Upload
adele-mcbride
View
219
Download
0
Tags:
Embed Size (px)
Citation preview
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