Care-related risk factors for chronic diabetic complications in developing countries: a case from Egypt.

This work was the second phase of a wider study aiming at defining a plan for the improvement of health care services for diabetic patients and to decrease the incidence of its complications. The aim of this phase of the study was to define preventable risk factors for chronic diabetic complications, 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. Multivariate logistic regression analysis revealed that diabetic patients over 49 y of age, and female gender were more 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.