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Current Diabetes Reviews

Author(s): Samir Assaad Khalil*, Magdy Helmy Megallaa, Kamel Hemida Rohoma, Myriam AbouSeif Guindy, Adel Zaki, Mohamed Hassanein, Amin Helmy Malaty, Hanaa Mohamed Ismael, Ibrahim Fahmy Kharboush, Dalal Nasr-Eldein El Kafash, Hassan Nooman Sallam and Iman Abdelkareem Desouky

DOI: 10.2174/1573399814666180125100917

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Prevalence of Chronic Diabetic Complications in Newly Diagnosed versus Known Type 2 Diabetic Subjects in a Sample of Alexandria Population, Egypt

Page: [74 - 83] Pages: 10

  • * (Excluding Mailing and Handling)

Abstract

Background: In Egypt, data on the prevalence of chronic diabetic complications, which are essential for the adjustment of policies and practices related to diabetes care, are scarce. Therefore, the aim of this study was to determine the frequency of chronic complications of diabetes; namely neuropathy, Diabetic Kidney Disease (DKD), retinopathy and Peripheral Arterial Disease (PAD) in newly-diagnosed versus known type 2 diabetic patients.

Subjects & Methods: This is a cross-sectional study that is based on a previous household survey conducted on a representative sample of the population of Alexandria, Egypt. This study included 506 consecutive subjects with type 2 diabetes; 323 patients with previously known T2DM and 183 patients with newly diagnosed T2DM (discovered during the survey). For each participant, a focused history was taken. Comprehensive clinical examination was done including fundus examination, foot examination and assessment of ankle brachial index. Laboratory tests included HbAlc, lipids profile, serum creatinine and Urinary Albumin Creatinine Ratio (UACR).

Results: Peripheral neuropathy was detected in 20% of the studied patients; 29.4% of known patients and 3.3% of newly diagnosed patients (p<0.001). Diabetic kidney disease was detected in 33.2% of the studied patients; 46.1% of known patients and 10.4% of newly diagnosed patients (p<0.001). Diabetic retinopathy was detected in 34.6% of the studied patients; 48.3% of known patients and 10.4% of newly diagnosed patients (p<0.001). Peripheral arterial disease was detected in 32.6% of the studied patients; 45.5% of known patients and 9.8% of newly diagnosed patients (p<0.001). In patients with known diabetes, the presence of any of the studied complications (neuropathy, diabetic kidney disease, retinopathy or PAD) was significantly associated with the presence of all other complications (p< 0.001). In patients with newly-diagnosed diabetes, the presence of diabetic kidney disease was significantly associated with the presence of retinopathy (p<0.001), with no significant association with PAD (p=0.357).

Conclusion: The present study confirms that a considerable proportion of people with T2DM have microvascular complications and/or PAD at the time of, and possibly years before, diagnosis. Having shown that, it is strongly recommended to apply appropriate screening strategies for subjects with diabetes at the time of diagnosis. Finally, these results should be considered as a call for action for the health care planners and providers in our region to plan for early screening for diabetes and its complications to reduce the disease burden in our community.

Keywords: Prevalence, diabetic complications, Alexandria, Egypt, chronic, hyperglycemia.

[1]
Standards of medical care in diabetes-2016: Summary of revisions. Diabetes Care 2016; 39(Suppl. 1): S4-5.
[2]
International Diabetes Federation IDF Atlas7th edition Last accessed on 2016 July 27 Available from: http://www.diabetesatlas.org
[3]
Zhang P, Zhang X, Brown J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87(3): 293-301.
[4]
Jönsson B. Revealing the cost of Type II diabetes in Europe. Diabetologia 2002; 45(6): S5-S12.
[5]
Orasanu G, Plutzky J. The pathologic continuum of diabetic vascular disease. J Am Coll Cardiol 2009; 53(5)(Suppl.): S35-42.
[6]
van Dieren S, Beulens JWJ, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil 2010; 17((supplement 1):): S3-8.
[7]
Lee ET, Keen H, Bennett PH, Fuller JH, Lu M. Follow up of the WHO multinational study of vascular disease in Diabetes: General description and morbidity. Diabetologia 2001; 44(Suppl. 2): S3-S13.
[8]
Turner RC, Holman RR. Lessons from UKPDS. Diabetes Res Clin Pract 1995; 28(Suppl. 7): S151-7.
[9]
Vishwanath K, McGavin DD. Diabetic retinopathy: clinical findings and management. Community Eye Health 2003; 16: 21-4.
[10]
Shaw JE, Sicree RA, Zimmet PZ. Global estimation of the prevalence of diabetes for 2030. Diabetes Res Clin Pract 2010; 87(1): 4-14.
[11]
Ahmedani MY, Hydrie MZ, Iqbal A, Gul A, Mirza WB, Basit A. Prevalence of microalbuminuria in type 2 diabetic patients in Karachi: Pakistan: a multicenter study. J Pak Med Assoc 2005; 55(9): 382-6.
[12]
Roper NA, Bilous RW, Kelly WF, Unwin NC, Connolly VM. Cause-specific mortality in a population with diabetes: south tees diabetes mortality study. Diabetes Care 2002; 25(1): 43-8.
[13]
Tracey M, McHugh S, Fitzgerald A, Buckley C, Canavan R, Kearney P. Trends in the incidence of visual impairment due to diabetic retinopathy in Ireland, 2004–2013. Eur J Public Health 2015; 25((supplement 3):): 156.
[14]
Buckley CM, O’Farrell A, Canavan RJ, et al. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the republic of Ireland. PLoS One 2012; 7(7): e41492.
[15]
Zoungas S, Woodward M, Li Q, et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia 2014; 57(12): 2465-74.
[16]
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008; 26(2): 77-82.
[17]
Ricci-Cabello I, Ruiz-Pérez I, De Labry-Lima AO, Márquez-Calderón S. Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. Health & Social Care in the Community 2010; 18(6): 572-87.
[18]
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577-89.
[19]
Charbonnel B, Dormandy J, Erdmann E, Massi-Benedetti M, Skene A. A. PROactive Study Group.The prospective pioglitazone clinical trial in macrovascular events (PROactive): Can pioglitazone reduce cardiovascular events in diabetes? Study design and baseline characteristics of 5238 patients. Diabetes Care 2004; 27: 1647-53.
[20]
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129-39.
[21]
Patel A, Chalmers J, Poulter N. ADVANCE: Action in diabetes and vascular disease. J Hum Hypertens 2005; 19(Suppl. 1): S27-32.
[22]
] Action to Control Cardiovascular Risk in Diabetes Study Group. Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes N Engl J Med 2008; 358: 2545-59.
[23]
Chawla A, Chawla R, Bhasin GK, Soota K. Profile of adolescent diabetics in North Indian population. J Clin Diabetol 2014; 1: 1-3.
[24]
Krentz AJ, Clough G, Byrne CD. Interactions between microvascular and macrovascular disease in diabetes: Pathophysiology and therapeutic implications. Diabetes Obes Metab 2007; 9: 781-91.
[25]
Al-Wakeel JS, Hammad D, Al Suwaida A, Mitwalli AH, Memon NA, Sulimani F. Microvascular and macrovascular complications in diabetic nephropathy patients referred to nephrology clinic. Saudi J Kidney Dis Transpl 2009; 20: 77-85.
[26]
Matheus AS, Gomes MB. Early aggressive macrovascular disease and type 1 diabetes mellitus without chronic complications: A case report. BMC Res Notes 2013; 6: 222.
[27]
American Diabetes Association. Classification and diagnosis of diabetes. Standards of Medical Care in Diabetes. Diabetes Care 2014; 37 (Suppl 1)..
[28]
Kamei N, Yamane K, Nakanishi S, et al. Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening. J Diabetes Complications 2005; 19: 47-53.
[29]
Armstrong DG, Lavery LA, Vela SA, et al. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med 1998; 158: 289-92.
[30]
Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment a report of the task force of the foot care interest group of the American diabetes association, with endorsement by the American association of clinical endocrinologists. Diabetes Care 2008 Aug 1;; 31(8): 1679-85.
[31]
Spencer K. Analytical reviews in clinical biochemistry: the estimation of creatinine. Ann Clin Biochem 1986; 23: 1-25.
[32]
American Diabetes Association. Classification and diagnosis of diabetesStandards of Medical Care in Diabetes Diabetes Care 2014; 37 (Suppl. 1).
[33]
Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). J Am Coll Cardiol 2006; 47(6): 1239-312.
[34]
Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Student ed. Belmont, Calif In: Wadsworth, Cengage Learning; . 2013.
[35]
Diabetes Atlas IDF. International Diabetes Federation, Brussels, 2015. Available from: http://www.diabetesatlas.org/resources/2015-atlas.html Last accessed:5 March 2016
[36]
Somaratne JB, Whalley GA, Bagg W, Doughty RN. Early detection and significance of structural cardiovascular abnormalities in patients with Type 2 Diabetes Mellitus. Expert Rev Cardiovasc Ther 2008; 6(1): 109-25.
[37]
Harris R, Leininger L. Preventive care in rural primary care practice. Cancer 1993; 72(3)(Suppl.): 1113-8.
[38]
Herman WH, Aubert RE, Engelgau MM, et al. Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications. Diabet Med 1998; 15(12): 1045-51.
[39]
Beulens JW, Grobbee DE, Nealb B. The global burden of diabetes and its complications: an emerging pandemic. European Journal of Cardiovascular Prevention & Rehabilitation 2010; 17(1)(Suppl.): s3-8.
[40]
Alwakeel JS, Sulimani R, Al-Asaad H, et al. Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution. Ann Saudi Med 2008; 28(4): 260-6.
[41]
Al-Till MI, Al-Bdour MD, Ajlouni KM. Preva- lence of blindness and visual impairment among Jordanian diabetics. Eur J Ophthalmol 2005; 15: 62-8.
[42]
Rotimi C, Daniel H, Zhou J, et al. Prevalence and determinants of diabetic retinopathy and cataracts in West African type 2 diabetics. Ethn Dis 2003; 13: S110-7.
[43]
Litwak L, Goh SY, Hussein Z, Malek R, Prusty V, Khamseh ME. Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A 1 chieve study. Diabetol Metab Syndr 2013; 5(1): 1.
[44]
Raman R, Gupta A, Krishna S, Kulothungan V, Sharma T. Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 27). J Diabetes Complications 2012; 26(2): 123-8.
[45]
Weerasuriya N, Siribaddana S, Dissanayake A, Subasinghe Z, Wariyapola D, Fernando DJ. Long-term complications in newly diagnosed Sri Lankan patients type 2 diabetes mellitus. QJM 1998; 91(6): 439-43.
[46]
Harzallah F, Ncibi N, Alberti H, et al. Clinical and metabolic characteristics of newly diagnosed diabetes patients: experience of a university hospital in Tunis. Diabetes Metab 2006; 32(6): 632-5.
[47]
Heydari I, Radi V, Razmjou S, Amiri A. Chronic complications of diabetes mellitus in newly diagnosed patients. Int J Diabetes Mellit 2010; 2(1): 61-3.
[48]
Alrawahi AH, Rizvi SGA, Al-Riami D. Al- Anqoodi, Z. Prevalence and risk factors of diabetic nephropathy in Omani type 2 diabetics in Al-Dakhiliyah region. Oman Med J 2012; 27(3): 212-6.
[49]
Yokoyama H, Sone H, Oishi M, Kawai K, Fukumoto Y, Kobayashi M. Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15). Nephrol Dial Transplant 2009; 24: 1212-9.
[50]
Ringborg A, Lindgren P, Martinell M, Yin DD, Schon S, Stalhammar J. Prevalence and incidence of Type 2 diabetes and its complications 1996-2003 – Estimates from a Swedish population-based study. Diabet Med 2008; 25: 1178-86.
[51]
Heydari I, Radi V, Razmjou S, Amiri A. Chronic complications of diabetes mellitus in newly diagnosed patients. Int J Diabetes Mellit 2010; 2(1): 61-3.
[52]
Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM. UK Prospective Diabetes Study Group.Risks of progression of retinopathy andvision loss related to tight blood pressure control in type 2 Diabetes Mellitus: UKPDS 69. Arch Ophthalmol 2004; 122(11): 1631-40.
[53]
Funatsu H, Yamashita H. Pathogenesis of diabetic retinopathy and the rennin angiotensin system. Ophthalmic Physiol Opt 2003; 23(6): 495-501.
[54]
El-Bab MF, Shawky N, Al-Sisi A, Akhtar Ml. Retinopathy and risk factors in diabetic patients from Al-Madinah Al-Munawarah in the Kingdom of Saudi Arabia. Clin Ophthalmol 2012; 6(1): 269-76.
[55]
Ashok S, Ramu M, Deepa R, Mohan V. Prevalence of neuropathy in type 2 diabetic patients attending a diabetes centre in South India. J Assoc Physicians India 2002; 50(4): 546-50.
[56]
Del Cañizo Gómez FJ, Pérez CF, Ruiz IM. de Gorospe Pérez-Jáuregui C, Rodríguez BS, Losada TG, Galindo ASMicrovascular complications and risk factors in patients with type 2 diabetes. Endocrinologíay nutrición 2011; 58(4): 163-8.
[57]
Stratton IM, Adler AI, Neil HA, et al. Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational studies. BMJ 2000; 12(321): 405-12.
[58]
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention;2005. Available at: http://www. cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf2016. . (Accessed on: June 2016).
[59]
Bansal D, Gudala K, Esam HP, Nayakallu R, Vyamusani RV, Bhansali A. Microvascular complications and their associated risk factors in newly diagnosed type 2 diabetes mellitus patients international journal of chronic diseases 2014; 30: 2014..
[60]
Manaviat MR, Afkhami M, Shoja MR. Retinopathy and microalbuminuria in type II diabetic patients. BMC Ophthalmol 2004; 4: 9.