Diabetes mellitus (DM) is one of the ten most common causes of death worldwide. The increasing incidence and prevalence of diabetes mellitus creates a huge health and economic concern, and the increase in incidence has reached epidemic proportions.
History
Egypt is an intercontinental country straddling the Mediterranean, North Africa, and the Middle East. Egypt is one of the oldest and greatest countries in history. Thousands of years ago, the ancient Egyptians had extensive knowledge of the human body and medicine.
DM was described by the ancient Egyptian physician Hesy-Ra. He was the first person to do so in 1552 BC. He recorded his description of the symptoms of diabetes mellitus on Egyptian papyrus.
Diabetes in Egypt: Statistics
Egypt is 1 of 21 countries and territories in the International Diabetes Federation’s Middle East and North Africa region. The disease affects 537 million people worldwide, including 73 million in the Middle East and North Africa. By 2045, this number will reach 135.7 million.
Here is information provided by the International Diabetes Federation (IDF):
Diabetes in 2021, Egypt | |
Total adult population | 59,379,900 |
Prevalence of diabetes in adults | 18.4% |
Total cases of diabetes in adults | 10,930,700 |
Data on the epidemiology of diabetes in Egypt are sparse. However, according to the Israel Defense Forces, Egypt has the ninth-highest diabetes prevalence in the world. The IDF estimates that the number of people with diabetes in the Middle East and North Africa will double to 108 million by 2045. In fact, 40 to 50 percent of people with diabetes or prediabetes remain undiagnosed, although these numbers may seem quite high. In Egypt, diabetes is the leading cause of chronic renal failure, blindness, lower limb amputation, stroke, and acute coronary syndrome.
Causes of Diabetes in Egypt
Here are the most common causes of diabetes in Egypt.
Obesity
Obesity is the most common cause of diabetes. Egypt has one of the highest obesity rates in the world, especially among women. The country has the third highest obesity rate in the Middle East and North Africa region, after Saudi Arabia and the United Arab Emirates. According to the 2008 Egyptian Demographic and Health Census, approximately 50% of Egyptian men and 65-80% of Egyptian women are overweight or obese.
In Egypt, obesity is the leading cause of cardiovascular disease, diabetes, and osteoarthritis. The most common risk factors for obesity include genetics, which cannot be changed, and poor eating habits and lack of physical activity, which can be changed.
Physical Inactivity/Sedentary Lifestyle
Among 4,918 households surveyed in Cairo in 1995, 81% reported being physically inactive. The main reasons for these findings are the lack of awareness and education about the need for exercise, as well as limited opportunities for exercise that are not accessible to everyone, especially in rural areas. Due to overpopulation and traffic congestion, Egyptians avoid walking or running in public places, which may be their only option due to limited and expensive access to gyms or sports clubs.
Hepatitis C Infection
Egypt has the highest prevalence of chronic hepatitis C infection in the world. According to the Egyptian Demographic and Health Survey, approximately 15% of Egyptians are serologically positive for hepatitis C virus (HCV) antibodies, and 10% are actively infected. Type 2 diabetes is common in patients with chronic hepatitis C infection.
Pesticides
Diabetes is a multifactorial disease with both genetic and environmental factors. The current status of risk factors from environmental chemicals cannot be ignored. One potential risk factor for developing type 2 diabetes is exposure to agricultural pesticides. Egypt is the fifth largest pesticide user in Africa, so the link between pesticides and diabetes in Egypt must be considered.
Pesticide exposure occurs in two ways: the direct route usually affects farmers, but the indirect route affects most Egyptians because they are exposed to small amounts of pesticides in contaminated food.
Smoking
Smoking is a risk factor for type 2 diabetes. According to the 2014 Surgeon General’s report, smokers have a significantly higher risk of developing type 2 diabetes than non-smokers, and this risk increases with the number of cigarettes smoked per day. In addition, smoking reduces the response to antidiabetic drugs and increases the likelihood of diabetic complications such as end-stage renal failure, leg ulcers, amputations, peripheral neuropathy, retinopathy, blindness, coronary artery disease, and stroke.
Despite the high cost of cigarettes, the proven harms of smoking, and improved health education, smoking remains a serious public health problem in Egypt.
Poor Dietary Habits
Egyptians tend to follow a Mediterranean diet consisting mainly of vegetables, legumes, fruits, and fish, with a moderate amount of animal protein. On the other hand, Egyptians consume large amounts of white bread and refined rice, which are high in carbohydrates and with increased glycemic index.
In addition, Egypt is one of the world’s largest consumers of trans fats. Trans fats promote dyslipidemia by increasing low-density cholesterol (LDL) and reducing high-density cholesterol (HDL), increasing the risk of type 2 diabetes. Trans fats are found in many products consumed in large quantities by Egyptians, including margarine, cakes, cookies, and fried foods.
In addition, junk food is a widespread and extremely harmful phenomenon in cities. Junk food is high in calories, salt, and fat, but has little nutritional value, and can lead to central obesity and type 2 diabetes. However, in rural areas with high poverty rates, the diet mainly consists of products high in carbohydrates and fats and low in animal protein.
If the above poor dietary habits are maintained for a long time, it will undoubtedly lead to type 2 diabetes in susceptible people.
Low Health Awareness
Many diabetic patients, especially those who are uneducated and live in rural poor areas, are not aware of the dangers and consequences of obesity and diabetes. They are not aware of the importance of continuous blood glucose monitoring and eye and foot examinations for prevention and early detection of complications. There are no screening or health checks in Egypt.
Dietary restrictions, weight loss, and exercise are the first measures for diabetes treatment before starting drug treatment. Nonetheless, most patients do not want to change their habits and lifestyle. Even having a prescription, they do not follow the doctor’s recommendations.
Possible Solutions
Possible Solutions to deal with Egypt’s DM problem are as follows:
1. Screening and follow-up programs for diabetic patients should be established in national and university hospitals through public health insurance and provide low-cost blood glucose meters.
2. Proper health education should be carried out through schools, universities, and media to educate the public about healthy lifestyles, obesity control, diabetes prevention, and proper nutrition.
3. Doctors should talk to patients, encourage them to share their concerns openly, include them in the treatment plan, develop a comfortable diabetes treatment plan that suits each patient, and help them stick to it.
4. This metabolic epidemic should be fought with the help of qualified diabetes educators and nutritionists, preventive cardiologists, and trained general practitioners.
5. Hepatitis C infection must be identified and treated early.
6. The use of pesticides in agriculture must be regulated, farmers and other people, directly exposed to pesticides must be equipped with protective equipment, pesticide residues in food and water must be monitored, and safety education must also be conducted. And their dangers need to be avoided.
7. The number of students in endocrinology should be increased.
8. The Ministry of Health and relevant departments should provide high-quality professional training in preventive cardiology and set up preventive cardiology clinics in hospitals.
Today diabetes has reached an alarming level. Obesity, lack of exercise, hepatitis C infection, pesticides, smoking, and poor eating habits are the main reasons for the rapid increase in the prevalence of diabetes in Egypt, which requires effective diabetes management strategies and cooperation between individuals, doctors, and the government.