A WHO report says Egyptians suffer from a high rate of diabetes. However, as Reem Leila reports, the illness is not being given due attention Diabetes is an emerging public health problem in Egypt. Five per cent of the population is diabetic -- nearly four million people -- and the figure increases every year by almost five per cent. But despite the alarming figures, the scale of the problem is still widely underestimated. According to the WHO Eastern Mediterranean Region Office (EMRO), over 180 million people throughout the world have diabetes; the number is expected to double by 2030. While much work has been done in many countries to address diabetes, more needs to be done especially in the Middle East and in Egypt in particular. Diabetes mellitus, as is medically called, is a costly illness in terms of death rates and decrease in the quality of life for those who suffer from it. It poses a considerable financial burden on individuals, their families, the health sector and governments. The National Diabetes Institute of Egypt, in collaboration with the Ministry of Health and Population (MOHP) and WHO, is currently conducting a national survey on diabetes and other non-communicable diseases (NCDs). The most recent data goes back to 2005. "Correct and early diagnosis is essential," said Mary George of the National Diabetes Institute, adding that emphasis should be placed on using appropriate diagnostic criteria. "It is an integral component of clinical care and forms the basis for self-management. In Egypt, treatment should not only consider lowering the blood glucose but should also focus on correcting risk factors of NCDs such as smoking, obesity, physical inactivity and hypertension." George believes that diabetes should be taken seriously by everyone. She says there should be "an integrated component of clinical care that forms the basis for self-management. "The objectives of diabetes control cannot be achieved unless effective educational programmes are developed at all levels of care: primary, secondary and tertiary. It is noteworthy, however, that primary care provision may vary from a basic level to one of considerable sophistication. Essential to any programme of diabetes education are trained personnel with knowledge of diabetes and expertise in health education methods at the appropriate level of care provision." Abdel-Rahman Shahin, official spokesman at the Health Ministry, said the ministry subsidises insulin for diabetic patients to make it available at prices ranging from LE6 to LE6.30. The WHO report stated that NCDs are the primary cause of mortality and morbidity in countries of the eastern Mediterranean region. NCDs are emerging as a major health problem in Egypt, where 41 per cent of all deaths are caused by chronic disease. As life expectancy increases and the elderly population continues to grow, chronic diseases will place an ever greater burden on society. In Egypt, George says 12.7 per cent of diabetes patients die of related complications. Two-thirds of this percentage is divided among patients who suffer renal impairment and blindness while the remaining one-third includes patients who have heart complications. Shahin said that although there is increasing concern internationally about diabetes, Egypt's percentage of sufferers is average. The WHO report said that in the Middle East, treatment should also focus on "poor nutritional habits such as fast food," Shahin said. Healthcare systems should ensure that people with diabetes have access to basic diabetes management services and proper follow-up for complications. "Globally, the prevalence of diabetes continues to increase, owing to ageing and to demographic and socio- economic changes. The cost of caring for people with diabetes is two to four times the amount spent on non-diabetic people in most healthcare systems," according to the report. In Egypt particularly, Shahin said the main problem of diabetic patients is diabetes in the lower limbs. Patients tend to neglect their health and do not control the level of glucose in their blood thus leading to amputating toes. Sometimes a leg must be severed. The 2005 data regarding the prevalence of diabetes among children and adolescents shows that the occurrence of diabetes among children aged 10 to 18 was 0.7 per cent. The frequency was higher among females than males and equal in urban and rural areas. Children with fasting blood glucose levels between 100mg and 125mg were considered pre-diabetic; they represented 16.4 per cent of the total sample. Males were more likely than females to be pre-diabetic. The rate differed according to age group, with the older age group of 16 to 18 showing higher percentages for both sexes. Pre-diabetic males were equally prevalent in urban and rural areas while there were more pre-diabetic females in rural than urban areas. "The high occurrence of pre-diabetic adolescents is an alarming signal of an increase in the incidence of diabetes among Egyptians in the future," Shahin said.
