Prevalence and Complications of Diabetes Mellitus in Northern Africa

A Systematic Review

Manouk Bos; Charles Agyemang

BMC Public Health. 2013;13(387)

Conclusions

This review suggests that diabetes and related complications are common problem in Northern Africa and suggest an urgent need for action to prevent diabetes and its related sequelae in this world region. The situation still requires more up-to-date research to help guide clinical and the preventive efforts.

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Authors' contributions
MB and CA conceived the idea, developed and refined the methodological approach. MB carried out the literature search, extracted the data and wrote the first draft of the manuscript. MB and CA contributed to the interpretation of the results. All authors read and approved the final manuscript.

Acknowledgements
The authors thank the editors and reviewers for their useful suggestions, which helped to improve the earlier version of this manuscript.

Table 1. Prevalence of type 2 diabetes in North Africa 1995–2012
	Author	Sample size (participation rate %) +Methods	Age range	site	Methods	Prevalence (%) (95%CI)			Prevalence undiagnosed diabetes (% of all diabetics)	Prevalence IGT (%)(95%CI)	Prevalence IFG (%)		% Obese (BMI ≥ 30) (95% CI)
	Author	Sample size (participation rate %) +Methods	Age range	site	Methods	Males	Females	Total	Prevalence undiagnosed diabetes (% of all diabetics)	Prevalence IGT (%)(95%CI)	Males	Females	Males	Females
Algeria	Malek 2001 [7]	1457 (90) Random sample	30–64	Urban and rural	OGTT (WHO 85)	8.6	7.8	8.2 (6.8–9.6) Urban: 9.7 Rural: 7.3	4 8	7.1 (5.8–8.4)		-	-	-
	Latifa 2007 [8]	805 (72) Random sample	≥20	Urban	FBG (WHO)	15.7	16.5	16.1	-	-	-		10.5	27.9
	Zaoui 2007 [9]	7656 Random sample	≥20		FBG (WHO 85)	15.8 Urban: 17.1 Rural: 14.1	7.5 Urban: 7.1 Rural: 7.8	10.5 Urban: 10.8 Rural: 10.1	-	-			43.2 Urban: 56.7 Rural: 27.2	37.1 Urban: 51.8 Rural: 20.0
Egypt	Herman 1995 [10]	4620 (41–85) Random sample	≥20	Urban and Rural	RPG+FBG (WHO 85)	Urban, higher SES: 12.9 Urban, lower SES: 7.0 Rural: 2.7	Urban, higher SES: 8.1 Urban, lower SES: 10.0 Rural: 2.1	Urban, higher SES: 20.0 Urban. lower SES: 13.5 Rural: 4.9	Urban, higher SES: 50 Urban, lower SES: 38 Rural: 51	Urban, higher SES: 8.6 Urban, lower SES: 5.4 Rural: 31.1			Urban, higher SES: 56 Urban, lower SES: 19 Rural: 6	Urban higher SES: 45 Urban, lower SES: 64 Rural: 25
Libya	Kadiki 2001 [11]	868 (86.6)	≥20	Urban and Rural	OGTT (WHO 98 ADA 97)	16.3 (14.5–18.3)	13 (10.0–16.1)	14.1 (10.9–17.1) Urban: 14.5 Rural: 13.5	38 Urban: 18 Rural: 49	8.5 (5.8–11.3) Urban: 5.8 Rural: 11.8			with diabetes: 19.5 with IGT: 11.8
Morocco	Tazi 2003 [12]	1662 (96.4) Random sample	≥20	Urban and Rural	FBG (ADA 97)	6.6 (4.7–8.6)	6.6 (5.1–8.1)	6.6 (5.4–7.8) Urban: 9.0 (7.1–10.8) Rural 4.4 (3.0–5.8)					7.2 (5.2–9.1)	19.1 (16.5–21.6)
Tunisia	Bougerra 2007 [13]	1735 (96.4) Random sample	≥19	Urban and Rural	FBG (WHO 80 ADA 97)	9.5 Urban: 12.3 Rural: 5.6	10.1 Urban: 12.5 Rural: 5.9	9.9	75	-	5.3 Urban: 5.5 Rural: 4.9	5.1 Urban: 4.8 Rural: 5.7	BMI ≥25: 5.4	BMI ≥25: 4.2
	Ghannem 1992 [14]	555 (76) Random sample	≥20	semi-Urban	OGTT (WHO 85)	6.3	6.6	6,5	39	-			12	26
	Ghari 2002 [15]	692 (69) Random sample	35–50	Urban and Rural	FBG (ADA 97)	6.1 Urban: 9.3 Rural: 2.0	8.9 Urban: 10.4 Rural: 4.5	7.2 Urban: 9.9 Rural: 3.4	31	-				37
	Elasmi 2002 [16]	2483 (99.6) Random sample	35–70	Urban and Rural	FBG (ADA 97)	16 Urban: 17 Rural: 11	Urban: 15 Rural: 15						19 Urban: 19 Rural:: 11	46 Urban: 47 Rural:: 37
	Elbagir 1996 [17]	1284 (not reported) Random sample	≥25	Urban and Rural	OGTT (WHO 85)	3.5	34	3.42 (2.4–4.4) Urban: 3.87 (2.6–5.2) Rural: 2.62 (1.2–4.1)	64 Urban: 63 Rural: 67	2.88 (2.0–3.8) Urban: 3.27 (2.1–4.5) Rural: 2.18 (0.8–3.5)
	Elbagir 1998 [18]	724 (not reported) sample	≥25	Urban and Rural	OGTT (WHO 85)	Urban: 15.8 (9.2–22.4) Rural: 2.8 (2.1–7.7)	Urban: 10.7 (6.4–15.0) Rural: 8.3 (3.5–13.1)	8.25 (6.3–10.3) Urban: 9.54 (6.9–12.2) Rural: 6.08 (3.2–9.0)	62 Urban: 36 Rural: 50	7.87 (5.8–9.8) Urban: 8.03 (5.5–10.5) Rural: 7.60 (4.4–10.8)			BMI≥27: 24	BMI≥25: 45

OGTT: Oral Glucose Tolerance Test FBG: Fasting Blood Glucose RPG: Random Plasma Glucose Test WHO 80/85/89: WHO Health Organozation 1985/98/99 diagnostic criteria ADA 97/04 America Diabetes Association 1997 diagnostic criteria IFG: Impaired Fasting Glucose IGT: Impaired Glucose Tolerance SES: Socioeconomic Status.

Table 2. Chronic complication of diabetes in North Africa 1995–2012
Complication	Author (year)	Location	Sample	Setting	Type of Diabetes	Prevalence % (95% CI)
Retinopathy	Macky 2011 [19]	Egypt	1325	hospital outpatient clinic	Mixed	20.5 (16.3–26.4)
	Herman 1998 [20]	Egypt	1451	outpatients clinic	Mixed	41.5 (35.8–47.2)
	Hamed 2008 [21]	Egypt	8O	hospital inpatient clinic	Mixed	20
	Kadiki 1999 [22]	Egypt	960	hospital outpatient clinic	Type 2	30.5
	Emahdi 1991 [23]	Sudan	413	hospital inpatient clinic	Type 2	17.4
	Elbagir 1995 [24]	Sudan	91	hospital outpatient clinic	Mixed	43
	Harzallah 2006 [26]	Tunisia	370	hospital inpatient and outpatient clinic	Mixed	8.1
	Ayed(1993) [27]	Tunisia	400	Hospital outpatient clinic	Mixed	37.5
Albuminuria	Herman 1998 [20]	Egypt	1451	outpatient clinic	Mixed	21.0 (15.4–26.5)
	Elbagir 1995 [24]	Sudan	128	Hospital outpatient clinic	Mixed	Proteinuria: 22
Nephropathy	Herman 1998 [20]	Egypt	1451	outpatient clinic	Mixed	6.7 (3.3–7.0)
	Hamed 2008 [21]	Egypt	80	Hospital inpatient clinics	Mixed	46.3
	Kadiki 1999 [22]	Libya	960	Hospital outpatient clinics	Type 2	25.2
	Elmahdi 1991 [23]	Sudan	413	hospital inpatient clinic	Type 2	9.2
	Harzallah 2006 [26]	Tunisia	370	hospital inpatient and outpatient CliniC	Mixed	13.1
Neuropathy	Herman 1998 [20]	Egypt	1451	outpatient clinic	Mixed	21.9 (17.7–26 0)
	Hamed 2008 [21]	Egypt	SO	hospital inpatient	Mixed	60
	Kadiki [22]	Libya	960	hospital outpatient	Type 2	45 7
	Elmadi 1991 [23]	Sudan	413	hospital inpatient	Type 2	31.5
	Elmagir.199S [24]	Sudan	128	hospital outpatient	Mixed	36.7
	Ahmed 1993 [25]	Sudan	120	hospital inpatient	Mixed	40.0
	Harzallah 2006 [26]	Tunisia	370	hospital inpatient and outpatient clinic	Mixed	24.3