Prevalence and Risk Factors of Diabetes Mellitus in an Egyptian Village

Abstract

Diabetes mellitus is emerging as a clinical and public health problem in rural Egypt. OBJECTIVE: to determine the Magnitude of the problem of diabetes by its different types Insulin Dependent Diabetes Mellitus, Non Insulin Dependent Diabetes Mellitus, Impaired Glucose Tolerance and Gestational Diabetes Mellitus [IDDM, NIDDM, IGT &GDM] in an Egyptian village and the possible risk factors contributing to that problem. To determine complications and dyslipidemia of the uncontrolled patients and their KAP towards management the of the disease. SUBJECTS AND METHODS: . A cross sectional survey of all the target groups by past history of diabetes mellitus or treatment. The childhood and adolescents group [5-<20 years= 1768] were screened for the asymptomatic glucosuria and confirmed by measurement of fasting serum glucose and serum glucose two hours after a 75 g oral glucose load. The pregnants [N=172] were subjected to a glucose challenge test with a 50 g glucose load .The adults 220 years [N=2409] were screened by a random capillary glucose testing and those with =5.6 mmol/l were subjected to measurement of fasting serum glucose and serum glucose two hours after a 75 g oral glucose load. All diagnosed cases were subjected a questionnaire interview covering the possible risk factors according to the type of diabetes. A case control study was done where the diagnosed NIDDM [142] and IGT [55] cases and an age and sex matched non diabetic control group [205] were subjected to a questionnaire interview, estimation of body mass index, determination of Sedentary lifestyle and HCV antibody determination. A comparative study between the controlled [Hemoglobin A1c <7%] and uncontrolled [Hemoglobin A1c>7%] previously diagnosed NIDDM and IGT patients were subjected to KAP study about management of the disease,clinical examination with special reference to cardiovascular and neurological examination and examination of the ocular fundi and any other diabetic complication and Lipid profile study. RESULTS: The prevalence of of IDDM 1.1/1000. The possible risk factors were winter season , family history, past history of viral infection and consanguinity. The overall prevalence of GDM was 2.9% and the most frequent possible risk factors of GDM were; previous GDM, =3rd –- gravida, sedentary life, high socio-economic score, obesity, overweight and family history of diabetes. The prevalence of the previously diagnosed, newly diagnosed and overall prevalence of NIDDM were 4.3%, 1.6% and 5.9% respectively and that the prevalence of the previously diagnosed, newly diagnosed and overall prevalence of IGT patients was 0.5%, 1.8% and 2.3% respectively. The possible risk factors of NIDDM were obesity [OR=10.4], sedentary life [OR=10.3], virus C hepatitis [OR=6.4), Family history of NIDDM [OR=6.4], overweight [OR=5.2], high socio-economic score [OR=3.6] and consanguinity [OR=2.9] ; while the possible risk factors of IGT were sedentary life [OR=16.8], high socio-economic score [OR=6.4], overweight [OR=6.1], obesity [[OR=4.1], middle socio-economic score [OR=3.6], virus C hepatitis [OR=3.5], and Family history of NIDDM [OR=3.3].The paternal history of NIDDM and IGT were significantly more risky than the maternal history [OR=31 and 13.6 respectively]. About 73.1% and 58.3% of the previously diagnosed NIDDM and IGT cases were uncontrolled depending on the level of glycosylated haemoglobin and most of the complications were among the uncontrolled NIDDM cases with higher mean levels of serum total cholesterol, serum triglycerides, serum LDL-C, and serum uric acid compared to the controlled .There was a significant statistical difference between controlled and uncontrolled NIDDM and IGT cases as regards good knowledge about diabetes mellitus, positive attitudes towards the disease and most of the healthful practices as proper diet control, weight monitoring, adherence to the prescribed medicine, periodic blood pressure check up, and regular blood glucose check up . Further survey studies in similar rural areas are recommended and the issue of diabetes mellitus and its risk factors as obesity and virus C hepatitis should be addressed on the primary health care level.