PREVELANCE OF COMPLICATIONSPREVELANCE OF COMPLICATIONS OF DIABETES MELLITUS OF DIABETES MELLITUS

IN EGYPT IN EGYPT

Prof Morsi ArabProf Morsi ArabUniversity of AlexandriaUniversity of Alexandria

Age /y < 2020-40 40-70 > 70 Total

(n)

2000

M. 4.1 %12.6 %77.8%5.5%940

(100%)

F. 3.6% 12.3 %80.0% 4.1%1060

(100%)

Age and Sex ( percent )

0

5

10

15

20

25

30

35

%

-10 -20 -30 -40 -50 -60 -70 >>

Age/group

Age % Distribution

male

female

Type 116.6 %

Type 283.4 %

IGT0.4 %

GDM0.6 %

? Not well defined3.0 %

Type of Diabetes

BMI Over 24 (overweight)

Over 27

( Obese)

Over 30

(very obese)

Male 81.2 % 62.6 %38.5 %

Female90%77.5 %60.5 %

BMI

Increased BMI and Gender

0

10

20

30

40

50

60

70

80

90 %

>24 >27 >30

BMI

Obesity

Male

Female

Comparative prevalences of overweight among Comparative prevalences of overweight among diabetic patients at urban and rural Governorates:diabetic patients at urban and rural Governorates:

GovernoratesB.M.I. >24

89.9 %

87.2 %

78.3 %

A Alexandria &

Cairo

B Lower

Egypt

C Upper

Egypt

Prevalence of Overweight among Diabetic patients in Egyptian Governorates

89.90% 87%

78.30%

0.00%

100.00%

A B C

Smoking

3

51.8

0

10

20

30

40

50

60

male female

%

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 %

19.80%

15.60%

31.30%

12.50%

20.80%

> 220

200-220

151-200

121-150

-120

120 mg/dl

Hyperglycemia Fasting

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 %

Post Prandial

13.50%

7.90%

17.40%

16%

45.20%

> 260 220-260180-220160-180<160

180 mg/dl

Hyperglycemia

Diast. B.P. mm Hg

< 80 - 90 - 100-110> 120Total

(n)

124434923286151926

%

(64.6 %)

18.112.14.50.7 100%

( 35.4 % )

Uncontrolled ”Diastolic” Hypertension ( > 80 mmHg)

Diastolic Blood PressureDiastolic Blood Pressure

64.60%

18.10%

12.10%

4.50%

0.70%

> 120

110

100

90

< 80

80 mm Hg

Syst. B.p. Hg

< 130 -150 - 180 - 200 > 200 Total

(n) 103543039954101928

%

53.722.320.7 2.8 0.5100 %

( 53.7)

%

( 46.3 )

%

Uncontrolled “Systolic” Hypertension (>130 mmHg)

Systolic Blood PressureSystolic Blood Pressure

53.70%

22.30%

20.70%

2.80%

>200200180150< 130

130 mm Hg

0.50%

S. Cholesterol

mg/dl

< 150 -200 -250 > 250 Total

Pts (n)1115924131301246

%(8.9 %)(47.5 %)(33.2 %)(10.4 %)

(56.4 % )(43.6 %)

Hypercholsterolemia (>200 mg/dl)

56.40%

33.20%

10.40%

>250

201-250

-200

Lipid Control

Serum Cholesterol

200 mg

TG

mg/dl

< 100 -150 -200 -250>250

Pts. (n) 1533853569777

%(14.3 )(36.1)(33.3)(9.1)(7.2)

( 50.4% )( 49.6% )

Hypertriglyceridemia (>150 mg/dl)

Lipid ControlLipid ControlSerum TriglyceridesSerum Triglycerides

50.40%

33.30%

9.10%

7.20%

> 250

201-250

151-200

-150

Column1

150 mg

Obesity as BMI group( A)

< 24

( B)

24-30

( C )

> 30

Syst. B.P. > 150 mm Hg 8.7 %20.5 % *30.6 % *

Diast. B.P. > 80 mm Hg 17.1 %32.9 % *41.5 % *

S. Cholest. > 200 mg/dL19.7 %24.5 % *50.4 % *

S. Triglycerides >150mg/dL23.5 %22.6 %54.9 % *

Fasting Bl.Gluc.>120mg/dL72.3 %73.8 %80.0 %

N.B. (%) percentage of patients above the acceptable levels , (*) Significant

Obesity as a Risk Factor for Hyperglycemia , Hypertension and Hyperlipidemia

8.70%

20.50%

30.60%

17.10%

32.90%

41.50%

19.70%

24.50%

50.40%

23.50%

22.60%

54.90%

72.30%

73.80%80.00%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Syst. Diast. S.Cholest S. Triglyc. Fasting Bl

A B C

ObesityObesity

HypoglycemiaHypoglycemia- - Occurrence of Hypoglycemic episodes in Occurrence of Hypoglycemic episodes in = 20.5%= 20.5%

---------------------------------------------------------------------------------------------------------------------------------------------------- - - The mean age of patients who developed The mean age of patients who developed hypoglycemic episodes at any time hypoglycemic episodes at any time = 50.8 years= 50.8 years

- - The mean age of patients who did not experience The mean age of patients who did not experience hypoglyceamic episodes hypoglyceamic episodes = 52.1 years= 52.1 years

Diabetes KetoAcidosis (DKA)Diabetes KetoAcidosis (DKA)

- Occurrence of DKA episodes in - Occurrence of DKA episodes in = 12.2 %.= 12.2 %.

----------------------------------------------------------------------------------------------------------------------------------------

- The mean age in patients who developed DKA - The mean age in patients who developed DKA =42.5 years=42.5 years

- The mean age in patients who never developed DKA - The mean age in patients who never developed DKA =53.1 years=53.1 years

Cardiac ComplicationsCardiac Complications

Angina : 15.0 %Angina : 15.0 %

Signs of Cardiac Dysfunction: 21.3 % Signs of Cardiac Dysfunction: 21.3 % (C. H.V. and or arrhythmia ) (C. H.V. and or arrhythmia )

Positive ECG Changes : 7.9 %Positive ECG Changes : 7.9 %

15.00%

7.90%

21.80%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Angina ECG+ve H.F-Arryth

Cardiac Complications

Serum CreatinineSerum Creatinine

mg/dl < 101-2[> 2.0 ]Total

n634620711325

%4847(5 %(100%

Retinopathy ( in 1173 patients )Retinopathy ( in 1173 patients ) - Free 68.9 % - Free 68.9 %

- Back ground 22.6 % - Back ground 22.6 % - Proliferative 9.5 % - Proliferative 9.5 %

Retinopathy

68.9 %

9.5%

22.6 % Free

B.ground

Prolif.

Retinopathy in correlation with Retinopathy in correlation with Duration of DMDuration of DM

0%

20%

40%

60%

80%

100%

1 3 6 9 12 15 >15

Free Non-Prol. Prol.

Loss of AR and Duration of DM

Duration

( years )

>1-3-6-9-12-15-18-21-24>24

% of Present /

total

766751513233271391

Ankle Reflex loss as early indicator of neuropathy n 1833 pts., AR was : - present in 44.5 %

- absent in 55.5%

Ankle reflex and Duration of DM

0

10

20

30

40

50

60

70

80

<1 -3 -6 -9 -12 -15 -18 -21 -24 >24

Duration /year

%

l

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 %

22.00%

9.70%

6.80%

3.00%

1.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Fungus Isch Ulcers Ampt. Deform.

Frequency of Foot ComplicationsFrequency of Foot Complications

Fertility and Frequency of Abortions in Diabetic Females

-The average number of normally born children / pt = 3.6-The average number of normally born children / pt = 3.6

- The average number of aborted children / pt = 0.9- The average number of aborted children / pt = 0.9

- The frequency of abortions among all pregnancies = 21.5%- The frequency of abortions among all pregnancies = 21.5%

0.90%

3.60%

labour Abortion

FertilityFertility

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