Transcript Diabetes in Egypt (2003) Prof. Morsi Arab PREVELANCE OF COMPLICATIONS OF DIABETES MELLITUS IN EGYPT.

Diabetes in Egypt
(2003)
Prof. Morsi Arab
PREVELANCE OF COMPLICATIONS
OF DIABETES MELLITUS
IN EGYPT
Distribution in Governorates
Alex
1
Menoufeya
2
El Menia 3
Assiut 4
no
.
population
Mansoura 5
El Behira 6
Kafr El Sheikh 7
Matrouh 8
Other Govern. 9
Governorates
Governorate Ale Me El Ass Ma EL Kaf Mat Oth
Population
Age and Sex ( percent )
Age
< 20
20-40 40-70
> 70
Total
(n)
(Year)
M.
4.1 %
12.6 %
77.8%
5.5%
940
(100%)
F.
3.6%
12.3 %
80.0%
4.1%
1060
(100%)
Type of Diabetes
Type 1
Type 2
16.6 %
83.4 %
IGT
0.4 %
GDM
0.6 %
? Not well defined 3.0 %
Type of Diabetes
.
%
.
.
Type
Type
.
IGT
Type of DM
GDM
???
BMI
Increased BMI and Gender
BMI
Obesity
Male
Female
Over 24
(overweight)
Over 27
( Obese)
Over 30
(very obese)
81.2 %
62.6 %
38.5 %
90%
77.5 %
60.5 %
Obesity
%
Male
Female
>
>
>
BMI
Smoking
%
.
male
female
Fertility; Abortions and Labour in Diabetic Females .
(among 1060 diabetic females)
- The average number of normally born children / pt
- The average number of aborted children / pt
= 3.6
= 0.9
- The frequency of abortions among all pregnancies
- The average frequency of Caesarian labour
= 21.5%
= 4.7 %
Parental History of Diabetes
Diabetic Mother in
Diabetic Father in
Both parents in
Neither Parents in
: 29.1 %
: 22.3 %
: 7.8 %
:39.3 %
DM in Parents
%
%
%
%
%
%
%
.
%
%
%
%
%
%
%
Both
Father
Mother
None
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
- Accepted 161-180 mg/dl
Total
= 13.5 %
= 7.9 %
= 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 %
Uncontrolled Diastolic Hypertension
Diast.
< 80
B.P. mm
Hg
1244
(n)
- 90
- 100 -110
> 120
Total
349
232
86
15
1926
18.1 12.1
4.5
0.7
100%
(64.6)
%
( 35.4 )
Uncontrolled Systolic Hypertension
SBP
< 130
-150
- 180
- 200
> 200
Total
1035
430
399
54
10
1928
53.7
22.3
20.7
2.8
0.5
100 %
(mmHg)
(n)
%
( 53.7) ( 46.3 )
Diabetes KetoAcidosis (DKA)
- Incidence ( among all patients at all frequencies at
any time of the duration of diabetes ) = 12.2 %.
- The mean age in patients who developed DKA ( at
least once in life )
= 42.5 years
- The mean age in patients who never developed DKA
= 53.1 years
Hypoglycemia
- Incidence of Hypoglycemic episodes at any frequency
and at any time during the course of Diabetes.
Among 1588 patients was
= 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
Serum Cholesterol and Hypercholsterolemia
S. Cholesterol
mg/dl
Pts (n)
%
< 150
151-200
201-250
> 250
Total
111
592
413
130
1246
(8.9%)
(47.5%)
(56.4% )
(33.2%)
(10.4%)
(43.6%)
Cardiac Complications
Angina = 15.0 %
Positive E.C.G. Changes : 7.9 %
Signs of Cardiac Dysfunction: 21.3 %
(C. H.V. and or arrhythmia )
Retinopathy ( in 1173 patients )
- Free
- Back ground
- Proliferative
68.9 %
22.6 %
9.5 %
Retinopathy
. %
. %
Free
B.ground
Prolif.
. %
Serum Creatinine
Mg/dl
< 10
1-2
> 2.0
Total
n
634
620
71
1325
%
48
47
5%
100%
Ankle Reflex as early indicator of neuropathy
n 1833 pts., AR was : - present in 44.5 %
- absent in 55.5 %
Loss of AR and Duration of DM
Duration >1 -3 -6
(Y)
% of
76 67 51
Present /
total
-9 -12 -15
-18 -21 -24 >24
51 32
27
33
13
9
1
%
Ankle reflex and Duration of DM
<
-
-
-
-
-
-
Duration /year
-
-
>
Prevalence
of foot complications
among diabetic patients
Among 2000 patients :
1- Fungus infection
2- Foot ulcers
3- Evident Ischaemic changes
4- Amputations
5- Deformities
= 22.0 %
= 6.8 %
= 9.7 %
= 3.0 %
= 1.0 %
Treatment by Insulin
I- Out of 2000 diabetic patients :
- 882 are insulin recipients ( 44.1 %)
- 199 are on animal insulin ( 23 % )
- 683 are on Human insulin ( 77 %)
II- The average total daily dose = ( 45.5 units)
- 34.1 % of pts on ( one ) injection
- 58.4 % of pts on ( two ) injections)
- 7.5 % of pts on multiple injections
III- The form of insulin received is
- Intermediate in 83.0%
- Mixed in 14.6 %
- 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 ).
Cost of one
day in USD
Relative Extra
burden
40.00
(100)
DM + C.V.D.
51.30
128%
DM+ Renal Failure
141.70
354%
DM + Diabetic foot
138.7
346%
State of DM
DM (uncomplicated)
Admitted for glyceamic control
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
Cost of Medications and Medical
supplies
Basic hospital expenses
- Food
- Health Care Team
- All other running expenses
Average total cost per day
L.E.
%
99.00
55 %
9.00
19.80
52.20
5%
11 %
29 %
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/y
3.6 – 29.2
14.6 – 116.8
32.8 – 262.8
54.7 – 438.0
Animal I U/40 *
Human I U/40 **
Human I U/100
Human I in pen device U/100
(B) Oral Antidiabetic Agents
Type of oral antidiabetic Agents
Glibenclamide
Gliclazide
Glimepride
Metformin
Rapiglinide
Nateglinide
Rosiglitazone
* Heavily subsidized
Daily dose
Cost in
USD/y
5 mg - 20 mg
80 mg - 240 mg
1 mg 6 mg
500 mg- 1500 mg
3 mg
360 mg
4 mg
14.0- 56.0
27.0- 81.0
32.0-162.0
10.0- 30.0
- 235
- 405
- 446
** 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. )
76.4
Physician fees and other specialist
consultations
Total
66.6
143 USD/Year
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
Saudi
Arabia
Percapit. Income in
USD
1490
1180
13730
6900
Animal Insulin U/40
(40 units /d)
14.6 *
134.3
NA
NA
Human Insulin U/40
(40 units /d)
55.5 **
313.9
NA
NA
Human Insulin
U/100 (40 units/d)
132.9
318.3
258.4
213.0
Human Insulin in
Device U/100 (40
units/d)
219.0
446.7
-------
-------
* 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. Income
in USD
1490
1180
13730
6900
Glibenclamide
(5-20 mg)
14-56
41-164
94-376
Cliclazide
(80-240 mg)
27-81
48-144
98-294
Glimeperide
( 1-6 mg )
32-162
57-292
-------
Metformin
(100-1500 mg)
20-30
24-36
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.)
Saudi Arabia
Egypt
Morocco
Qatar
Percapit.
Income in
USD
1490
1180
13730
6900
Rapiglinide
( 3mg)
235
------
------
243
Nateglinide
(360 mg )
405
------
------
------
Rosiglitazine
( 4 mg )
446
------
------
584
Thank You