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The global diabetes pandemic: the Tunisian experience

European Journal of Clinical Nutrition volume 61, pages 160–165 (2007)Cite this article

Abstract

Objective:

The prevalence of diabetes mellitus is known to be increasing rapidly worldwide, but few population-based surveys have been undertaken in Africa or the Middle East. The aims of this study are to report the prevalence of diabetes mellitus and impaired fasting glucose (IFG) in Tunisia, to compare the prevalence to previous studies and to analyse the relationship between diabetes and age, sex, area of residency and body mass index (BMI).

Subjects and setting:

We have used data from the Tunisian National Nutrition Survey, a cross-sectional health study providing a large nationally representative sample of the Tunisian population including 3729 adults. We used the American Diabetes Association diagnostic criteria to determine the prevalence of diabetes mellitus and IFG.

Results:

The overall diabetes prevalence was 9.9% (9.5% in men and 10.1 in women) giving age-adjusted prevalence of diabetes of 8.5% (7.3% in men and 9.6% in women). Step-wise logistic regression showed age of more than 40 years, urban residency and high BMI to each be significantly and independently related to diabetes prevalence. The prevalence of diabetes mellitus has more than doubled in Tunisia over a 15-year period.

Conclusions:

Our study has demonstrated a high prevalence of diabetes in the adult population with a wide difference among the rural and urban areas with an increased prevalence compared to previous studies. The results underline the need to increase public awareness and to emphasize the benefit of lifestyle modification in order to prevent type II diabetes.

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References

  • Abdul-Rahim HF, Husseini A, Bjertness E, Giacaman R, Gordon NH, Jervell J (2001). The metabolic syndrome in the west bank population. An urban–rural comparison. Diabetes Care 24, 275–279.

    Article  CAS  Google Scholar 

  • Ajlouni K, Jaddou H, Batieha A (1998). Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors. J Intern Med 244, 317–323.

    Article  CAS  Google Scholar 

  • Al-Habori M, Al-Mamari M, Al Meeri A (2004). Type II diabetes mellitus and impaired glucose tolerance in Yemen: prevalence, associated metabolic changes and risk factors. Diabetes Res Clin Pract 65, 275–281.

    Article  CAS  Google Scholar 

  • Al-Mahroos F, McKeigue PM (1998). High prevalence of diabetes in Bahrainis: association with ethnicity and raised plasma cholesterol. Diabetes Care 21, 936–942.

    Article  CAS  Google Scholar 

  • Asfour MG, Lambourne A, Soliman A, Al-Behlani S, Al-Asfoor D, Bold A et al. (1995). High prevalence of diabetes mellitus and impaired glucose tolerance in the Sultanate of Oman: results of the 1991 National Survey. Diabetes Med 12, 1122–1125.

    Article  CAS  Google Scholar 

  • Bouguerra R, Ben Salem L, Alberti H, Ben Rayana C, El Khadhi A, El Alti J et al. (2006). The prevalence of metabolic abnormalities in the Tunisian adult: a population based study. Diabetes Metab 32, 215–221.

    Article  CAS  Google Scholar 

  • Dunstan DW, Zimmet PZ, Welborn TA, De Courten MP, Cameron AJ, Sicree RA et al. (2002). The rising prevalence of diabetes and impaired glucose tolerance. The Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 25, 829–834.

    Article  Google Scholar 

  • Elbagir MN, Eltom MA, Elmahadi EM, Kadam MS, Berne C (1996). A population-based study of the prevalence of diabetes and impaired glucose tolerance in adults in northern Sudan. Diabetes Care 19, 1126–1128.

    Article  CAS  Google Scholar 

  • Elbagir MN, Eltom MA, Elmahadi EA, Kadam MS, Berne C (1998). A high prevalence of diabetes mellitus and impaired glucose tolerance in the Danagla Community in Northern Sudan. Diabetes Med 15, 164–169.

    Article  CAS  Google Scholar 

  • Ghannem H, Maarouf R, Tabka A, Haj frej A, Marzouki M (1993). La triade obésité, hypertension et troubles de la glycorégulation dans une population semi-urbaine du Sahel Tunisien. Diabetes Metab 19, 310–314.

    CAS  Google Scholar 

  • Gharbi M, Akrout M, Zouari B (2002). Diabetes non insulino-dependent; prevalence et facteurs de risque en Tunisie. Rev Epidemiol Sante Publique 50, 349–355.

    CAS  PubMed  Google Scholar 

  • Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR et al. (1998). Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults. The third national health and nutrition examination survey, 1988–1994. Diabetes Care 21, 518–524.

    Article  CAS  Google Scholar 

  • Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L, Kahn SE et al. (2003). Visceral adiposity and the risk of impaired glucose tolerance. Diabetes Care 26, 650–655.

    Article  Google Scholar 

  • Jaber LA, Brown MB, Hammad A, Nowack SN, Zhu Q, Ghafoor A et al. (2003). Epidemiology of diabetes among Arab Americans. Diabetes Care 26, 308–313.

    Article  Google Scholar 

  • King H, Aubert RE, Herman WH (1998). Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21, 1414–1431.

    Article  CAS  Google Scholar 

  • Mokdad AH, Ford ES, Bowman BA, Nelson DE, Engelgau MM, Vinicor F et al. (2000). Diabetes trends in the US: 1990–1998. Diabetes Care 23, 1278–1283.

    Article  CAS  Google Scholar 

  • Mokdad AH, Bowman BA, Ford ES, Dietz WA, Vinicor F, Bales VS et al. (2003). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289, 76–79.

    Article  Google Scholar 

  • Papoz L, Ben khalifa F, Eschwege E, Ben Ayed H (1988). Diabetes mellitus in Tunisia: description in urban and rural populations. Int J Epidemiol 17, 419–422.

    Article  CAS  Google Scholar 

  • Ramachandran A, Snehalatha C, Latha E, Vijay V, Viswanathan M (1997). Rising prevalence of NIDDM in an urban population in India. Diabetologia 40, 232–237.

    Article  CAS  Google Scholar 

  • Ramachandran A, Snehalatha C, Latha E, Manoharan M, Vijay V (1999). Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population. Diabetes Res Clin Pract 44, 207–213.

    Article  CAS  Google Scholar 

  • Samer J (2003). Health and development in the Arab world: which way forward? BMJ 326, 141–143.

    Article  Google Scholar 

  • Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S et al. (2002). Population-based study of diabetes and risk characteristics in Turkey. Results of the Turkish Diabetes Epidemiology Study (TURDEP). Diabetes Care 25, 1551–1556.

    Article  Google Scholar 

  • The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1980). Expert on Diabetes Mellitus, Second Technical Report Series No.646 World Health Organisation: Geneva.

  • The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997). Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20, 1183–1197.

  • United Nations Population Division. World Population Prospects Population database. http://esa.un.org/unpp.

  • Wild S, Roglic G, Green A, Sicree R, King H (2004). Global prevalence of diabetes estimates of the year 2000 and projections for 2030. Diabetes Care 27, 1047–1053.

    Article  Google Scholar 

  • World Health Organisation (1997). Global Prevalence and secular trends in obesity. Obesity. Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. World Health Organisation: Geneva, pp 17–40.

  • Zimmet P (2003). The burden of type 2 diabetes: are we doing enough? Diabetes Metab 29, 6S9–6S18.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The Tunisian National Nutrition Study was funded by the National Institute of Nutrition and we thank all the participants and health professionals involved in the study.

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Authors and Affiliations

  1. Institut National de Nutrition, Tunis, Tunisia

    R Bouguerra, L B Salem, C B Rayana, J E Atti, S Gaigi & C B Slama

  2. Department of Clinical Medical Sciences, University of Newcastle, Newcastle-upon Tyne, UK

    H Alberti

  3. Department of Preventive Medicine, Faculty of Medicine, University of Tunis, Tunisia

    B Zouari

  4. Department of Endocrinology and Metabolism, Imperial College, University of London, London, UK

    K Alberti

Authors
  1. R Bouguerra
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  2. H Alberti
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  3. L B Salem
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  4. C B Rayana
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  5. J E Atti
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  6. S Gaigi
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  7. C B Slama
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  8. B Zouari
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  9. K Alberti
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Corresponding authors

Correspondence to R Bouguerra or H Alberti.

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Bouguerra, R., Alberti, H., Salem, L. et al. The global diabetes pandemic: the Tunisian experience. Eur J Clin Nutr 61, 160–165 (2007). https://doi.org/10.1038/sj.ejcn.1602478

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  • DOI: https://doi.org/10.1038/sj.ejcn.1602478

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