A pilot collaborative project that could be adopted by other regions in Tunisia
Type 2 diabetes and high blood pressure: real public health burden
Type 2 diabetes (T2D) and high blood pressure (HBP) are a major public health problem worldwide. These complex metabolic diseases lead to serious degenerative organic complications leading to disability and death. 1.6 million people will have died from diabetes in 2016. In fact, World Health Organization (WHO) estimates that diabetes was the seventh leading cause of death in 2016. HBP, a silent killer that promotes heart and cerebrovascular accidents, currently kills 7.5 million people a year, about 12.8% of the total of all deaths.
According to the International Diabetes Federation (IDF), 425 million people worldwide have diabetes. The IDF describes the phenomenon as a real pandemic, as the progression is considerable. Thus, the WHO (World Health Organization) predicts 622 million diabetics by 2040. The prevalence of HBP ranges from 30 to 45% in the general population.
The situation in Tunisia
In Tunisia, the prevalence of diabetes increased from 9% in 2007 to 15% in 2017, while hypertension was estimated at 30.6%. Hence, public awareness on the importance of healthy eating and physical activity as conditions for a better future can be raised especially among children and adolescents. Also, primary care health professionals need to be properly trained in diabetes and HBP prevention and care, and provided with the necessary screening tools and medications. In addition to this alarming epidemiological finding, it has become apparent that the complications of these diseases weigh very heavily in the balance of health problems.
In our country, screening for these diseases is insufficient, particularly outside the capital and in rural areas where there is a major problem of access to health care facilities. The management of these diseases is also inadequate.
The Zaghouan Regional Diabetes CSO «blew the whistle»
The Zaghouan Regional Diabetes Association has identified a major problem in the screening and management of T2D and hypertension in the Zaghouan region (50 km from Tunis). Within the framework of the call launched by the Institut Pasteur de Tunis (IPT)’s Science Shop “Science Together”, to collect social needs from Tunisian civil society, the Zaghouan Regional Diabetes Association expressed a need to study the epidemiological statue of T2D and HBP in the region.
New collaborations were born
This need was selected by the IPT SS and a new collaboration has been established between the the Zaghouan Regional Diabetes Association and the Laboratory of Biomedical Genomics and Oncogenetics (known for its experience in the multidisciplinary investigation of metabolic diseases) at IPT. Other regional and national stakeholders in the field of health are also involved in this project which extends over a period of 17 months from February 2019.
Indeed, this work is co-created by researchers from different scientific backgrounds (doctor, epidemiologist, nutritionist, sociologist, student.) from different state institutions: Institut Pasteur de Tunis, Regional Hospital of Zaghouan, the department of diabetology and nutritional diseases in the Nutrition Institute of Tunis and the Direction of Care and Basic Health, with the support of private partners.
A collaborative project with big ambitions
After the approval of the biomedical ethics committee of IPT, a study will be realized from 400 voluntary participants. During patient recruitment campaigns, anthropometric, demographic, nutritional, and genealogical data will be collected. Biological material samples (blood and urine) will be collected for biochemical analyses. All the data collected and generated will be analyzed by statistical tools.
The data collected as well as the results obtained will allow a better understanding of the epidemiological situation of T2D and HBP in the Zaghouan region. Indeed, our study will allow also for a better understanding of the causal links between these two diseases and the different clinical and environmental factors.
In addition, our project seeks to make scientific research and the data it produces accessible to all people at all levels of society. Through this study, we will provide the Ministry of Health with an official figure on the prevalence of diabetes and hypertension in the Zaghouan region.
This will allow to improve the management of diabetic and/or hypertensive patients, to better follow the evolution of these two diseases and to prevent their degenerative complications. Thus, there will be an improvement in the patient’s quality of life and a reduction in the costs of care.
During this project, presentations and awareness-raising camps will be conducted by the student involved in the project to health workers at the Zaghouan Regional Hospital and hospitalized patients in order to reinforce the concept of open science and science for all.
Taking into account its great socio-economic impact, the DiaTensioZag project can be a pilot project for the epidemiological study of T2D and HBP for other regions in Tunisia.