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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