Diabetes as a Global Health Problem: IDF Meets the Challenge

1. Diabetes as a Global Health Problem The IDF meets the Challenge By Prof. Morsi ArabIDF Chairman MENA Region

11. MENA

14. Reported Incidence of Type1 Diabetes at the MENA Region per 100.000 population under 15 yrs ( Diabetes Atlas 2006) • Afghanistan 1.2 • Algeria 8.6 • Bahrain 2.5 • Egypt 8.0 • Iran 3.7 • Iraq 3.7 • Jordan 3.2 • Kuwait 22.3 • Lebanon 3.2 • Libya 9.0 • Morocco 8.6 • Palestine 3.2 • Oman 2.5 • Pakistan 0.5 • Qatar 11.4 • Saudi Arabia 12.3 • Sudan 10.1 • Tunisia 7.3 • Emirates 2.5 • Yemen 2.5

16. ِAt The MENA Region Prevalence of Diabetesis 9.2 % (age 20 -79) Prevalence of IGT …….is 8.1 % 24.5 millions with Diabetes & 22.4 with IGT out of the top 10 highest diabetes prevalence rate countries 6 are MENA countries Estimated death due to DM as % of all deaths is 11.5% ( 11.1% in Europe and 11.8 % in MENA )

17. Diabetes Mortality World wide =3.2 millions die from complications associated with diabetes In the ME :( with high prev. of diab.) one in 4 deaths in adults 35-64 years is related to diabetes

18. MENA

19. The pyramidal structure of the Egyptian population > 60 -60 -50 - 40 -30 -20 -10

23. Age Group 10 20 30 40 50 60

25. Saini Eastern desert Western desert Nubia

29. DIABETES IS PART OF THE WIDER HEALTH PROBLEM : THE METABOLIC SYNDROME20-25 % of the world adult population have the metabolic syndrome ( MTS) , and these are : - 5 times at risk to develop diabetes type 2 - 3 times likely to have a heart attack or stroke - twice likely to die

30. “Obesity” is always involved , or associated with all elements of the Metabolic Syndrome : But Which type of Obesity ?

32. “ Abdominal Obesity “ as measured by waist circumference is more indicative of the Metabolic Syndrome profile than increased BMI

34. The new international Diabetes Federation (IDF) definition According to the new IDF definition , for a person to be defined as having the metabolic syndrome he/she must have : Central Obesity ( defined as waist circumference * with ethnicity specific values ) plus any two of the following four factors :

35. Diabetes Mellitus and its state of control and complications in the MENA Region

36. 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 %

37. Hyperglycemia Fasting 120 mg/dl

38. Post Prandial Hyperglycemia - Controlled < 160 mg/dl = 13.5 % - Accepted161-180 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 %

39. Hyperglycemia 180 mg/dl

40. Diastolic Blood Pressure 80 mm Hg

41. Systolic Blood Pressure 0.50% 130 mm Hg

42. Lipid Control Serum Cholesterol 200 mg

43. Lipid ControlSerum Triglycerides 150 mg

44. Obesity as a Risk Factor for Hyperglycemia , Hypertension and Hyperlipidemia

45. Cardiac Complications

46. Retinopathy (in 1173 patients )- Free68.9 %- Back ground22.6 %- Proliferative9.5 %

48. Retinopathy in correlation with Duration of DM

49. l

50. Frequency of Foot Complications