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

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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.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12889-015-1416-z) contains supplementary material, which is available to authorized users.

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          Most cited references24

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          Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.

          Ali Mokdad, Earl S. Ford, Barbara BOWMAN … (2003)
          Obesity and diabetes are increasing in the United States. To estimate the prevalence of obesity and diabetes among US adults in 2001. Random-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001. Body mass index, based on self-reported weight and height and self-reported diabetes. In 2001 the prevalence of obesity (BMI > or =30) was 20.9% vs 19.8% in 2000, an increase of 5.6%. The prevalence of diabetes increased to 7.9% vs 7.3% in 2000, an increase of 8.2%. The prevalence of BMI of 40 or higher in 2001 was 2.3%. Overweight and obesity were significantly associated with diabetes, high blood pressure, high cholesterol, asthma, arthritis, and poor health status. Compared with adults with normal weight, adults with a BMI of 40 or higher had an odds ratio (OR) of 7.37 (95% confidence interval [CI], 6.39-8.50) for diagnosed diabetes, 6.38 (95% CI, 5.67-7.17) for high blood pressure, 1.88 (95% CI,1.67-2.13) for high cholesterol levels, 2.72 (95% CI, 2.38-3.12) for asthma, 4.41 (95% CI, 3.91-4.97) for arthritis, and 4.19 (95% CI, 3.68-4.76) for fair or poor health. Increases in obesity and diabetes among US adults continue in both sexes, all ages, all races, all educational levels, and all smoking levels. Obesity is strongly associated with several major health risk factors.
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            Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis.

            Carole Willi, Patrick Bodenmann, William A Ghali … (2007)
            Observational studies have suggested an association between active smoking and the incidence of type 2 diabetes. To conduct a systematic review with meta-analysis of studies assessing the association between active smoking and incidence of type 2 diabetes. A search of MEDLINE (1966 to May 2007) and EMBASE (1980 to May 2007) databases was supplemented by manual searches of bibliographies of key retrieved articles, reviews of abstracts from scientific meetings, and contact with experts. Studies were included if they reported risk of impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes in relationship to smoking status at baseline; had a cohort design; and excluded persons with diabetes at baseline. Two authors independently extracted the data, including the presence or absence of active smoking at baseline, the risk of diabetes, methods used to detect diabetes, and key criteria of study quality. Relative risks (RRs) were pooled using a random-effects model. Associations were tested in subgroups representing different patient characteristics and study quality criteria. The search yielded 25 prospective cohort studies (N = 1.2 million participants) that reported 45 844 incident cases of diabetes during a study follow-up period ranging from 5 to 30 years. Of the 25 studies, 24 reported adjusted RRs greater than 1 (range for all studies, 0.82-3.74). The pooled adjusted RR was 1.44 (95% confidence interval [CI], 1.31-1.58). Results were consistent and statistically significant in all subgroups. The risk of diabetes was greater for heavy smokers (> or =20 cigarettes/day; RR, 1.61; 95% CI, 1.43-1.80) than for lighter smokers (RR,1.29; 95% CI, 1.13-1.48) and lower for former smokers (RR, 1.23; 95% CI, 1.14-1.33) compared with active smokers, consistent with a dose-response phenomenon. Active smoking is associated with an increased risk of type 2 diabetes. Future research should attempt to establish whether this association is causal and to clarify its mechanisms.
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              A generic model for the assessment of disease epidemiology: the computational basis of DisMod II

              Jan J Barendregt, Gerrit van Oortmarssen, Theo Vos … (2003)
              Epidemiology as an empirical science has developed sophisticated methods to measure the causes and patterns of disease in populations. Nevertheless, for many diseases in many countries only partial data are available. When the partial data are insufficient, but data collection is not an option, it is possible to supplement the data by exploiting the causal relations between the various variables that describe a disease process. We present a simple generic disease model with incidence, one prevalent state, and case fatality and remission. We derive a set of equations that describes this disease process and allows calculation of the complete epidemiology of a disease given a minimum of three input variables. We give the example of asthma with age-specific prevalence, remission, and mortality as inputs. Outputs are incidence and case fatality, among others. The set of equations is embedded in a software package called 'DisMod II', which is made available to the public domain by the World Health Organization.
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                Author and article information

                Contributors
                Olfa Saidi: olfa.saidi@yahoo.fr
                Martin O’Flaherty: M.OFlaherty@liverpool.ac.uk
                Nadia Ben Mansour: nadiabmy@gmail.com
                Wafa Aissi: docaissi@gmail.com
                Olfa Lassoued: olfalassoued30@gmail.com
                Simon Capewell: capewell@liverpool.ac.uk
                Julia A Critchley: jcritchl@sgul.ac.uk
                Dhafer Malouche: mdhafer.ticv@gmail.com
                Habiba Ben Romdhane: habibabr@yahoo.fr
                Journal
                Journal ID (nlm-ta): BMC Public Health
                Journal ID (iso-abbrev): BMC Public Health
                Title: BMC Public Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2458
                Publication date (Electronic): 7 February 2015
                Publication date PMC-release: 7 February 2015
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 104
                Affiliations
                [ ]Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia
                [ ]Department of Public Health and Policy, University of Liverpool, Liverpool, UK
                [ ]Population Health Research Institute, St George’s, University of London, London, UK
                Article
                Publisher ID: 1416
                DOI: 10.1186/s12889-015-1416-z
                PMC ID: 4348374
                PubMed ID: 25885910
                SO-VID: 4fef2a73-8eb8-4190-9c36-c881b514fb22
                Copyright © © Saidi et al.; licensee BioMed Central. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 30 April 2014
                Date accepted : 14 January 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Public health
                Keywords: type 2 diabetes prevalence,demographic changes,obesity trends,smoking trends,projection,target strategies,modeling,tunisia
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: type 2 diabetes prevalence, demographic changes, obesity trends, smoking trends, projection, target strategies, modeling, tunisia

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