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Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model

Authors: Olfa Saidi, Martin O’Flaherty, Nadia Ben Mansour, Wafa Aissi, Olfa Lassoued, Simon Capewell, Julia A Critchley, Dhafer Malouche, Habiba Ben Romdhane, on behalf of EC FP7 funded MEDCHAMPS project

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Most projections of type 2 diabetes (T2D) prevalence are simply based on demographic change (i.e. ageing). We developed a model to predict future trends in T2D prevalence in Tunisia, explicitly taking into account trends in major risk factors (obesity and smoking). This could improve assessment of policy options for prevention and health service planning.

Methods

The IMPACT T2D model uses a Markov approach to integrate population, obesity and smoking trends to estimate future T2D prevalence. We developed a model for the Tunisian population from 1997 to 2027, and validated the model outputs by comparing with a subsequent T2D prevalence survey conducted in 2005.

Results

The model estimated that the prevalence of T2D among Tunisians aged over 25 years was 12.0% in 1997 (95% confidence intervals 9.6%–14.4%), increasing to 15.1% (12.5%–17.4%) in 2005. Between 1997 and 2005, observed prevalence in men increased from 13.5% to 16.1% and in women from 12.9% to 14.1%. The model forecast for a dramatic rise in prevalence by 2027 (26.6% overall, 28.6% in men and 24.7% in women).
However, if obesity prevalence declined by 20% in the 10 years from 2013, and if smoking decreased by 20% over 10 years from 2009, a 3.3% reduction in T2D prevalence could be achieved in 2027 (2.5% in men and 4.1% in women).

Conclusions

This innovative model provides a reasonably close estimate of T2D prevalence for Tunisia over the 1997–2027 period. Diabetes burden is now a significant public health challenge. Our model predicts that this burden will increase significantly in the next two decades. Tackling obesity, smoking and other T2D risk factors thus needs urgent action. Tunisian decision makers have therefore defined two strategies: obesity reduction and tobacco control. Responses will be evaluated in future population surveys.
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Literature
1.
go back to reference Gaziono TA, Bitton A, Anoud S, Abrahms-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low-and middle income countries. CurrProbl Cordial. 2010;35:72–115. Gaziono TA, Bitton A, Anoud S, Abrahms-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low-and middle income countries. CurrProbl Cordial. 2010;35:72–115.
2.
go back to reference Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–49. doi: 10.1016/j.diabres.2013.11.002, Epub 2013 Dec 1.CrossRefPubMed Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–49. doi: 10.1016/j.diabres.2013.11.002, Epub 2013 Dec 1.CrossRefPubMed
4.
go back to reference Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors. JAMA. 2003;289:76–9.CrossRefPubMed Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors. JAMA. 2003;289:76–9.CrossRefPubMed
5.
go back to reference Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17:961–9.CrossRefPubMed Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17:961–9.CrossRefPubMed
6.
go back to reference Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Weight gain as a risk factor for clinical diabetes mellitus in women. Diabetes Care. 1994;17:961–9.CrossRefPubMed Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Weight gain as a risk factor for clinical diabetes mellitus in women. Diabetes Care. 1994;17:961–9.CrossRefPubMed
7.
go back to reference James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001;9:228–33.CrossRef James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001;9:228–33.CrossRef
8.
go back to reference Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes.A systematic review and meta-analysis. JAMA. 2007;298(22):2654–64.CrossRefPubMed Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes.A systematic review and meta-analysis. JAMA. 2007;298(22):2654–64.CrossRefPubMed
9.
go back to reference Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet. 1992;339(8802):1128–30.CrossRefPubMed Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet. 1992;339(8802):1128–30.CrossRefPubMed
10.
go back to reference Schwartz GG, Il’yasova D, Ivanova A. Urinary cadmium, impaired fasting glucose, and diabetes in the NHANES III. Diabetes Care. 2003;26(2):468–70.CrossRefPubMed Schwartz GG, Il’yasova D, Ivanova A. Urinary cadmium, impaired fasting glucose, and diabetes in the NHANES III. Diabetes Care. 2003;26(2):468–70.CrossRefPubMed
11.
go back to reference Eliasson M, Asplund K, Evrin PE, Lundblad D, 1, 1. Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin: the northern Sweden MONICA study. Atherosclerosis. 1995;113:41–53.CrossRefPubMed Eliasson M, Asplund K, Evrin PE, Lundblad D, 1, 1. Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin: the northern Sweden MONICA study. Atherosclerosis. 1995;113:41–53.CrossRefPubMed
12.
go back to reference Godsland IF, Wynn V, Walton C, Stevenson JC. Insulin resistance and cigarette smoking. Lancet. 1992;339(8809):1619–20.CrossRefPubMed Godsland IF, Wynn V, Walton C, Stevenson JC. Insulin resistance and cigarette smoking. Lancet. 1992;339(8809):1619–20.CrossRefPubMed
13.
go back to reference Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world: a growing challenge. N Engl J Med. 2007;356:213–5.CrossRefPubMed Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world: a growing challenge. N Engl J Med. 2007;356:213–5.CrossRefPubMed
16.
go back to reference Al-Quwaidhi AJ, Pearce MS, Sobngwi E, Critchley JA, O’Flaherty M. Comparison of type 2 diabetes prevalence estimates in Saudi Arabia from a validated Markov model against the international diabetes federation and other modelling studies. Diabetes Res Clin Practice. 2014;1 0 3:4 9 6–5 0 3.CrossRef Al-Quwaidhi AJ, Pearce MS, Sobngwi E, Critchley JA, O’Flaherty M. Comparison of type 2 diabetes prevalence estimates in Saudi Arabia from a validated Markov model against the international diabetes federation and other modelling studies. Diabetes Res Clin Practice. 2014;1 0 3:4 9 6–5 0 3.CrossRef
17.
go back to reference Abu-Rmeileh MEN, Husseini A, Capewell S, O’Flaherty M. Preventing type 2 diabetes among Palestinians: comparing five future policy scenarios. BMJ Open. 2014;3:e003558. 10.1136/ bmjopen-2013-003558.CrossRef Abu-Rmeileh MEN, Husseini A, Capewell S, O’Flaherty M. Preventing type 2 diabetes among Palestinians: comparing five future policy scenarios. BMJ Open. 2014;3:e003558. 10.1136/ bmjopen-2013-003558.CrossRef
18.
go back to reference Al Ali R, Mzayek F, Rastam S, Fouad MF, O’Flaherty M, Capewell S, et al. Forecasting future prevalence of type 2 diabetes mellitus in Syria. BMC Public Health. 2013;13:507.CrossRefPubMedPubMedCentral Al Ali R, Mzayek F, Rastam S, Fouad MF, O’Flaherty M, Capewell S, et al. Forecasting future prevalence of type 2 diabetes mellitus in Syria. BMC Public Health. 2013;13:507.CrossRefPubMedPubMedCentral
19.
go back to reference Sözmen K, Unal B, Capewell S, Critchley J, O’Flaherty M. Estimating diabetes prevalence in Turkey in 2025 with and without possible interventions to reduce obesity and smoking prevalence, using a modelling approach. Int J Public Health. 2015 Jan;60 Suppl 1:13-21. doi: 10.1007/s00038-014-0622-2. Epub 2014 Dec. http://www.ncbi.nlm.nih.gov/pubmed/25471076. Accessed on 25 January 2015. Sözmen K, Unal B, Capewell S, Critchley J, O’Flaherty M. Estimating diabetes prevalence in Turkey in 2025 with and without possible interventions to reduce obesity and smoking prevalence, using a modelling approach. Int J Public Health. 2015 Jan;60 Suppl 1:13-21. doi: 10.1007/s00038-014-0622-2. Epub 2014 Dec. http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​25471076. Accessed on 25 January 2015.
20.
go back to reference Barendregt JJ, Van Oortmarssen GJ, Vos T, Murray CJ. A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Popul Health Metrics. 2003;1(1):4.CrossRef Barendregt JJ, Van Oortmarssen GJ, Vos T, Murray CJ. A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Popul Health Metrics. 2003;1(1):4.CrossRef
22.
go back to reference Barendregt JJ, Baan CA, Bonneux L. An indirect estimate of the incidence of non-insulin-dependent diabetes mellitus. Epidemiology. 2000;11(3):274–9.CrossRefPubMed Barendregt JJ, Baan CA, Bonneux L. An indirect estimate of the incidence of non-insulin-dependent diabetes mellitus. Epidemiology. 2000;11(3):274–9.CrossRefPubMed
23.
go back to reference Muggeo M, Verlato G, Bonora E, et al. The Verona diabetes study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality. Diabetologia. 1995;38(3):318–25.CrossRefPubMed Muggeo M, Verlato G, Bonora E, et al. The Verona diabetes study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality. Diabetologia. 1995;38(3):318–25.CrossRefPubMed
24.
go back to reference National Institute of Statistics, Tunisia. Yearly Statistics Report: Edition N° 40; 1997. National Institute of Statistics, Tunisia. Yearly Statistics Report: Edition N° 40; 1997.
26.
go back to reference Bouguerra R, Alberti H, Salem LB, Rayana CB, Atti JE, Gaigi S, et al. The global diabetes pandemic: the Tunisian experience. Eur J ClinNutr. 2007;61(2):160–5.CrossRef Bouguerra R, Alberti H, Salem LB, Rayana CB, Atti JE, Gaigi S, et al. The global diabetes pandemic: the Tunisian experience. Eur J ClinNutr. 2007;61(2):160–5.CrossRef
28.
go back to reference Institut National de Santé Publique. Epidémiologie des broncho-pneumopathies chroniques chez l’adulte. Résultats de l’enquête nationale menée en 1996–1997; Publications de l’Institut National de Santé Publique N°2. 1999. Institut National de Santé Publique. Epidémiologie des broncho-pneumopathies chroniques chez l’adulte. Résultats de l’enquête nationale menée en 1996–1997; Publications de l’Institut National de Santé Publique N°2. 1999.
29.
go back to reference Cardiovascular epidemiology and prevention research laboratory. Epidemiological transition and health impact in North Africa in 2005. TAHINA Project Final Report. Tunisia Edition 2006. Cardiovascular epidemiology and prevention research laboratory. Epidemiological transition and health impact in North Africa in 2005. TAHINA Project Final Report. Tunisia Edition 2006.
30.
go back to reference Romdhane HB, Ali SB, Aissi W, Traissac P, Aounallah-Skhiri H, Bougatef S, et al. Prevalence of diabetes in Northern African countries: the case of Tunisia. BMC Public Health. 2014;14:86. doi:10.1186/1471-2458-14-86.CrossRefPubMedPubMedCentral Romdhane HB, Ali SB, Aissi W, Traissac P, Aounallah-Skhiri H, Bougatef S, et al. Prevalence of diabetes in Northern African countries: the case of Tunisia. BMC Public Health. 2014;14:86. doi:10.1186/1471-2458-14-86.CrossRefPubMedPubMedCentral
31.
go back to reference Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA J Am Med Assoc. 2012;307(5):491–7.CrossRef Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA J Am Med Assoc. 2012;307(5):491–7.CrossRef
33.
go back to reference Direction Des Soins De Santé De Base. Le programme national de lutte anti tabagique: Réalités et perspectives. Tunis; 2009 Direction Des Soins De Santé De Base. Le programme national de lutte anti tabagique: Réalités et perspectives. Tunis; 2009
34.
go back to reference Institut National de Nutrition et de Technologie Alimentaire. Stratégie Nationale de Prévention et de Lutte contre l’Obésité. Tunis; 2010 Institut National de Nutrition et de Technologie Alimentaire. Stratégie Nationale de Prévention et de Lutte contre l’Obésité. Tunis; 2010
36.
go back to reference International Diabetes Federation. Diabetes Atlas. 5th ed. Brussels, Belgium: International Diabetes Federation; 2011. International Diabetes Federation. Diabetes Atlas. 5th ed. Brussels, Belgium: International Diabetes Federation; 2011.
37.
go back to reference Beltaïfa L, Traissac P, El Ati J, Lefèvre P, Ben Romdhane H, Delpeuch F. Prevalence of obesity and associated socioeconomic factors among Tunisian women from different living environments. Obes Rev. 2009;10(2):145–53.CrossRefPubMed Beltaïfa L, Traissac P, El Ati J, Lefèvre P, Ben Romdhane H, Delpeuch F. Prevalence of obesity and associated socioeconomic factors among Tunisian women from different living environments. Obes Rev. 2009;10(2):145–53.CrossRefPubMed
38.
go back to reference Elasmi M, Feki M, Sanhaji H, Jemaa R, HajTaeib S, Omar S, et al. Prevalence of conventional cardiovascular risk factors in the Great Tunis population. Rev Epidemiol Sante Publique. 2009;57(2):87–92.CrossRefPubMed Elasmi M, Feki M, Sanhaji H, Jemaa R, HajTaeib S, Omar S, et al. Prevalence of conventional cardiovascular risk factors in the Great Tunis population. Rev Epidemiol Sante Publique. 2009;57(2):87–92.CrossRefPubMed
39.
go back to reference Aounallah-Skhiri H, Ben Romdhane H, Traissac P, Eymard-Duvernay S, Delpeuch F, Achour N, et al. Nutritional status of Tunisian adolescents: associated gender, environmental and socio-economic factors. Public Health Nutr. 2008;11(12):1306–17.CrossRefPubMed Aounallah-Skhiri H, Ben Romdhane H, Traissac P, Eymard-Duvernay S, Delpeuch F, Achour N, et al. Nutritional status of Tunisian adolescents: associated gender, environmental and socio-economic factors. Public Health Nutr. 2008;11(12):1306–17.CrossRefPubMed
40.
go back to reference Le tabac en Tunisie. Association Tunisienne de Lutte Contre le Cancer 2008. Le tabac en Tunisie. Association Tunisienne de Lutte Contre le Cancer 2008.
41.
go back to reference Sicree R, Shaw J. Type 2 diabetes: an epidemic or not, and why it is happening, Diabetes metabolic syndrome. Clin Res Rev. 2007;1(2):75–81. Sicree R, Shaw J. Type 2 diabetes: an epidemic or not, and why it is happening, Diabetes metabolic syndrome. Clin Res Rev. 2007;1(2):75–81.
42.
go back to reference Alberti H, Boudrigua N, Nabli M. “Dammsokker”: factors associated with the quality of care of patients with diabetes: a study in primary in Unisia. Diabetes Care. 2007;30(8):2013–8.CrossRefPubMed Alberti H, Boudrigua N, Nabli M. “Dammsokker”: factors associated with the quality of care of patients with diabetes: a study in primary in Unisia. Diabetes Care. 2007;30(8):2013–8.CrossRefPubMed
43.
go back to reference Alberti KG, Zimmet P, Shaw J. International DiabetesFederation: a consensus on type 2 diabetesprevention. Diabet Med. 2007;24(5):451–63.CrossRefPubMed Alberti KG, Zimmet P, Shaw J. International DiabetesFederation: a consensus on type 2 diabetesprevention. Diabet Med. 2007;24(5):451–63.CrossRefPubMed
44.
go back to reference Saaristo T, Peltonen M, Keinänen-Kiukaanniemi S, Vanhala M, Saltevo J, Niskanen L, et al. National type 2 diabetes prevention programme in Finland: FIN-D2D. Int J Circumpolar Health. 2007;66(2):101–12.CrossRefPubMed Saaristo T, Peltonen M, Keinänen-Kiukaanniemi S, Vanhala M, Saltevo J, Niskanen L, et al. National type 2 diabetes prevention programme in Finland: FIN-D2D. Int J Circumpolar Health. 2007;66(2):101–12.CrossRefPubMed
45.
go back to reference Spollett RG. Diabetes in Finland: what can happen when a country takes diabetes seriously. Diabetes Spectrum. 2009;22(3):188–90.CrossRef Spollett RG. Diabetes in Finland: what can happen when a country takes diabetes seriously. Diabetes Spectrum. 2009;22(3):188–90.CrossRef
46.
go back to reference World Health Organization. Targets to monitor progress in reducing the burden of noncommunicable diseases. 2011. World Health Organization. Targets to monitor progress in reducing the burden of noncommunicable diseases. 2011.
Metadata
Title
Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model
Authors
Olfa Saidi
Martin O’Flaherty
Nadia Ben Mansour
Wafa Aissi
Olfa Lassoued
Simon Capewell
Julia A Critchley
Dhafer Malouche
Habiba Ben Romdhane
on behalf of EC FP7 funded MEDCHAMPS project
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1416-z

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