Diabetes in Egypt (2003)
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Transcript of Diabetes in Egypt (2003)
Diabetes in EgyptDiabetes in Egypt
(2003)(2003)
Prof. Morsi Arab
PREVELANCE OF COMPLICATIONSPREVELANCE OF COMPLICATIONS OF DIABETES MELLITUS OF DIABETES MELLITUS
IN EGYPT IN EGYPT
0
100
200
300
400
500
600
700
800
900no . po
pula
tion
Governorates
Distribution in Governorates
Governorate Ale Me El Ass Ma EL Kaf Mat OthPopulation 836 401 268 155 129 102 40 17 51
Alex 1
Menoufeya 2
El Menia 3
Assiut 4
Mansoura 5
El Behira 6
Kafr El Sheikh 7
Matrouh 8
Other Govern. 9
Age (Year)
< 20 20-40 40-70 > 70 Total (n)
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 )
Type 1 16.6 %Type 2 83.4 %
IGT 0.4 %
GDM 0.6 %
? Not well defined 3.0 %
Type of Diabetes
16.6
83.4
0.4 0.6 3
0
10
20
30
40
50
60
70
80
90%
Type 1 Type 2 IGT GDM ???Type of DM
Type of Diabetes
BMI Obesity
Over 24 (overweight)
Over 27 ( Obese)
Over 30(very obese)
Male 81.2 % 62.6 % 38.5 %
Female 90% 77.5 % 60.5 %
BMIIncreased BMI and Gender
010
203040
506070
8090 %
>24 >27 >30 BMI
Obesity
MaleFemale
Smoking
3
51.8
0
10
20
30
40
50
60
male female
%
Fertility; Abortions and Labour in Diabetic Females . (among 1060 diabetic females)
- The average number of normally born children / pt = 3.6The 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%- The average frequency of Caesarian labour = 4.7 %- The average frequency of Caesarian labour = 4.7 %
Parental History of DiabetesParental History of Diabetes
Diabetic Mother in : 29.1 %Diabetic Mother in : 29.1 % Diabetic Father in : 22.3 % Diabetic Father in : 22.3 % Both parents in : 7.8 % Both parents in : 7.8 % Neither Parents in :39.3 % Neither Parents in :39.3 %
40%
34% 34%
23.70%
0%
5%
10%
15%
20%
25%
30%
35%
40% %
Both Father Mother None
DM in Parents
Fasting Hyperglycemia - Controlled (< 120 mg/dl ) = 19.8 %- Total Uncontrolled = 80.2 % Hyperglycemic 121-150 mg/dl = 15.6 % Marked hyperglycemia 151-200 = 31.3 % Severe hyperglycemia 211-220 = 12.5 % Very severe hyperglycemia > 220 = 20.8 %
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 181-220 mg/dl = 17.4 % * Severe 221- 260 mg/dl = 16.0 % * Very Severe > 260 mg/dl = 45.2 % TOTAL = 100 %
Diast. B.P. mm Hg
< 80 - 90 - 100 -110 > 120 Total
(n) 1244 349 232 86 15 1926
% (64.6)
18.1 12.1 4.5 0.7 100%
( 35.4 )
Uncontrolled Diastolic Hypertension
SBP (mmHg)
< 130 -150 - 180 - 200 > 200 Total
(n) 1035 430 399 54 10 1928
%
53.7 22.3 20.7 2.8 0.5 100 %
( 53.7) ( 46.3 )
Uncontrolled Systolic Hypertension
Diabetes KetoAcidosis (DKA)Diabetes KetoAcidosis (DKA)
- - Incidence ( among all patients at all frequencies at Incidence ( among all patients at all frequencies at any time of the duration of diabetes ) any time of the duration of diabetes ) = 12.2 %.= 12.2 %.
- The mean age in patients who developed DKA ( at - The mean age in patients who developed DKA ( at least once in life ) least once in life ) = 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
HypoglycemiaHypoglycemia
- Incidence of Hypoglycemic episodes at any frequency - Incidence of Hypoglycemic episodes at any frequency and at any time during the course of Diabetes. and at any time during the course of Diabetes. Among 1588 patients was Among 1588 patients was = 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
S. Cholesterol mg/dl
< 150 151-200 201-250 > 250 Total
Pts (n) 111 592 413 130 1246
% (8.9%) (47.5%) (33.2%) (10.4%)
(56.4% ) (43.6%)
Serum Cholesterol and Hypercholsterolemia
Cardiac ComplicationsCardiac Complications
Angina = 15.0 %Angina = 15.0 %
Positive E.C.G. Changes : 7.9 % Positive E.C.G. Changes : 7.9 %
Signs of Cardiac Dysfunction: 21.3 % Signs of Cardiac Dysfunction: 21.3 % (C. H.V. and or arrhythmia ) (C. H.V. and or arrhythmia )
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 % FreeB.groundProlif.
Serum CreatinineSerum Creatinine
Mg/dl < 10 1-2 > 2.0 Total
n 634 620 71 1325
% 48 47 5% 100%
Loss of AR and Duration of DM
Duration( Y )
>1 -3 -6 -9 -12 -15 -18 -21 -24 >24
% of Present /total
76 67 51 51 32 33 27 13 9 1
Ankle Reflex 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
%
Prevalence of foot complications
among diabetic patients
Among 2000 patients : 1- Fungus infection = 22.0 % 2- Foot ulcers = 6.8 % 3- Evident Ischaemic changes = 9.7 % 4- Amputations = 3.0 % 5- Deformities = 1.0 %
Treatment by InsulinTreatment by Insulin I- I- Out of 2000 diabetic patientsOut of 2000 diabetic patients : : - 882 are insulin recipients ( 44.1 %) - 882 are insulin recipients ( 44.1 %) - 199 are on animal insulin ( 23 % ) - 199 are on animal insulin ( 23 % ) - 683 are on Human insulin ( 77 %) - 683 are on Human insulin ( 77 %)II- The average total daily doseII- The average total daily dose = ( 45.5 units) = ( 45.5 units) - 34.1 % of pts on ( one ) injection - 34.1 % of pts on ( one ) injection - 58.4 % of pts on ( two ) injections) - 58.4 % of pts on ( two ) injections) - 7.5 % of pts on multiple injections - 7.5 % of pts on multiple injections III- The form of insulin received isIII- The form of insulin received is - Intermediate in 83.0% - Intermediate in 83.0% - Mixed in 14.6 % - Mixed in 14.6 % - Short in 4.2 % - Short in 4.2 %
The Extra Burden of Cost of Treatment of Complicated Diabetes at a Private Alexandria
Hospital, 2001 ( average of 100 diabetic patients ).
State of DMCost of oneday in USD
Relative Extraburden
DM (uncomplicated)
Admitted for glyceamic control
DM + C.V.D.
DM+ Renal Failure
DM + Diabetic foot
40.00
51.30
141.70
138.7
(100)
128%
354%
346%
Distribution of costs of Hospital Treatment of Diabetic Patients ( L.E. per day ) at a Private Hospital for Middle Class Egyptian Population at the City of
Alexandria , Egypt 2001
L.E. %
Cost of Medications and Medicalsupplies
99.00 55 %
Basic hospital expenses - Food - Health Care Team - All other running expenses
9.0019.8052.20
5 %11 %29 %
Average total cost per day 180 L.E. (= 40 $ ) 100 %
Estimated Costs of Ambulatory (out patient) Treatment of Diabetes in Egypt at 2001
Cost Prices in USD/ year(A) Insulin ( Dose 10-80 units /d )
Type of Insulin Cost in USD/yAnimal I U/40 *Human I U/40 **Human I U/100Human I in pen device U/100
3.6 – 29.214.6 – 116.832.8 – 262.854.7 – 438.0
(B) Oral Antidiabetic Agents
Type of oral antidiabetic Agents Daily dose Cost inUSD/y
GlibenclamideGliclazideGlimeprideMetforminRapiglinideNateglinideRosiglitazone
5 mg - 20 mg80 mg - 240 mg1 mg - 6 mg500 mg- 1500 mg
- 3 mg360 mg
4 mg
14.0- 56.027.0- 81.032.0-162.010.0- 30.0
- 235- 405- 446
* Heavily subsidized ** moderately subsidized
Estimated Costs of Ambulatory (out patient) Treatment of Diabetes in Egypt at 2001
Cost Prices in USD/ year ( Cont.)
( C ) Other costs at average frequencies per year
Laboratory , and other follow – up investigations (E.C.G radiol., etc. )
Physician fees and other specialist consultations
Total 143 USD/Year
76.4
66.6
The Burden of the Cost of Ambulatory Treatment of Diabetes on Individuals at Low-Income and High-Income
Middle East Countries, based on the Cost Prices of Insulins and Oral Antidiabetic Agents (in USD per year)
Egypt Morocco Qatar SaudiArabia
Percapit. Income inUSD
1490 1180 13730 6900
Animal Insulin U/40(40 units /d)
Human Insulin U/40(40 units /d)
Human InsulinU/100 (40 units/d)
Human Insulin inDevice U/100 (40units/d)
14.6 *
55.5 **
132.9
219.0
134.3
313.9
318.3
446.7
NA
NA
258.4
-------
NA
NA
213.0
-------
* Heavily subsidized ** moderately subsidized
The Burden of the Cost of Ambulatory Treatment of Diabetes on Individuals at Low-Income and High-Income Middle East
Countries , based on the Cost Prices of Insulins and Oral Antidiabetic Agents ( in USD per year) (Cont.)
Egypt Morocco Qatar Saudi Arabia
Percapit. Incomein USD
1490 1180 13730 6900
Glibenclamide (5-20 mg)
Cliclazide(80-240 mg)
Glimeperide( 1-6 mg )
Metformin(100-1500 mg)
14-56
27-81
32-162
20-30
41-164
48-144
57-292
24-36
94-376
98-294
-------
44-66
The Burden of the Cost of Ambulatory Treatment of Diabetes on Individuals at Low-Income and High-Income Middle East
Countries , based on the Cost Prices of Insulins and Oral Antidiabetic Agents (in USD per year) (Cont.)
Egypt Morocco Qatar Saudi Arabia
Percapit.Income inUSD
1490 1180 13730 6900
Rapiglinide( 3mg)
Nateglinide(360 mg )
Rosiglitazine( 4 mg )
235
405
446
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243
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584
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