Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action

Table 5 Select studies reporting on microvascular complications of diabetes in the Middle East and North Africa region

Complication	Ref.	Country	Sample size (% male)	Setting	Duration of diabetes (yr)	Method of assessment	Prevalence %
Retinopathy	Al-Rubeaan et al[89], 2015	Saudi Arabia	50464 (56.0)	Saudi National Diabetes Registry	13.4 ± 8.2	Chart review	19.7 (10.6 PDR)
	Macky et al[101], 2011	Egypt	1325 (28.5)	Hospital-based	48% for 5-15	Slit lamp	20.5 (2.3 PDR)
	Jammal et al[104], 2013	Jordan	127 (63.8)	Clinic-based	Newly diagnosed	Slit lamp	7.9
	Uddin et al[99], 2018	Pakistan	958 (56.0)	Multi-Clinics	Newly diagnosed	Slit lamp	15.9
	Abu Al-Halaweh et al[81], 2017	Palestine	1308 (35.9)	Primary Care Centers	7.1 ± 6.3	Digital retinal photo	21.8
	Elshafei et al[97], 2011	Qatar	540 (360/540)	Community-based	12.9 ± 9.1	Slit lamp	23.5
	Heydari et al[98], 2012	Iran	1022 (40.2)	Clinic-based	11.2 ± 8.2 DR; 5.8 ± 5.4 no DR	Slit lamp	23.6
	Arej et al[96], 2019	Lebanon	2205	Community-based	9.1 ± 7.1	Digital retinal photo	12.6
	Kahloun et al[102], 2014	Tunis	2320 (39.8)	Hospital-based	7.6	Slit lamp	26.3 (3.4 PDR)
Nephropathy	Al-Rubeaan et al[107], 2018	Saudi Arabia	54670 (51.2)	Saudi National Diabetes Registry	13.6 ± 8.1	ACR and GFR	10.8 (1.2 micro; 8.1 macro; 1.5 ESRD)
	Uddin et al[99], 2018	Pakistan	958 (56.0)	Multi-Clinics	Newly diagnosed	ACR	24.0
	Zakkerkish et al[110], 2013	Iran	350 (32.0)	Diabetes Clinic	4.6 ± 5.5	ACR	20.6 (5.1 macro)
	Shahwan et al[108], 2019	Palestine (Ramallah)	550 (54.7); Age above 35 yr	Diabetes Clinic	8.9 ± 6.8	ACR	34.6 (5.8 macro)
	Ali and Al Lami[109], 2016	Iraq	224 (58.9)	Diabetes Clinic	23.2 % ≥ 9	ACR (2 out of 3)	16.1
Neuropathy	Khedr et al[22], 2016	Egypt (Qena)	9303 (51.1); 837 with diabetes	Community	NR	MNSI, then ENG	18.5
	Ghandour et al[114], 2018	Palestine (Ramallah)	517 (32.0)	Primary Health Clinic	9.0 ± 7.5	Monofilament test	38.2
	Chahbi et al[115], 2018	Morocco	300 (50.7)	Diabetes Clinic	10.6 ± 7.4	Diabetic Neuropathy Score	15.4 (DN4 painful)
	Garoushi et al[112], 2019	Libya	450 (50.2)	Diabetes Clinic	15.1± 7.1	Diabetic Neuropathy Score	42.2 (s-LANSS ≥ 12 pain)
	Kiani et al[113], 2013	Iran	521 (NR)	Diabetes Clinic	9.2 ± 7.4	NSS and NDS	49.3

NR: Not recorded; MNSI: Michigan neuropathy screening instrument, ENG: Electroneurogram; PDR: Proliferative diabetic retinopathy; ACR: Albumin to creatinine ratio; S-LANSS: Leeds assessment of neuropathic symptoms and signs; NSS: Neuropathy symptom score; NDS: Neuropathy disability score; DR: Diabetic retinopathy; GFR: Glomerular filtration rate; ESRD: End-stage renal disease.