The document discusses diabetes mellitus, a condition characterized by hyperglycemia due to insulin deficiency, and highlights the rising incidence of both type 1 and type 2 diabetes, particularly in Libya where obesity is a significant risk factor. It presents a study assessing demographic characteristics, knowledge, and attitudes about diabetes risk factors among 100 diabetic patients in Benghazi, revealing a high prevalence of obesity and a need for educational programs about diet and exercise. The findings emphasize the importance of lifestyle changes in managing diabetes and the relationship between obesity and the disease's complications.

1. Diabetesmellitus; characteristics, epidemiology
& risk factors
Family& communitymedicine department
Prepared by:
 Dr Mohanad ElZwi
 Dr Yousef Biuk

2. Diabetes Mellitus
Definition:
It is a clinical syndrome characterized by
hyperglycemia due to absolute or relative
deficiency of insulin; leading to
disturbance in metabolism of CHO,
proteins and fats, and causes significant
disturbance of water and electrolyte
homeostasis.

3. Types:
• Type 1 DM.
• Type 2 DM.
• Gestational DM.
• Other types.

4. Risk factors
1-Sedentery life style.
2-Obesity.
3-Unhealthy eating habit.
4-Family history of DM.
5-History of gestational DM..

5. 1- Sedentary life style:
Facts:
•Regular activities promote health
and psychological well being.
•Physical activity contributes to healthy body weight.
•A regimen of walking should be followed; starting by
10 minutes for 3 days a week and increased to at
least 30 minutes for five days a week.

6. 2- Obesity:
An excess body fat
accumulates to an extent
that it may have an adverse effect on
health, Leading to reduced life expectancy
and/or increased health problems.

7. Epidemiology
• Incidence of both type1 & type2 are rising.
• Before the 20th century, obesity was rare.
• In 1997 the WHO recognized obesity as a
global epidemic.
• It was estimated that in year 2000 that 171
million people had diabetes, this is expected
to be doubled by 2030.
• In 2005 WHO estimated that at least
400 million adults (9.8%) are obese, with
higher rates among women than men.

8.  In the UK,50% of the adult population are
overweight (BMI 25-29.9), 20% are obese
(BMI >30).
 There is a strong link between obesity
and type 2 DM.
 The co-morbidities associated Obesity are
most commonly shown in metabolic
syndrome (DM type 2, high BP, high bl.
cholesterol, high triglycerides levels).
 Complications are either directly caused by
obesity or indirectly related through
mechanisms sharing a common cause such
as unhealthy diet or sedentary life style.

9. 1. Body weight:
i. Body mass index
(Quetelet’s index)
a simple index of weight for height, commonly
used to identify underweight, overweight,
obese in adult.
Assessment of obesity

10. The most commonly used definitions of
BMI, established by WHO.
BMI Risk of co-
morbidities
Underweight <18.5 Low
Normal 18.5-24.99 Average
Overweight 25-29.99 Increased
Obese class I 30-34.99 Moderate
Obese class II 35-39.9 Severe
Obese class III 40 or more Very severe

11. ii. Broca index = Height (cm) – 100:
Easy & rapid method but not accurate.
C.Corpulence index = Actual wt./Desirable wt.
should not exceed 1.2.
iii. Ponderal index = Ht(cm)/Body wt(kg)³
iv. Lorentz’s formula =
Ht(cm)–100–[Ht(cm)–150/2(if female) 4(male)]
2. Skin fold thickness:
Using (Herpenden skin caliper), it is a rapid
& non invasive method to assess body fat.

12. 3. Waist circumference (WC) &
Waist:Hip ratio (WHR):
An index of intra-abdominal fat mass (central
obesity) & total body fat.
• Any increase in WC (men>02cm,
women>88cm) increases risk of
cardiovascular disease & metabolic
complications.
• Any increase in WHR (men>1.0,
women>0.85) indicates abdominal fat
accumulation.

13. Management of Obesity
 The main treatment of obesity consists of
dieting & physical exercise; diet programs
may produce weight loss over a short term
but keeping this weight off can be a
problem & often requires making exercise
& lower calorie diet permanent for a
person’s life style.
1) Dieting:
Diets to promote weight loss are generally
divided into four categories (low fat, low
carbohydrate, low calorie, very low
calorie).

14. 2) Exercise:
Muscles consume energy divided from both fat &
glycogen. Due to the large size of leg muscles,
walking, running & cycling are most effective ways.
3) Weight loss programs:
That promote lifestyle changes & diet modification,
this may involve eating smaller meals.
4) Medications:
Only two antiobesity medications are currently
approved by FDA for long term use.
A) Orlistat
B) Sibutramine
5) Surgery:
surgery is only recommended for severely obese
people (BMI <40).

15. Literature Review

16. Libya has the highest prevalence of
diabetes mellitus type 2 in North Africa
and in the Arab world
 A study by Dr. A Eltobgi in Tripoli in which
Early results showed that 73% of the
individuals are diabetic or at high risk to
have DM. About 70% of those individuals
are obese (BMI >30%), & about 95% are
obese and have family history of DM.
 So type 2 DM affects >70% in Libya which
is one of the highest prevalence in North
Africa and among Arab nations. The most
possible cause is eating habits.

17.  Another study carried out by Yousef A. Al-
Turki in Riyadh and results showed 19% of
patients were at ideal weight, while 35%
were overweight, 41% were moderately
obese and 5% were morbidly obese.
 So overweight and obesity are coexisting
risk factors amongst hypertensive and
diabetic adult patients, and are an important
focus for treatment and prevention of high
blood pressure and diabetes.
 Other studies conducted in Europe and
other countries around the world showed
the same strong relation between Obesity &
type2 DM.

18. Aim of the study
 To asses the demographic
characteristics, Knowledge, attitude
about risk factors (as obesity &
sedentary life style) and practice to
control DM.

19. Methodology
 Descriptive cross sectional study have been
done in (Sidy-Hussein) clinic which is the
first Diabetic clinic in Benghazi.
 The study involved (a convenient sample)
of 100 diabetic patients of different age
groups, 50 males & 50 females of Libyan &
Non-Libyan patients via questionnaire in
2010. The data was collected and then
analyzed by SPSS program.
 The study involved the measurement of
weight & height to find out the body mass
index.

20. Results

21. (Fig): Distribution of patients according to age
groups.
13%
55%
32%
18-38 years
39-59 years
>59 years

22. (Fig): Distribution of patients according to
gender.
0%
20%
40%
60%
80%
100%
50%
50%
Females
Males

23. (Fig): Distribution of patients according to
nationality.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Libyan Non-Libyan
85%
15%

24. (Fig): Distribution of patients according to
education.
0%
5%
10%
15%
20%
25%
30%
Illetaracy Primary Secondary University
29% 30%
23%
16%

25. (Fig): Distribution of patients according to duration of the
disease.
0%
10%
20%
30%
40%
50%
60%
<2 years 2-4 years 5-7 years >7 years
14% 14% 16%
56%

26. (Fig): Distribution of patients according to age at
diagnosis.
0%
10%
20%
30%
40%
50%
60%
2-22. 23-43 44-64 65-85
4%
53%
41%
2%
Age
Age

27. (Fig): Distribution of patients according to type of
DM.

28. (Fig): Distribution of patients according to type of
treatment.
41.20%
29.90%
28.90%
Insulin
OHG
Both

29. Yes No No
answer
Total
Risk factors No. % No. % No. % No. %
Family history 68 68 % 32 32 % 0 0 % 100 100 %
Excessive
sweet diet
43 43 % 56 56 % 1 1 % 100 100 %
Obesity 52 52 % 40 40 % 8 8 % 100 100 %
Sedentary life
style
54 54 % 46 46 % 0 0 % 100 100 %
Smoking 16 16 % 67 67 % 17 17 % 100 100 %
OCP 6 6 % 43 43 % 51 51 % 100 100 %
Hypertension 39 39 % 61 61 % 0 0 % 100 100 %
Stress 66 66 % 34 34 % 0 0 % 100 100 %
(Table): Distribution of patients according to their risk factors.

30. (Fig): Distribution of patients according to their
knowledge And attitude about the ideal method to
control DM.
0% 10% 20% 30% 40%
OHG, insulin, diet & ideal BW
OHG, insulin & diet control
Oral hypoglycemics & insulin
Traditional therapy
38%
19%
12%
5%

31. (Fig): Distribution of patients according to exercise
practicing.
0%
20%
40%
60%
80%
100%
36%
1%
63%
Yes
Miss
ed

32. (Fig): Distribution of patients if they have a diet control
plan.
67.70%
32.30%
Yes
No

33. (Fig): Distribution of patients according to knowledge & attitude that
sedentary life style is one of the most important risk factors of
type2DM.
82.50%
6.20%
11.30%
Yes
No
I don't know

34. (Fig): Distribution of diabetic patients according to co-morbidity with
DM.
1 1 1 2

35. YES % NO %
Patients know the maintenance of ideal
B.wt helps in D.M control
77 % 23 %
Patients know the exercise helps in control
of plasma glucose
87 % 13 %
Patients have an idea about complications
of obesity
70 % 30 %
(Table): Distribution of patients according to their knowledge about
important facts regarding DM & Obesity.
Mild Moderate Heavy Total
No. % No. % No. % No. %
28 28% 61 61% 11 11% 100 100%
(Table): Distribution of patients according to their physical activities.

36. BMI Male Female
N % N %
Healthy 11 22 % 3 6 %
Overweight 19 38 % 7 14 %
Obese 17 34 % 22 44 %
Very obese 3 6 % 18 36 %
Total cases 50 100 % 50 100 %
(Table): Distribution of patients according to their BMI.
Standard
deviation
MeanMaximumMinimumNo. of
patients
63.57172.2
4
414.0058.0070Fasting
plasma
glucose level
(Table): The study group’s last fasting plasma glucose levels.

37. Conclusion
 Majority of patients' age groups were between 39-59 years old.
 Most of patients were obese and overweight.
 The knowledge of patients about family history of DM as a risk
factor for D.M is 68 %, & regrading sedentary life style 54% and
regarding obesity 52%.
 77 % of patients know that the maintenance of ideal Body weight
helps in the control of D.M.
 Only 12 % of patients are measuring their wt. in every clinic visit.
 Most of patients have an idea about the complications of obesity.
 Most of patients have a plan for diet control.
 Most of patients do regular exercise.

38. Recommendations
 We recommend more educational programs
that should be directed to both diabetics as
well as non-diabetics.
 We encourage our patients to continue doing
exercise.
 We advise the patients’ families to share
them in their healthy diet.
 Psychological support is critically important in
the management of DM and obesity.

39. References:
 A Eltobgi. Libya has the highest prevalence of diabetes mellitus type 2 in North
Africa and in the Arab world. Endocrine Abstracts (2009) 19 P138.
 Yousef A. Al-Turki, ABFM. The prevalence of overweight and obesity amongst
hypertensive and diabetic adult patients in primary health care. Saudi Medical
Journal 2000; Vol. 21 (4): 340-343.
 Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, Mayer H, Kratzer W,
Debatin KM, Heinze E. Type II diabetes mellitus and impaired glucose regulation
in Caucasian children and adolescents with obesity living in Germany. Int J Obes
Relat Metab Disord. 2004 Feb;28(2):307-13.
 da Silva RC, Miranda WL, Chacra AR, Dib SA. Insulin resistance, beta-cell
function, and glucose tolerance in Brazilian adolescents with obesity or risk
factors for type 2 diabetes mellitus. J Diabetes Complications. 2007 Mar-
Apr;21(2):84-92.
 K.park, Obesity in: Park’s textbook of prevention & social medicine, 18th edition,
Jabalpur (India), Ms Banarsidas Bhanot, 2005; 316-18.
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40. Acknowledgment
 We thank our patients who gave us
the time to make our work satisfactory.
 Thanks to Sidy-Hussen clinic team.
 Thanks to Dr. Fayek who reviewed our
work.
 Thanks to family and community
medicine department team.

41. Thank you for attention