Introduction: Egypt has the ninth highest diabetes mellitus (DM) prevalence in the world. There is a growing interest in community involvement in DM management. Aim of the study: The aim of the study was to evaluate the tailored diabetes care model (DCM) implementation in Alexandria governorate by community pharmacy-based intervention (CPBI) from a clinical, humanistic, and economic aspect. Methods: This is a 6-month period cross-over cluster randomized control trial conducted in Alexandria. Ten clusters owing 10 community pharmacies (CPs) recruited 100 health insurance-deprived T2DM patients with >7% HbA1c in 6-months. The study was divided into 2 phases (3 months for each period) with a 1-month washout period in between. After CPs training on DCM, the interventional group received pictorial training for 45 minutes in first visit, and 15 minutes in weekly visits, whereas the control group patients received the usual care (UC). At baseline and end of each phase (3 months), patients had clinical and physical activity assessments, filled all forms of study questionnaire (knowledge, self-management, satisfaction, and adherence) and did all laboratory investigations (Fasting Blood Glucose [FBG]), HbA1c, protein-creatinine clearance (PCR), creatine clearance (GFR), and lipid profile. Results: There was no significant difference in the basal systolic and diastolic blood pressure between patients in the CBPI and UC groups, but the CBPI had significantly decreased the mean SBP and DBP by ( P = .008, .040, respectively). Also, significant waist circumference and BMI reductions (−5.82 cm and −1.86 kg/m2, P = .001) were observed in the CBPI. The CBPI patients achieved a greater reduction in FBG and HbA1C than the UC patients (102 mg/dL and 1.9%, respectively P < .001). Also, significant reductions in total cholesterol, LDL, and triglyceride (−6.4, −15.4, and −6.3 mg/dL respectively, P = .001) were achieved in the CBPI group. No significant differences were found in HDL, GFR, and PCR. Moreover, significant improvements of behavior, score of knowledge, self-management, satisfaction, and adherence were observed in CBPI patients. After multivariate analysis, HbA1C readings were significantly influenced by baseline HbA1C and eating habits. The cost saving for CPBI was −1581 LE per 1% HbA1c reduction. Conclusion: This is the first study in Egypt that illustrated the positive impact of pictorial DCM delivered by CPBI collaborative care on clinical, humanistic, laboratory, and economic outcomes to local T2DM patients.
Background Obesity has emerged as a public health crisis in many populations including Egypt. Adipose tissue produces a number of adipokines, one of them is adiponectin which has attracted much attention because of its antidiabetic and antiatherogenic effects. Objective To determine the effect of a weight loss program on serum adiponectin level and insulin resistance among overweight and obese adult premenopausal females. Study design A pre-postintervention study was carried out among 95 premenopausal overweight and obese females (body mass index ≥ 25 kg/m2) aged 20 to 40 years at the integrated health clinic affiliated to the High Institute of Public Health, Alexandria, Egypt, from February 2016 to February 2017. All participants underwent a weight loss program based on a reduced calorie balanced diet and advised to increase their physical activity. Dietary instructions and follow-up were done weekly throughout 16 weeks. Blood samples were collected to investigate serum adiponectin level and insulin resistance at the beginning and the end of the intervention. Results After 16 weeks, a significant decrease in body weight by 9.7% was associated with a significant increase in serum adiponectin from 13.3 ± 4.9 μg/ml to 18.5 ± 5.6 μg/ml. Both fasting insulin and insulin resistance had decreased significantly by 13.6% and 13.7%, respectively. Conclusion A weight reduction program depending on a reduced calorie diet for 16 weeks was associated with a significant increase in total adiponectin level and reduction in insulin resistance. An emphasis on the importance of keeping normal weight through nutritional education and the promotion of healthy diets is recommended to reduce the risk of occurrence of insulin resistance, type 2 diabetes, and cardiovascular diseases.
Background: Overweight and obesity are a public health crisis among adolescents worldwide. Adolescence is a crucial period for learning and adopting healthy eating and lifestyle habits that persist into adulthood. Obesity in childhood is linked to early menarche which places the adolescent girl in high risk of developing metabolic diseases as Type 2 DM and cardiovascular diseases and hormone related cancer as breast and endometrial cancer. Objective(s): The aim of this study was to assess the prevalence of overweight and obesity in preparatory school girls in Alexandria and to examine their relation to dietary habits and age at menarche. Methods: A cross sectional study was conducted. A total of 730 preparatory school girls from 4 governmental schools were chosen using stratified random sampling. A selfadministered questionnaire was used to collect demographic data, dietary habits, physical activity status and menstrual history. Anthropometric measurements were taken (weight, height, waist circumference, BMI) and percentiles were compared to CDC growth charts. Results: In the present study, the prevalence of overweight in preparatory school girls was 14.7%, while that of obesity was 34.7% according to CDC charts. The prevalence of abdominal obesity was 24.7%. The prevalence of overweight/obesity was lower in girls whose mothers were working. Almost half (47.9 %) of girls who scored poor in the dietary habits questionnaire were obese, compared to 38% who had normal body weight. Dietary habits that were associated with obesity were eating meals away from home and consuming 2-3 loafs of "balady" bread daily. As for the age at menarche 51.9% of those who started menstruating before the age of 12 years were obese compared to 35.5% of girls who started menses after the age of 12 and this was statistically significant (p=0.004). Age at menarche was negatively correlated with BMI. Conclusion and recommendations: About one third of preparatory governmental school girls were obese. This was negatively associated with the age at menarche. Dietary habits that were significantly associated with overweight/obesity included eating away from home and increased consumption of bread. These habits should be the targets for school based nutrition education campaigns.
Excessive muscle mass loss is common following bariatric surgery due to decreased protein intake. Therefore, this study aimed to examine factors associated with muscle mass loss after three months in patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) and Mini-gastric bypass (MGB) in a bariatric surgery centre in Alexandria, Egypt. An observational study was performed on 50 patients, 25 of whom underwent LSG, whereas 25 underwent MGB. At baseline and after three months, physical activity level, energy and protein intake were assessed. Bioelectric impedance analysis assessed the body composition preoperatively and after three months. The current study's demonstrated that LSG and MGB three months postoperatively lost -17.3 ± 2.8 % and -18.5 ± 3.1 %, respectively, of their weight. Nevertheless, in MGB, patients lost more muscle mass (-17.2±12.4 %) compared to LSG (-11.5 ± 5.6 %) (p=0.063). In MGB, females lost -23.5 ± 11.6 % of their muscle mass compared to -7.9 ± 6.6 % in males (p<0.05). Muscle mass loss in < 60 g protein eaters was higher in MGB than LSG (M ± SD= 20.3 ± 12.5 % vs -13.0 ± 5.3 %, p=0.033). While muscle mass loss in ≥ 60 g protein eaters was -5.6± 1.5 % in LSG and 7.4± 5.9 % in MGB. In conclusion, females in MGB lost more muscle mass than males after three months. Protein intake ≥ 60 g/day during the first three months postoperative is associated with low muscle mass loss. High preoperative HbA1c correlates with muscle mass loss in MGB especially in females . High preoperative Hba1c and protein intake of < 60 g/d are associated with muscle mass loss in LSG.
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