egyptian perspective on prediabetes & diabetes ibrahim el ebrashy prof. of internal medicine...

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