The Onset of NIDDM and its Relationship to Clinical Diagnosis in Egyptian Adults

Abstract

The onset of diabetes relative to clinical diagnosis was estimated in Egyptians with noninsulindependent diabetes mellitus (NIDDM) based on the relationship between retinopathy and duration of diabetes. Between July 1992 and October 1993 the Diabetes in Egypt (DIE) Project performed a cross-sectional, population-based survey with clinical and laboratory follow-up to describe the prevalence of microvascular, neuropathic, and macrovascular complications among Egyptians a 20 years of age with diagnosed diabetes, previously undiagnosed diabetes, impaired glucose tolerance, and normal glucose tolerance. The sample of persons with diabetes diagnosed prior to the survey had medical examinations which included a dilated eye examination and retinal photographs. Generalized linear models were used to relate the probability of retinopathy to duration of diabetes. Among 218 persons with diabetes diagnosed prior to the DIE project, 87 (40 %) had diabetic retinopathy. The onset of retinopathy was estimated to occur 2.6 years (p = 0.04) prior to clinical diagnosis. The estimated annual incidence of retinopathy was 5 % and the estimated prevalence at the time of clinical diagnosis of diabetes was 12 %. On the basis of reports that retinopathy does not occur until approximately 5 years after the development of diabetes, the onset of NlDDM was estimated to occur 7.6 years prior to its clinical diagnosis. This estimate of the onset of NIDDM in Egyptians is comparable to other estimates reported for US and Australian populations. KEY WORDS Non-insulindependent diabetes mellitus Diagnosis Retinopathy Epidemiology Egypt Patients and Methods The method of identification and description of the study Population has been reported elsewhere.' Between July 1992 and October 1993, the Diabetes in Egypt (DIE)

Screening for type 2 diabetes: literature review and economic modelling

“…Thompson and colleagues 57 used data from Egypt, and a similar backwards extrapolation method to that of Harris and colleagues, but estimated that the onset of retinopathy was only 2.6 years before clinical diagnosis. The 95% CI was wide at 0.3 to 8.4 years; they had data on 218 patients.…”

Random Plasma Glucose in Serendipitous Screening for Glucose Intolerance: Screening for Impaired Glucose Tolerance Study 2

“…42 In the USA, it has been estimated that diabetes goes on for 10 years before clinical recognition, 43 and longer delay leads to higher glucose levels at the time of diagnosis. 44 Delay likely explains why many patients have diabetes complications at the time of diagnosis, 7,45,46 with increased cardiovascular risk, 47 and exhibit an increase in cardiovascular events, health care system resource use, and costs before diagnosis. [48][49][50] Consistent with such observations, earlier diagnosis appears to lead to improved outcomes.…”

“…5 Diabetes in its earliest stages is asymptomatic, and clinical recognition is estimated to occur 8-12 years after onset of dysglycemia. 6,7 As a consequence of the delay in diagnosis, individuals with newly diagnosed diabetes often exhibit early evidence of complications. 8,9 Moreover, although effective treatment of diabetes can reduce the development of complications 10,11 , factors such as loss of beta cell mass 12 can make it difficult to normalize glucose levels 13,14 , and many patients do not meet national standards for control.…”

Screening for type 2 diabetes: literature review and economic modelling

“…This period reflects the estimated preclinical phase of diabetes. 54,179 In the base-case analysis, the DPP interventions were assumed to continue for only 3 years (the trial period). Thereafter, patients were simulated to progress from IGT to diabetes at the baseline rate and accrue no intervention costs.…”