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

3. Total (n) 2000 > 7040-7020-40< 20Age /y 940 (100%) 5.5%77.8%12.6 %4.1 %M. 1060 (100%) 4.1%80.0%12.3 %3.6%F. Age and Sex ( percent )

5. 16.6 %Type 1 83.4 %Type 2 0.4 %IGT 0.6 %GDM 3.0 %? Not well defined Type of Diabetes

6. 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

8. Comparative prevalences of overweight among diabetic patients at urban and rural Governorates: B.M.I. >24 89.9 % 87.2 % 78.3 % Governorates A Alexandria & Cairo B Lower Egypt C Upper Egypt

11. Fasting Hyperglycemia - Controlled (< 120 mg/dl ) = 19.8 % -Uncontrolled = 80.2 % - ------------------------------------- Hyperglycemic 121-150 mg/dl = 15.6 % Marked hyperglycemia -200 = 31.3 % Severe hyperglycemia -220 = 12.5 % Very severe hyperglycemia > 220 = 20.8 %

12. 120 mg/dl Hyperglycemia Fasting

13. Post Prandial Hyperglycemia - Controlled < 160 mg/dl = 13.5 % - Accepted 161-180 mg/dl = 7.9 % Total = 21.4 % - Uncontrolled (>180 mg/dl ) = 78.6 % * Moderate -220 mg/dl = 17.4 % * Severe - 260 mg/dl = 16.0 % * Very Severe > 260 mg/dl = 45.2 %

14. 180 mg/dl Hyperglycemia

15. Total> 120-110- 100- 90< 80Diast. B.P. mm Hg 192615862323491244 (n) 100%0.74.512.118.1 (64.6 %) % ( 35.4 % ) Uncontrolled ”Diastolic” Hypertension ( > 80 mmHg)

16. Diastolic Blood Pressure 80 mm Hg

17. Total> 200- 200- 180-150< 130Syst. B.p. Hg 192810543994301035(n) 100 %0.52.820.722.353.7 % ( 46.3 ) % ( 53.7) % Uncontrolled “Systolic” Hypertension (>130 mmHg)

18. Systolic Blood Pressure 130 mm Hg 0.50%

19. Total> 250 -250 -200< 150 S. Cholesterol mg/dl 1246130413592111Pts (n) (10.4 %)(33.2 %)(47.5 %)(8.9 %)% (43.6 %) (56.4 % ) Hypercholsterolemia (>200 mg/dl)

20. Lipid Control Serum Cholesterol 200 mg

21. >250 -250 -200 -150< 100TG mg/dl 7797356385153Pts. (n) (7.2)(9.1)(33.3)(36.1)(14.3 )% ( 49.6% )( 50.4% ) Hypertriglyceridemia (>150 mg/dl)

22. Lipid Control Serum Triglycerides 150 mg

23. ( C ) > 30 ( B) 24-30 ( 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

24. Obesity

25. 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

26. 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

27. 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 %

28. Cardiac Complications

29. Serum Creatinine Total[> 2.0 ]1-2< 10mg/dl 132571620634 n 100%(5 %(4748 %

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

32. Retinopathy in correlation with Duration of DM

33. Loss of AR and Duration of DM >24-24-21-18-15-12-9-6-3>1Duration ( years ) 191327333251 6776% of Present / total Ankle Reflex loss as early indicator of neuropathy n 1833 pts., AR was : - present in 44.5 % - absent in 55.5 %

34. l

35. 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 %

36. Frequency of Foot Complications

37. Fertility and Frequency of Abortions in Diabetic Females -The average number of normally born children / pt = 3.6 - The average number of aborted children / pt = 0.9 - The frequency of abortions among all pregnancies = 21.5%

38. Fertility Fertility Abortions : 21.5%

39. 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.

40. 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.

41. 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.

42. Alexandrie – Palais du Montazah Thank You