Pattern of Diabetes Emergencies among adult Yemeni Diabetic Patients Dr. Zayed Atef Faculty of Medicine Sana’a University

Introduction: Diabetes is a serious public health problem that threatens the quality of life of patients. It can lead to acute and chronic complications. It is a significant causes of disability and death in many countries.

Acute and chronic complications of DM affect many organs and are responsible for the majority of morbidity and mortality associated with the disease. Diabetes is the sixth leading cause of death in U.S.A and the leading cause of blindness, non-traumatic limb amputation and ESRD

It is clearly that multifactor including hyperglycemia, duration of diabetes, age, sex, level of education, socio-economic and social habits that may impact the pattern of complications and diabetes progression.

So what are the types of diabetic complications and which is more frequent in Yemeni diabetics and what is the impact of Local environmental and social habit in the prognosis of diabetic complications that which we will try to answer through this study.

Objectives: To study the pattern of diabetic emergencies and its prevalence among Yemeni diabetics, to determine the relative importance and the impact of the level of education and so the local social habits in the complications of diabetes

The patients of study were adults diabetic cases who presented to the emergency departments of the main three governmental hospitals in Sana'a "Al-Thawra"," Al-Jomhory" and "Al-Kuwait" hospitals during the period from 1/7 to30/9/2005

All patients have been subjected to: -Through history taking,including: age, sex, type of DM, duration of illness, type of therapy, family history, special habits " mainly Kat chewing and smoking" and the education level.

-Clinical examination, including: Body weight, height and then body mass index and blood pressure. The data was collected through questionnaire which has been utilized.

Results: General characteristics of patients in the study: A total of 200 diabetic patients "116 males 84 females" (fig.1) were involved in our study of the total study population 12.5% were type 1 and 87.5% were type 2 DM (fig.2)

The patients age range from15-75 years with 15.5%patients aged from 15-40, 50% aged from years and 34.5% more than 60 years old. (fig.3)

Distribution of body mass index in the study population Table no(1) %Number Body Mass Index Under weight 4284Normal Over weight 2244Obese Total

Table No. (2) Distribution of Family history in the study population %Number Family history Yes No Total

Table No. (3) The distribution of educational level in the study population %NumberEducational level 53106Illiterate Read and write 816Basic school 612Secondary school 5.511University Total

Table No.(4) The presenting problems to the emergency department in the study population %NumberPresenting problem 1938IHD 1224CVA 1428Infections 8.517DKA 816HF Diabetic foot 510Uncontrolled diabetes mellitus 5.511NKHOH 48HTN 3.57D. Nephropathy 4.59Hypoglycemia 2.55PVD 24Others * Total

DICUSSION In our study we found that I.H.D was the most presenting problem to emergency departments "ER" accounting 19% of cases followed by infection complications 14%, stroke 12% and diabetic foot 11.5%.

In general while C.V.S account of 45.5% of all cases presenting to " ER", the percentage of infections and diabetic foot is considered high, putting in consideration that diabetic foot which were presented to ER were in terminal stages which need either hospitalization and proper intervention or even amputation.

However, the high prevalence of these types of complications "mainly infections and diabetic foot" may attributed to some local factors. First of all Kat chewing: Since 61.5%of study sample were Kat chewers, and the more worsen that 53% of patients believe wrongly that Kat is useful for diabetes.

One of the most important local risk factor is the low socio-economic state of our patients which lead to lack of regular follow up and proper management. In our study we found that 75.5 of study sample had no periodic doctor visit. It is clear that delayed diagnosis and poor treatment has socio-economic significance.

Conclusion: There was a significant relationship between the level of patient education and knowledge about disease, and the prevalence of diabetes complications and poor prognosis.

So the corner stone to change the situation is encouraging health education programs for the public and diabetes patients.

The very low percentage (24.5%) of regular doctors visit is due to the poverty of patients and the high cost of regular follow up so we recommend to establish many diabetes centers in our countries. We need a politic decision to establish a bank in the region for support diabetic patients to get medical insurance for all health services. The high proportional of family history shows the need for screening programs in our countries.

Kat chewing is rooted problem in Yemen needs a huge effort against it and we need many activities to correct the wrong concepts about its effects on diabetes.