Diabetes In Egypt Research Articles

Artificial Intelligence Approaches for Predicting Diabetes in Egypt

One major public health concern in Egypt is the increasing incidence of diabetes mellitus. It is essential to recognize problems early and treat them effectively [1]. This work applies several machine learning methods to predict diabetes risk using a dataset from Egyptian diabetes and endocrinology clinics. Features including age, BMI, medical history, and other health markers are included in the dataset. Using performance criteria such as confusion matrix, F1-score, recall, accuracy, and precision, we assessed various models including K-Neighbors, Gaussian Naive Bayes, Bernoulli Naive Bayes, Extra Trees, SVC, and Logistic Regression. The findings indicate that diabetes can be accurately predicted using machine learning. Logistic Regression, with a cross-validated accuracy of 0.965, test accuracy of 0.957, precision of 0.94, recall of 0.90, and an F1-score of 0.92, proved to be the most effective model for this dataset.

Atherosclerotic cardiovascular disease and its risk factors in type 2 diabetes in egypt: insights from PACT-MEA study and implications for interventions

Atherosclerotic cardiovascular disease and its risk factors in type 2 diabetes in egypt: insights from PACT-MEA study and implications for interventions

Comorbidity of depression and type 2 diabetes in Egypt results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study.

Diabetes mellitus and depression are serious common diseases, and the number of people with both conditions is rising steadily. Depression in people with diabetes mellitus results in poorer prognosis through different mechanisms. On the other hand, the presence of diabetes in individuals with depression increases functional impairment that is associated with depression. The study aimed to assess the prevalence and factors associated with depression among adults with type 2 diabetes mellitus attending a diabetes clinic in Cairo, Egypt. A cross-sectional study was conducted among adult patients with diabetes type 2 attending a diabetes clinic in the endocrinology department in Ain Shams University Teaching Hospital, Cairo, Egypt. Data were collected through face-to-face interviews by trained psychiatrists and from patients' records. The prevalence of depression among diabetic patients was 21.8% (95% CI [15.6%, 29.1%]). Depression was more common among younger age groups and those with a higher level of education. There was no significant difference between those with lifetime depression compared to those without depression regarding physical health complications. The prevalence of depression among patients with type 2 diabetes is high. Given the impact of co-morbid diabetes and depression, diabetic patients should be routinely screened for the latter condition.

Diabetes Mellitus across the Arabo-Islamic World: A Revolution.

Mankind continues to suffer from the ever-growing diabetes epidemic and the rapid rise of type 2 diabetes mellitus (T2DM). This metabolic disease has been studied since ancient civilizations. The Arabo-Islamic civilization excelled in establishing some of the most notable discoveries and teachings that remained the blueprint for years to come in the field of diabetology. This article aimed to review the ancient history of diabetes mellitus, with its main focus on the Arabo-Islamic civilization, and to report our subjective views and analysis of some of the past recommendations based on modern-day findings. Discussion. It is natural to have the teachings of medicine dynamically inspired by one civilization to another, as various fields continue to expand and evolve. This also applies to diabetology as the Arabo-Islamic world used the outlines of prior civilizations to revolutionize the understanding of the disease. Al-Razi and Ibn Sina are probably two of the most renowned polymaths in history, and their contributions to diabetology are well documented. Ibn Maymun's postulation about the higher prevalence of diabetes in Egypt as compared to Andalusia is something to be carefully studied. It could be that diabetes mellitus' underdiagnosis and late-stage detection are some of the major reasons for the disparity between the two mentioned regions. Modern-day Arabo-Islamic scholars continue to excel in revolutionizing diabetology. The Arabo-Islamic world houses an impressive bout of scholars who have contributed since the ancient times to diabetology. This scientific locomotion shows no signs of stopping, as it continues to shine during the present day, and likely in the future.

Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015

BackgroundThere is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic.MethodsThis study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference.ResultsDiabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06).ConclusionDiabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.

Effect of Fasting Ramadan on Different Laboratory Parameters on Type 2 Diabetic Mellitus Patients

Background Diabetes mellitus (DM) is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. It has been estimated that by the year 2030, there will be 8.6 million adult with diabetes in Egypt, making it the country with the tenth largest population of diabetic in the world. Diabetes is associated with reduced life expectancy, significant morbidity due to micro and macro vascular complications and diminished quality of life. Objective To study the impact of Ramadan fasting on metabolic parameters and anthropometry in type 2 DM in Egypt. Patients and Methods This study was conducted on 80 type 2 diabetic patients who were intending to fast Ramadan. During Ramadan (2014) the average fasting hours were 15 h. Patients were recruited from the internal medicine outpatient clinic at Ain Shams University hospitals and from the nutrition institute. 6 Patients were under insulin treatment (Biphasic human insulin) & 74 patients were under oral hypoglycemic treatment {52 on combination treatment sulfonylurea + metformin & 9 on metformin only &13 of them were on sulfonylurea only}. Results We found that there was a statistically significant increase as regard lipid profile (serum triglycerides, serum total cholesterol, LDL-cholesterol and HDL-cholesterol) in after Ramadan measurement. Also CVD risk parameters have untimely increased after Ramadan this parameters including (10 years risk (Framingham score) systolic and diastolic blood pressure). In addition (Creatinine, HOMA IR and fasting insulin) showed increased level in after Ramadan measurement which indicate deterioration of blood glucose parameters. There was no statistical significant changes seen as regard anthropometric measures (BMI, WHR) in pre Ramadan and after Ramadan measurement. Also there was no statistical significant changes regarding fasting, 2 hours plasma glucose, A1c levels between pre-Ramadan fasting & after-Ramadan. In addition CRP and ACR showed no significant changes as regard measurement between before and after Ramadan. Conclusion Ramadan fasting appears to have significant effect on lipid profiles that could adversely impact cardiovascular outcome. These effects are mostly due to quality and quantity of food intake during Ramadan and the negative impact of sedentary life style. In addition the number of fasting days and period of daily fasting could affect glycemic control and renal function tests. Bad dietary habits, lack of exercise and irregular drug intake during Ramadan has a negative impact on glycemic control.

Evaluation of the Current International Registry Update for Children and Adolescents with Diabetes Mellitus Following Up in Diabetes Clinic, Pediatric Hospital, Ain Shams University

Background Diabetes team should have the access for receiving continuous feedback for the health care service to help successful improvement. Health professionals need to continuously work to improve the quality of pediatric diabetes care to reduce the risk of acute and chronic complications. Objective: To evaluate the current international SWEET registry update for the children and adolescents following regularly at Pediatric and Adolescents Diabetes Unit (PADU) during a period of six months and updating the existing electronic medical record (Database) in (PADU) to provide measures to improve patients outcome regarding both acute and chronic complications. Patients and Methods The present study is a prospective follow up study performed on 385 patients with diabetes mellitus type1, with a mean age 11.79 ± 4.16 years. All patient with diabetes mellitus type1 visiting diabetes clinic (PADU) were included in the study after obtaining an informed consent. Results Patients with longer diabetes duration have significant higher insulin dose, more attacks of DKA and less attacks of hypoglycemia comparing to those with shorter duration. Patients with poor glycemic control have more attacks of DKA (62 patients vs 58 patients), (p-value=0.046), and less attacks of hypoglycemia (25 patients vs 65 patients), compared to properly controlled patients (p-value=0.000). Patients on insulin pump show significant improvement of them HbA1c (11% vs 7.3%) (p –value=0.000), cholesterol (173 mg/dl vs 139.8 mg/dl) (p- value= 0.006) and SMBG (2.7 times vs 4.6 times) (p-value= 0.000), compared to patients on multiple daily injections (MDIs). Conclusion Diabetes care is the cornerstone for proper glycemic control and prevention of long term complications. This study showed the value of a registry system to enable monitoring of patients over many years. The study could be an important step in the development of a national registry system for diabetes in Egypt.

Association of treatment satisfaction and physician trust with glycemic control among primary care patients with type 2 diabetes in Egypt.

To evaluate the association of diabetes treatment satisfaction and trust in family physicians with glycemic control among primary care patients with type 2 diabetes mellitus. A cross-sectional study on 319 patients with type 2 diabetes mellitus from five primary healthcare centers in Egypt. Data were collected from February to August 2021 using a structured questionnaire that contained six parts: sociodemographic data, disease profile, the Diabetes Treatment Satisfaction Questionnaire (DTSQ), 8-item Morisky Medication Adherence Scale (MMAS-8), self-reported medication knowledge questionnaire (MKQ), and revised healthcare relationship trust scale (HCR). Multiple linear regression analysis was used to assess predictors of treatment satisfaction, physician trust, and HbA1c level. P values less than 0.05 were considered significant. The mean age was 59.66 years (± 7.87 years) and 55.17% were females. Multiple linear regression analysis for predicting HbA1c showed that HbA1c level was lower in patients with higher treatment satisfaction scores (β = - 0.289, p < 0.001) and higher medication adherence scores (β = - 0.198, p = 0.001). Treatment satisfaction scores were positively predicted by higher physician trust scores (β = 0.301, p < 0.001), increased medication adherence scores (β = 0.160, p = 0.002), and longer duration of diabetes (β = 0.226, p < 0.001). Positive predictors for physician trust included HbA1c level (β = 0.141, p = 0.012), medication knowledge (β = 0.280, p < 0.001), diabetes treatment satisfaction (β = 0.366, p < 0.001) and medication adherence (β = 0.146, p = 0.011). Optimizing diabetes treatment satisfaction and physician trust could have favorable associations with medication adherence and medication knowledge with a possible improvement in glycemic control. Family physicians should incorporate patients reported outcomes alongside traditional clinical measures in evaluating diabetes management in primary care.

Comparative Study between Gestational and Chronic diabetic women: Incidence, Predictive Factors and Maternal and Fetal complications

Objective: The rate of Diabetes in Egypt has significantly increased, exceeding international rates. The International Diabetes Federation (IDF) listed Egypt among the world's top 10 countries in the number of patients with Diabetes. There are two primary subtypes of Diabetes in pregnancy. One of these is pregestational diabetes mellitus (PGDM), which occurs before a woman becomes pregnant. The second is hyperglycemia, which was first detected during pregnancy and should be classified as DM in pregnancy (DIP) or gestational DM according to WHO guidelines (GDM). DIP is a disease that may be diagnosed if typical DM criteria are reached during screening, while GDM is diagnosed when women satisfy at least one of the criteria during a 100g oral glucose tolerance test, according to current guidelines (OGTT). GDM is a condition that affects pregnant women who develop hyperglycemia but do not have a history of Diabetes. Method: This prospective study was conducted on ninety pregnant females with normal menstrual cycles before pregnancy. Patient’s demographics, urine and blood analysis, HbA1c and OGTT at 24 weeks gestation, as well as ultrasonic screening for early prediction of any congenital malformations were assayed. Results: There was a significant difference in terms of Oral glucose tolerance test at week 24 during fasting, Oral glucose tolerance test at week 24 after one hour, Oral glucose tolerance test at week 24 after two hours, Oral glucose tolerance test at week 24 after three hours using 100 gms glucose; p-value &lt;0.05. Conclusion: The results of this study concluded that mothers with PGDM had worse pregnancy outcomes than those with GDM.

Psychosocial aspects of continuous subcutaneous insulin infusion in children with type 1 diabetes in Egypt; a limited resources country perspective

BackgroundNovel innovations continue to emerge in type-1 diabetes (T1D) management aiming to improve glycemic control. Assessing the psychosocial outcomes of different treatment modalities is specifically crucial among children with T1D and differs from one population to another.ObjectivesTo compare the health related quality of life (HRQoL) and confidence in diabetes self-management (CIDS) among children with T1D on continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) and to correlate them with the efficacy of glycemic control, Mini-International Neuropsychiatric Interview for Children and Adolescents(MINI-KID) depression module and socioeconomic-standard scale.MethodsThis real life study (ClinicalTrials.gov number NCT04756011) included 60 children with T1D (30 on CSII and 30 on MDI), aged 6–18 years. Disease duration, insulin therapy, average self-monitoring of blood glucose (SMBG) and HbA1C were assessed. CIDS, socioeconomic-standard, MINI-KID depression and HRQoL scales were applied.ResultsChildren with T1D on CSII have significantly higher HRQoL and CIDS than those on MDI (P < 0.001). A significant negative correlation is found between HRQoL and insulin daily dose(P = 0.022), HbA1C(P < 0.001), average SMBG(P < 0.001) and MINI-KID depression scale(P < 0.001). A significant positive correlation is found between HRQoL and CIDS(P < 0.001) and health care, home sanitation, family possessions and occupation socioeconomic scores(P = 0.033, P = 0.001, P < 0.001 and P = 0.006, respectively). Multivariate regression analysis revealed that HRQoL is most associated with MINI-KID depression scale (P = 0.004) and annual total cost(P < 0.001).ConclusionChildren with T1D on CSII have significantly better HRQoL, CIDS and HbA1C with less depression than those on MDI.

IDF21-0112 Gestational diabetes in Upper Egypt: Prevalence, risk factors, and short term outcomes

Background: The prevalence of GDM has increased depending on the diagnostic criteria used. GDM is also an area where there are lot of debates regarding its screening, diagnosis, and management. Furthermore, there are wide gaps between guidelines and clinical practice provided to women with GDM particularly in low resources areas as Upper Egypt. Aim: Despite the high prevalence of diabetes in Egypt, our knowledge of gestational diabetes mellitus (GDM) epidemiology in Upper Egypt is still lacking. The study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate its maternal and fetal outcomes. Method: The current study was a prospective cohort study conducted between July 2014 and July 2018. Universal screening for GDM in all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group India (DIPSI) criteria (non-fasting 2hr blood glucose after loading with 75gm glucose >140mg/dl). Those with GDM were followed up until delivery and postpartum. Maternal and fetal outcomes were recorded. Results: GDM had been diagnosed in 956 women out of 7141 with a prevalence rate of 13.4% using DIPSI criteria. Previous history of either GDM or macrosomic babies and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factor was observed in about half of the GDM women. Regarding treatment, 29% of GDM women were only responded to medical nutrition therapy. 81.5% of GDM women were delivered by caesarean section (CS), and 17 % had preterm labour. On the other hand, 74.3% of their neonates had physiological jaundice, 52.1% were admitted to the neonatal intensive care unit (NICU), 20.9% were hypoglycaemic. Postpartum oral glucose tolerance test (OGTT) showed DM in 14.3% of our GDM women, while 25.7% of them had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of these cases are without risk factors. Thus, universal screening by OGTT is recommended. MNT alone was not adequate for treatment of all cases. Postpartum OGTT is mandatory for all GDM women to pick up new cases of diabetes and prediabetes.

An Overview of Diabetes Mellitus in Egypt as a Major Public Health Problem

Abstract: Introduction: The prevalence of diabetes mellitus is rising rapidly in Egypt with major health and socioeconomic consequences. The shortage of endocrinologists is another important issue in Egypt that must be taken into consideration. Objective: To review and discuss the epidemiology, risk factors, and different ways of diabetes care in Egypt. In addition, the aim is also to analyze the problem of the shortage of endocrinologists and how it can be solved. Methods: Searching and reviewing medical literature using PubMed, Google scholar, and some other gray literature from the World Health Organization (WHO), International Diabetes Federation (IDF), and Centers for Disease Control and Prevention (CDC). Results: Egypt is ranked ninth in the prevalence of diabetes worldwide according to IDF with a prevalence of 15.2% in the adult population in early 2020. The prevalence is expected to continue rising to more serious levels. This high prevalence is attributed to common risk factors in Egypt such as obesity, physical inactivity, chronic hepatitis C infection, pesticides, smoking, and bad eating habits. Moreover, we are in an increased demand for more endocrinologists in the Egyptian health care system. Conclusion: Understanding and avoiding the risk factors of diabetes is a crucial step towards reducing its prevalence and minimizing its healthcare and socioeconomic burdens in Egypt. Effective strategies should be applied for proper diabetes management and improving the quality of life in diabetic patients. Increasing the number of endocrinologists is also a key element for better diabetes care. Keywords: Diabetes in Egypt, Diabetes epidemiology, Hepatitis C virus, Obesity, Smoking, Pesticides.

Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG)

Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level ≥ 92 mg/dL, 15.5% had 1-hour OGTT ≥180 mg/dL and 16.7% had ≥153 mg/dL. It was found that the age ≥ 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity.

Prevalence and Risk Factors for Gestational Diabetes in Aswan, Egypt According to International Association of the Diabetes and Pregnancy Study Groups (IADPSG)

Background: The prevalence of diabetes in Egypt has significantly increased exceeding international rates. Egypt is now ranked ninth highest in the world in terms of the disease according to IDF, 2019. Objective: Estimation of the prevalence of gestational diabetes mellitus (GDM) in Aswan Governorate in Egypt and determination of the risk factors associated with GDM. Patients and methods: Our study was a prospective study, which carried out in the Antenatal Clinic in the Obstetrics and Gynecology Department, Aswan University Hospital from July 2016 to July 2017. The pregnant women were collected form Aswan Governorate as part of a Gestational Diabetes care in Upper Egypt project in collaboration with World Diabetes Foundation. Our study included 1000 pregnant woman. All participants were screened for GDM at 24-28 weeks of gestation. Universal screenings for GDM were performed for the participants using oral glucose tolerance test (OGTT) according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations 2017. Results: According to IADPSG criteria, 17.5% of the screened cases had GDM, 16.8% had fasting blood glucose level ≥ 92 mg/dL, 15.5% had 1-hour OGTT ≥180 mg/dL and 16.7% had ≥153 mg/dL. It was found that the age ≥ 25 years and multiparity were significantly higher in GDM than in Non-GDM. Pregnant women living in rural areas and working women were significantly protected against GDM than those from urban areas. Both family history of diabetes and previous history of GDM represented the major risk factor in our studied group (P < 0.001 & < 0.001 respectively). 40.4 % of studied group exhibited no definite risk factors. There were significant increases in systolic B.P, diastolic B.P in GDM group versus non-GDM (p < 0.001 & p < 0.001 respectively). BMI was significantly higher in GDM than non-GDM (p = 0.024). Conclusion: GDM was highly prevalent in Aswan Governorate with a rate of 17.5%. The major risk factors of GDM were family history of DM and previous history of GDM, increase in age >25 and multiparity and obesity.

Risk factors for foot ulceration among adult patients with diabetes on chronic hemodialysis in Dakahlia Governorate, Egypt

Background Although risk factors for diabetic foot ulceration have been extensively studied in patients with diabetes in Egypt, there is surprisingly limited evidence among those on chronic hemodialysis (CHD). The study aimed to scrutinize the risk factors for foot ulceration in adult patients with diabetes with end-stage renal disease on hemodialysis in Dakahlia Governorate central hemodialysis units. Patients and methods This cross-sectional study included all diabetic patients under CHD aged more than or equal to 18 years (n=98), recruited over 7 months from the largest seven central hemodialysis units in Dakahlia Governorate, Egypt. Data collection consisted of a participant interview, medical record review, and noninvasive comprehensive foot examination. The assessment included peripheral neuropathy, peripheral arterial disease, other foot pathologies, footwear, and foot health care behavior. Results The study included 57 males and 41 females. The median duration of diabetes was 15 (2–33) years. Overall, 61 (62.2%) patients were on insulin therapy. The median duration of hemodialysis was 3 years. Insensate neuropathy and peripheral arterial disease were detected in 65.3 and 15.3% of patients, respectively. The prevalence of foot deformities was 18.36%. Plantar calluses and dry skin were diagnosed in 27.6 and 62.2% of patients, respectively. A total of two (2.04%) patients had active foot ulcers and nine (9.18%) patients had ulcers in remission; therefore, the overall diabetic foot ulceration prevalence was 11.22%. In addition, 10 (10.2%) patients had previous minor amputations, with no reported major amputations. Overall, 95.92% had poor foot health care behaviors, and 81.63% were using inappropriate footwear. None of the included patients previously used custom-made insoles. Conclusions The key finding of this article suggests a high prevalence of risk factors for foot ulceration among diabetic patients receiving hemodialysis. Diabetic foot screening should be included in the management strategy of those on CHD.

Impact of a Clinical Pharmacist Intervention Program on the Follow-up of Type-2 Diabetic Patients.

The primary aim of this current study was to investigate the impact of the clinical pharmacist interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes in Egypt. A prospective trial was conducted on 100 patients with uncontrolled type 2 diabetes admitted in the diabetes outpatient's clinics. Patients were randomly allocated into the clinical pharmacist intervention group and usual care group. In the intervention group, the clinical pharmacist, in collaboration with the physician had their patients receive pharmaceutical care interventions. In contrast, the usual care group patients received routine care without clinical pharmacist's interference. After 6-month of follow-up, of the average HbA1c and FBG values of the patients in the clinical pharmacist intervention group (HbA1c % from 8.6 to 7.0; FBG (mg/dL) from 167.5 to 121.5) decreased significantly compared to the usual care group patients (HbA1c % from 8.1 to 7.8; FBG (mg/dL) from 157.3 to 155.9) (P < .05). Additionally, the results indicated that mean scores of patients 'diabetes knowledge, medication adherence, and diabetes self-care activities of the patients in the clinical pharmacist group increased significantly compared to the control group (P < .05). The study demonstrated an improvement in HbA1c, FBG, and lipid profile, in addition to self-reported medication adherence, diabetes knowledge, and diabetes self-care activities in patients with type 2 diabetes who received pharmaceutical care interventions. The study outcomes support the benefits and the need to integrate clinical pharmacist interventions in the multidisciplinary healthcare team in Egypt.

Risk factors for foot ulceration among adult patients with diabetes on chronic hemodialysis in Dakahlia governorate, egypt

Background Although risk factors for diabetic foot ulceration have been extensively studied in patients with diabetes in Egypt, there is surprisingly limited evidence among those on chronic hemodialysis (CHD). The study aimed to scrutinize the risk factors for foot ulceration in adult patients with diabetes with end-stage renal disease on hemodialysis in Dakahlia Governorate central hemodialysis units. Patients and methods This cross-sectional study included all diabetic patients under CHD aged more than or equal to 18 years (n=98), recruited over 7 months from the largest seven central hemodialysis units in Dakahlia Governorate, Egypt. Data collection consisted of a participant interview, medical record review, and noninvasive comprehensive foot examination. The assessment included peripheral neuropathy, peripheral arterial disease, other foot pathologies, footwear, and foot health care behavior. Results The study included 57 males and 41 females. The median duration of diabetes was 15 (2–33) years. Overall, 61 (62.2%) patients were on insulin therapy. The median duration of hemodialysis was 3 years. Insensate neuropathy and peripheral arterial disease were detected in 65.3 and 15.3% of patients, respectively. The prevalence of foot deformities was 18.36%. Plantar calluses and dry skin were diagnosed in 27.6 and 62.2% of patients, respectively. A total of two (2.04%) patients had active foot ulcers and nine (9.18%) patients had ulcers in remission; therefore, the overall diabetic foot ulceration prevalence was 11.22%. In addition, 10 (10.2%) patients had previous minor amputations, with no reported major amputations. Overall, 95.92% had poor foot health care behaviors, and 81.63% were using inappropriate footwear. None of the included patients previously used custom-made insoles. Conclusions The key finding of this article suggests a high prevalence of risk factors for foot ulceration among diabetic patients receiving hemodialysis. Diabetic foot screening should be included in the management strategy of those on CHD.

The Management of Care of Egyptian Patients with Diabetes: A Report from the International Diabetes Management Practices Study Wave 7

Abstract Background: Diabetes Mellitus (DM) is a major and growing public health problem throughout the world. In developing countries, there is a scarcity in the published data regarding the quality of care of DM, including non-adherence of the patients, poor glycemic control, and the long-term consequences of DM. Aim of Study: The International Diabetes Management Practices Study (IDMPS) was developed to provide standard-ized data about the management of care of patients with diabetes in developing countries. In this report, we presented the results of the seventh wave of IDMPS about the manage-ment of care of DM in Egypt. Patients and Methods: IDMPS is an international, multi-center, observational, cross-sectional study to assess current practices in the management of care of people with DM. The primary outcome in the present study was the proportion of patients achieving glycemic targets (HbA1c) as per recom-mendations of International guidelines (HbA1c <7%) and as targeted by the treating physician. While the secondary out-comes included the proportion of patients achieving the triple target (defined as the combination of HbA1c <7%, Systolic/ Diastolic Blood Pressure [SBP/DBP] <130/80, and Low-Density Lipoprotein (LDL-CS) <100mg/dL), the proportion of patients with micro and macrovascular complications, the compliance to diet and lifestyle modification, the adherence to insulin therapy of T2DM treated by insulin, and the fre-quency and the severity of episodes of hypoglycemia in the past 3 months. Results: In Egypt, a total of 449 patients met the eligibility criteria for analysis. Of them, 149 (33.3%) were Type 1 DM (TIDM) patients and 300 (66.7%) were Type 2 DM (T2DM) patients. In patients with T2DM, 219 (73%) patients were on oral antidiabetic agents, 26 (8.7%) patients were on insulin therapy, and 55 (18.3%) patients received insulin plus hy-poglycaemic agents. The majority of T2DM, who were on insulin, received premix insulin alone. Sixty-three (42.3%) T 1DM patients were on basal + prandial insulin, 56 (37.6%) patients were on premix alone, 14 (9.4%) patients were on premix + prandial insulin, eight (5.4%) patients were on premix + basal insulin, six (4.0%) patients were on basal insulin alone, and two (1.3%) patients were on premix insulin alone. A total of 12 (15.4%) T 1DM patients were on premixed analogue insulin. A total of 12.2% and 17.8% of the T1DM and T2DM patients achieved the glycaemic target HbA1c <7% as per recommendations of international guidelines; while, 8.8% of T 1 DM patients and 13.6% of T2DM patients had an HbA1c below the targeted value per physicians' recommendation. The triple target was reached by only 1.4% of T1DM and 2.4% of T2DM patients. Only 214 (48.3%) patients had glucose meter; of them, 194 (90.7%) patients performed self-monitored blood glucose, mainly occasionally. In our cohort, a total of 49.7% of the patients reported one or more diabetes-related complications. In T2DM group, 51.7% of the patients had microvascular complications, mainly microalbuminuria and retinopathy. On the other hand, 17% of T2DM reported macrovascular complications, most commonly angina and myocardial infarction. Among T1DM patients, 42.9% experi-enced symptomatic episodes of hypoglycaemia in the past three months and 10.1% experienced severe episodes of hypoglycaemia in the past 12 months. Conclusion: In conclusion, the control of diabetes in Egypt is still poor with the vast majority of the patients do not achieve the targeted metabolic control as recommended by the international guidelines.

New Insights on Obesity and Diabetes from Gut Microbiome Alterations in Egyptian Adults

Obesity and diabetes are reaching epidemic levels globally. Metagenomics and microbiome science have recently emerged as new tools for studying common complex human diseases. We report in this study notable differences in gut microbiome in adult patients with obesity and diabetes in Egypt. The experimental design was based on comparisons of four study groups: (1) Controls (C) with a normal body mass index, without obesity or diabetes, (2) Obese adults (O) without diabetes, (3) adults with diabetes (D) who are not obese, and (4) Adults who are both obese and diabetic (OD). In a total study sample of 60 participants, we sequenced the 16S ribosomal RNA (rRNA) gene using the Illumina MiSeq platform. Alpha diversity analysis revealed greater diversity in bacterial communities of (D) than controls. Phylum-level analysis identified a trend for overrepresentation of Bacteroidetes (p < 0.07) in (O) and (D) than controls. The ratio of Firmicutes/Bacteroidetes (F/B) displayed a remarkable increase in (OD) than controls. At genus level, Faecalibacterium (p < 0.05) and Akkermansia (p < 0.001) distinguished (O) from controls, while Fusobacterium (p < 0.001) and Bacteroides (p < 0.001) was significantly more abundant in (OD) compared with D. Surprisingly, isoquinoline, quinone and ubiquinone alkaloid biosynthesis were overrepresented in controls compared with other three study groups. Presumably, the latter observation might potentially suggest an antihyperglycemic activity of the gut microbiota. In conclusion, the health state of the adults in our study defined the composition of the gut microbiota. Moreover, obesity and diabetes were associated with remarkably enriched populations of Firmicutes and Bacteroidetes. The abundance of Fusobacterium is worth further research and exploration as a candidate biomarker for prediabetes especially in obese individuals. The potential antihyperglycemic activity of the gut microbiota is also noteworthy for future studies in other world populations.

Relation between early stages of diabetic retinopathy and early stages of diabetic kidney disease in patients with type 2 diabetes in Egypt

Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research. Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied. Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR. Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM.