egyptian perspective on prediabetes & diabetes ibrahim el ebrashy prof. of internal medicine...
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Egyptian Perspective On Prediabetes & Diabetes
Ibrahim El EbrashyProf. Of Internal Medicine & Diabetes
Faculty Of Medicine-Cairo University
Dean
National Institute Of Diabetes & Endocrinology (NIDE )
Cairo – MOH
Egypt
Top 10 prevalence of diabetes (20-79 age groups) in 2007 (With 2025 prevalence)
5 10 15 20 25 30 35 400
Nauru
UAE
Saudi Arabia
Bahrain
Kuwait
Oman
Tonga
Mauritius
Egypt
Mexico
Prevalence (%)
Country
2007
2025
International Diabetes Federation. Diabetes Atlas. Brussels, Belgium: IDF; 2007
Preventing
CHRONIC DISEASES
a vital investment
World Health
Organization 2007
The burden and costs of chronic diseases in low-income and
middle-income countries
The Lancet , 5 December 2007
•They estimated the burden and loss of economic output associated with chronic diseases in 23 selected countries
• These countries were selected as leading countries collectively accounting for around 80% of the total mortality burden attributable to chronic diseases in developing countries.
•They aggregate estimates from coronary heart disease, stroke, and diabetes, since these disorders represent the greatest burden of the entire group of chronic diseases.
•All estimates are projected between 2005 and 2015.
Global Burden Of Diabetes Prevalence and Projections
2010 and 2030IDF, 2009.
10
TOP 10Number of people with diabetes (20-79 years)
2010 and 2030
11
T2DM trends in Egypt- Prevalence
35- 44
45- 54
55 - 65
25-34
0
5
10
Pre
vale
nce
(%
)
8.6
15
7.0
10.4
TotalMale Female
Age Categories
42.6 %
8.8 %20.3 %
28.3 %
Egyptian Ministry of Health (MOH ) Preventive Sector, Central Epidemiology and Disease Surveillance (ESU) 2006
T2DM trends in Egypt
0
5
10
15
20
25
PrevalenceInsulin
use
25-34
35-44
45-54
55-65
Total
OAD use
Age Categories
(%)
Undiagnosed
Egyptian Ministry of Health (MOH) Preventive Sector, Central Epidemiology and Disease Surveillance (ESU) 2006
T2DM trends in Egypt- Complications & Risk factors ( NIDE Data 2008 )
30 400 10 20 50
Neuropathy
Nephropathy
Retinopathy
BMI < 25
BMI 25-30
BMI > 30
60 70 80 90
Hypertension
Low HDL
High
Cholesterol
Prevalence (%)
T2DM trends in Egypt-Metabolic SyndromeNIDE Data 2008
90 % of T2DM patients in Egypt have Metabolic Syndrome
T1DM trends in EgyptNIDE Data 2009 ( 852 Patients )
16
Hereditary factors
6.70%5.20% 4%
31.30%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
Diabeticfather
Diabeticmother
Diabeticsiblings
Diabeticgrands
Diabetic father
Diabetic mother
Diabetic siblings
Diabetic grands
17
Infant feeding
80.60%
13.10%2.10%
Breast feeding
Artif icial cow s milk
Artif icial milk formula
18
Age of onset of diabetes
23.80%
46%
25.20% Age of onset > 5y.
Age of onset = 5:<10y.
Age of onset =10-15y.
19
BMI in diabetic children
56%27%
14% 3%
BMI < 25
BMI= 25:<30
BMI=30:<40
BMI >40
20
HbA1c among diabetic children
31%
22%14%
33%HbA1c<7%
HbA1c7:8%
HbA1c>8:9%
HbA1c>9%
21
Beta cell function among diabetic children
93.70%
6.30%
c-peptide < 1
c-peptide > 1
22
Continues Home Blood Glucose Monitoring
34.80%
25.80%
39.40%CHBGM with Device
CHBGM with visual strips
No CHBGM
MOH – Curative Care Sector Project:Early Detection of Diabetes Mellitus
Salah El-Ghazaly Harb*, Ibrahim El-Ebrashy***,
Mohamed Fahmy** and Madiha Said Abdel-Razik*
Faculty of Medicine Cairo* and Ain Shams** Universities and the National Institute For Diabetes & Endocrinology***
• The EDDP established "early detection of DM clinics (EDDMC) in 14 hospitals, in three phases.
• These hospitals are located in 12 governorates and distributed in the three Egypt Regions (Urban governorates, Lower Egypt and Upper Egypt).
• Throughout the period 2003-2009, more than 95000 at-risk ≥ 25 years of age individuals (hypertension, obesity, and positive family history of diabetes), but with negative history of DM had been examined.
Prevalence of Prediabetes & Undiagnosed Diabetes Among High Risk Subjects Dec. 2009
(Total number of subjects 95354) % 12.2Pre-
diabetes
% 14.0Un-
diagnosed Diabetes
% 73.8Normal
27
Country profilePercent with diabetes (20-79 years), 2010 (national)
10.4
Percent with diabetes (20-79 years), 2010 (comparative)11.4
Percent with diabetes (20-79 years), 2030 (comparative)13.7
Number of people with diabetes, 20104,787,100
Egypt
Percent with impaired glucose tolerance (20-79 years), 2010 (national)
4.8
Percent with impaired glucose tolerance (20-79 years), 2010 (comparative)
5.1
New cases of type 1 diabetes in children (under 14 years) 2010 (new cases per 100,000 population per year)
8.0
Deaths attributable to diabetes (20-79 years), 201058,116
Mean health expenditure per person with diabetes (USD), R=2, 2010
116
T2DM trends in Egypt- Current treatment practice
• Guidelines followed
• Majority follow ADA , EASD & IDF guidelines
• local clinical practice recommendation since 2009 MOH.
• Management Practices
• All oral anti-diabetic drugs available
• Metformin remains the mainstay of treatment together with SUs.
• TZDs are prescribed after failure of Metformin and SUs.
• Newer agents like DPP-IV are launched in the market.
• All types of insulin and insulin analogues are available.
• National DPP is just launched
Thank You