PREVELANCE OF COMPLICATIONS PREVELANCE OF COMPLICATIONS OF DIABETES MELLITUS OF DIABETES MELLITUS IN EGYPT IN EGYPT Prof Morsi Arab Prof Morsi Arab University of Alexandria University of Alexandria
Jan 13, 2016
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