الفهرس 
INTRODUCTION
Aims of the workOnly 14 pages are availabe for public view
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Abstract
This study aimed to evaluate the prevalence of diabetes among patients attending Assiut police hospital and the efficacy of medical treatment provided to them. Also the effect of co morbidities associated with diabetes. Although the selected sample was of high socioeconomic status yet the stressful life they exposed to it made it difficult to control the disease and limit the follow up.
This study included 100 diabetic patients who were attending the out patients clinic of Internal Medicine Departments of Assiut police hospital during the study period from march 2013 to September 2014. The patient group classified as 72 males (72%) and 28 females (28%) and their ages range from 15-70 years with mean age ± SD (53.34 ± 9.78).
Inclusion Criteria:
• Patients attending Assiut Police hospital with diabetes mellitus type 1 or type 2.
• police officers and their first degree relatives.
• Age group from 15 to70 years.
Exclusion Criteria:
• police officers’ assistants and their relatives.
• patients aged more than 70 or under 15 years.
All patients of the study were subjected to:
• Full history taking: Stressing on
Diabetic history( onset of diabetes, type, duration and types of treatment)
other co morbidity ( Hypertension, cardiac, hepatic obesity, dyslipidemia).
• Clinical examination: Stressing on
• Blood pressure.
• Fundus examination.
• Foot examinations.
• BMI
• ECG
• Laboratory investigations:
• Random blood sugar.
• Complete blood count.
• HbA1c every 3-6 months.
• Lipogram.
• Liver function test.
• Kidney function test.
• Microalbuminuria.
The results of this study showed that:
Out of 1025 patients with chronic diseases attending the hospital about 20% of them were diabetic and most of them were type 2 (93%).
66 % of diabetic patients were hypertensive while 67% were obese in addition to waist circumferences were high (> 102 in males and > 88 in females) in male patients were 81.9% and in female patients were 89.3%.
Diabetic peripheral neuropathy were prevalent in about 32% of the studied diabetic patients.
Despite the presence of full investigation of those type of patients regarding type of medication follow up study with all available laboratory yet there were 55% of the studied patients out of control of diabetes with HgA1c >7%.
Dyslipidemia one of the common co morbidities and complication of diabetes which 26% of the studied patients by medical history while by laboratory investigations it was found that ↑ TC in 42%, ↑ TG in 26%, ↑ LDL in 51% and ↓ HDL in 10% .
Chronic kidney disease with serum creatinine > 1.3 mg/dl was present in 34% of diabetic patients . Out of the remaining 66% normal serum createnine patients a positive microalbuminuria in 22.7% (15 patients).
Regarding diabetic control 45% were found controlled with Hb A1c < 7% and 55% were found uncontrolled with Hb A1c > 7% may be due to miss management, lack of awareness, refuse of follow up, resistance to drugs or the disease itself was complicated as associated with other co morbidities especially hypertension and dyslipidemia.
Regarding medication:
Oral antidiabetic drugs were the major therapy of the studied patients where sulphonylurea (63.4%) was the main line treatment as a monotherapy this means an error in management that is against recent guidelines which recommend starting with metformin first.
Delaying in insulin therapy was one of the barriers in controlling diabetes in type 2.
The relation between the level of rants and diabetes control was correlated to the high level of tasks.
There was no statistical significance difference were detected as regard different types of diabetes ,types of treatment and duration of diabetes in comparing controlled Hb A1C patients with uncontrolled Hb A1C patients with P-value = (0.906, 0.194 and 0.314) respectively.
Out of 100 patients result of ECG showed 15patients were ischemic heart disease and 85patients were normal.
There was no statistical significance increase in hypertensive patients were detected in comparing controlled Hb A1C patients with uncontrolled Hb A1C patients with P-value = (0.581). Also there was no statistical significance difference were detected as regard dyslipidemia, IHD, other co morbidities and no co morbidity patients were detected between comparing controlled Hb A1C patients with uncontrolled Hb A1C patients with P-value = (0.130), (0.974) and (0.837) and (0.272) respectively.
There was a statistical significance increase in Hb, RBCs, HCT were detected in comparing controlled Hb A1C patients with uncontrolled Hb A1C patients with P- value = (0.026), (0.036) and (0.041) respectively the increase in Hb might be false indicator due to smoking while there was no statistical significance difference were detected as regard MCV, MCH, MCHC, PLTs, and WBCs in comparing controlled Hb A1C patients with uncontrolled Hb A1C patients.
There was no statistical significance difference were detected as regard TC, TG, HDL, and LDL in comparing controlled Hb A1C patients with uncontrolled Hb A1C patients with P- value= (0.968), (0.436), (0.738) and (0.984) respectively.
The creatinine level was significantly increase in comparing controlled Hb A1C patients with uncontrolled Hb A1C patients with P- value =(0.000).
The prevalence and poor diabetic control are more in high police rants. The possible reason for high prevalence could be due to poor physical activity, altered sleep cycle, improper food habits and the tremendous work pressure and stress.
Limitation of the study:
An important limitation of this study was irregularity of attending of the patients to the hospital.
Conclusion
Based on the results of this study, we can conclude that:
The stressful life the police officers and their families have is one of the most contributing factor in the control of diabetes. Although the facilities offered by the hospital are enough yet the control of diabetes is hard to be gained and complications started to appear because of the deficiency of medical registration and continuous follow up. Medical registration of the patients and close follow up facilitate the prediction of complication and hence facilitate the right decision making for the patients.
Recommendations
To doctors: diabetic patients are very critical patients and should be referred to a specialist in diabetes because they need a very close follow up and medical registration ( every 3 to 6 months) to facilitate the follow up of patients and decrease the rate of complications the most important issue to be investigated and monitored in the renal and hepatic impairment as they are of a great important and vital organs for the patients.
To researchers: it is recommended to consider the obesity and stressful life conditions in the upcoming researches in the diagnosis and treatment of diabetes.
To the hospital: healthy life programs should be conducted to diabetic patients to ensure their ability to fight diabetes. also a special clinic should be considered for the obesity and diet control in the outpatient department.
Serving in the police forces requires a certain level of physical fitness and freedom from any disability “that may require excessive time lost from duty for necessary treatment.” When civilians apply to join the police forces, therefore, they are required to pass a medical exam and to disclose information about their medical history. While not all medical conditions disqualify a person from joining the police forces, many do, and any type of diabetes that requires treatment with medication generally does.