The Management of Care of Egyptian Patients with Diabetes: A Report from the International Diabetes Management Practices Study Wave 7
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The Management of Care of Egyptian Patients with Diabetes: A Report from the International Diabetes Management Practices Study Wave 7, SALAH SHELBAYA, MOHAMED HALAWA and MERHAN NASR
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.