Care-relatedriskfactorsforchronicdiabeticcomplications indevelopingcountries:acasefromEgypt M El-Shazly 1 * ,AZaki 1 and A Nicolucci 2 1 Medical Research Institute, Alexandria University, Egypt; and 2 Consorzio Mario Negri Sud, Italy Thisworkwasthesecondphaseofawiderstudyaimingatdefiningaplanfortheimprovementofhealthcareservicesfor diabetic patients and to decrease the incidence of its complications. Theaimofthisphaseofthestudywastodefinepreventableriskfactorsforchronicdiabeticcomplications,especially care-related factors. A total of 472 diabetic patients with chronic complications were compared with 528 control patients, free from complications, in a multicentric case–control study. Multivariatelogisticregressionanalysisrevealedthatdiabeticpatientsover49yofage,andfemalegenderweremore likely to develop chronic diabetic complications. Among clinical variables, type and duration of diabetes, glycemic control, and hypertension were significant predictors of diabetic complications. Regarding patient and system practices, non-health-insurance, need of help to reach health care facility, irregularity of follow-up visits and attending more than one clinic for follow-up, sources of health information other than physician and nurse, non-practicing leisure physical activities, and smoking were statistically significant risk factors. The study helped to identify preventable risk factors for serious complications of diabetes. It also identified groups of patients who needed priorities of screening programmes for potential development of complications since they were likely to develop such type of complications. Public Health (2002) 116, 289–296. doi:10.1038=sj.ph.1900855 Keywords: diabetes mellitus; chronic complications; health care; preventable risk factors Introduction Profound modifications in the socio-economic structure of thepopulationindevelopingcountriesareresponsiblefora rapid shift in the predominance of health problems from infant mortality and infectious diseases to mortality and morbidityduetochronicdiseases. 1 Diabetesmellitusisone of the most common chronic conditions and, due to the prevalenceofitsmajorcomplications,itcanseverelyaffect the duration and the quality of patient’s life. Chronic complications are the major cause of diabetic morbidity, high treatment cost, reduced productivity and short life expectancy. Progressive damage to eyes, kidneys, nerves, heart and arteries represents the major threat to the health and life of diabetic patient. 2 It should be recognized by patients,physiciansandgovernmentthattheexpectationof care usually will not be the elimination of disease, but rather maintenance of function of patient through prevent- ing the occurrence of complications. 3 Diabetic retinopathy is recognized as one of the most prevalentcomplicationsofbothtype1andtype2diabetes. 4 It is one of the leading causes of blindness in economically advanced countries. 5 Diabetic nephropathy is the leading causeofend-stagerenaldiseaseandthelargestcontributorto totalcostofdiabeticcare. 6 Diabeticneuropathyisthemost common symptomatic chronic complication and accounts for substantial morbidity in diabetic population. It shows a progressive course with limb amputation as the final end- point of the disease. 7 Foot complications of diabetes, man- ifested by ulcerations, infections, and neuropathy can too frequentlyleadtogangreneandlowerlimbamputation. 8 Many of these complications may be delayed or pre- vented, offering considerable opportunities for both re- duction in costs to the authorities and improvements in the quality of life of those affected. 9 Possibilities have appeared for limiting the progression of diabetic complica- tions and reducing their rate by improving the quality of care for diabetic patients through maintenance of nearly normal levels of blood glucose concentration. 3 Identifica- tion of the specific care-related risk factors in a defined *Correspondence: M El-Shazly, Department of Health and Vital Statistics, Ministry of Health, PO Box 5286, Safat 13053, Kuwait. E-mail: medhat_shazly@hotmail.com Accepted 25 April 2002 Public Health (2002) 116, 289–296 ß R.I.P.H. 2002 www.nature.com/ph