” Hypertension (>130 mmHg)

Systolic Blood Pressure 130 mm Hg 0.50%

Total> < 150 S. Cholesterol mg/dl Pts (n) (10.4 %)(33.2 %)(47.5 %)(8.9 %)% (43.6 %) (56.4 % ) Hypercholsterolemia (>200 mg/dl)

Lipid Control Serum Cholesterol 200 mg

> < 100TG mg/dl Pts. (n) (7.2)(9.1)(33.3)(36.1)(14.3 )% ( 49.6% )( 50.4% ) Hypertriglyceridemia (>150 mg/dl)

Lipid Control Serum Triglycerides 150 mg

( C ) > 30 ( B) ( A) < 24 Obesity as BMI group 30.6 % *20.5 % *8.7 % Syst. B.P. > 150 mm Hg 41.5 % *32.9 % *17.1 % Diast. B.P. > 80 mm Hg 50.4 % *24.5 % *19.7 % S. Cholest. > 200 mg/dL 54.9 % *22.6 %23.5 % S. Triglycerides >150mg/dL 80.0 %73.8 %72.3 % Fasting Bl.Gluc.>120mg/dL N.B. (%) percentage of patients above the acceptable levels, (*) Significant Obesity as a Risk Factor for Hyperglycemia, Hypertension and Hyperlipidemia

Obesity

Hypoglycemia - Occurrence of Hypoglycemic episodes in = 20.5% The mean age of patients who developed hypoglycemic episodes at any time = 50.8 years - The mean age of patients who did not experience hypoglyceamic episodes = 52.1 years Hypoglycemia - Occurrence of Hypoglycemic episodes in = 20.5% The mean age of patients who developed hypoglycemic episodes at any time = 50.8 years - The mean age of patients who did not experience hypoglyceamic episodes = 52.1 years

Diabetes KetoAcidosis (DKA) - Occurrence of DKA episodes in = 12.2 % The mean age in patients who developed DKA =42.5 years - The mean age in patients who never developed DKA =53.1 years Diabetes KetoAcidosis (DKA) - Occurrence of DKA episodes in = 12.2 % The mean age in patients who developed DKA =42.5 years - The mean age in patients who never developed DKA =53.1 years

Cardiac Complications Angina : 15.0 % Signs of Cardiac Dysfunction: 21.3 % (C. H.V. and or arrhythmia ) Positive ECG Changes : 7.9 % Cardiac Complications Angina : 15.0 % Signs of Cardiac Dysfunction: 21.3 % (C. H.V. and or arrhythmia ) Positive ECG Changes : 7.9 %

Cardiac Complications

Serum Creatinine Total[> 2.0 ]1-2< 10mg/dl n 100%(5 %(4748 %

Retinopathy ( in 1173 patients ) - Free 68.9 % - Back ground 22.6 % - Proliferative 9.5 %

Retinopathy in correlation with Duration of DM

Loss of AR and Duration of DM > >1Duration ( years ) % of Present / total Ankle Reflex loss as early indicator of neuropathy n 1833 pts., AR was : - present in 44.5 % - absent in 55.5 %

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Prevalence of foot complications 1- Fungus infection = 22.0 % 2- Foot ulcers = 6.8 % 3- Evident Ischaemic changes = 9.7 % 4- Amputations = 3.0 % 5- Deformities = 1.0 %

Frequency of Foot Complications

Fertility and Frequency of Abortions in Diabetic Females -The average number of normally born children / pt = The average number of aborted children / pt = The frequency of abortions among all pregnancies = 21.5%

Fertility Fertility Abortions : 21.5%

Conclusions : 1- The great majority of diabetic patients do not have adequate levels of glycaemic control, B.P. or serum lipids, according to accepted standards. 2- Obesity is widely prevalent, sometimes at its high degree (BMI >30) in all regional sectors of the population. 3- Obesity is a risk factor which correlates well with almost all metabolic aberrations.

Conclusions : (cont. ) 4- Prevalences of hypoglycaemic episodes and DKA are matching with known global standards. 5- While E.C.G. screening may reveal the presence of CAD in 7.9% only of diabetics, suggestive symptoms (angina) may be present in twice this prevalence ( 15%) and actual clinical cardiac morbidity in three times (21.3%) of cases. 6- Prevalences of Neuropathy and Retinopathy are highly correlated with the duration of diabetes.

Conclusions: ( cont.) 7- Serious foot complications are probably not as much prevalent as was anticipated. 8- Diabetic women are moderately fertile, about 1/4th of pregnancies however end into abortion.

Alexandrie – Palais du Montazah Thank You