We publish below the article entitled “Interest of information and systematic screening in the prevention and fight against the progression of diabetes and associated pathologies” reporting on the results of the Open Day of information and awareness and screening for diabetic disease and associated pathologies, which took place on November 14, 2024 at the Khaznadar youth center, in Tunis. The results are worrying to say the least…
Dr Fathi El Younsi *
With the change in lifestyle, moving more and more towards ultra-processed products, daily stress and rampant sedentary lifestyle, diabetic disease has seen a considerable increase in the number of affected individuals around the world in recent decades, reaching impressive values and causing the most alarming morbidity and mortality.
We are currently talking about a global epidemic or diabetic pandemic.
This is how there are more than 537 million diabetics in the world in 2021, five times what they were in the 1980s, which could reach 783 million in 2045 according to estimates from the International Diabetes Federation ( FID).
In Tunisia, the situation is just as alarming with more than 2 million diabetics recorded in 2021, i.e. a prevalence of around 16.3%.
Major cause of blindness, kidney damage leading to chronic kidney failure and hemodialysis (25 to 30% of dialysis patients in Tunisia are diabetic), coronary insufficiency and myocardial infarction, vascular accidents cerebral, arteritis of the lower limbs leading to amputation (8,400 amputations/year in France, 1 amputation every 30 seconds worldwide), and finally deaths with mortality estimated at 6.7 million deaths/year worldwide, or 1 death every 5 seconds, diabetes, described as “silent killer”constitutes a real scourge and a priority public health concern urgently requiring the establishment of an appropriate and effective prevention policy targeting all aspects of the disease.
It is in this context and on the occasion of the 34e edition of World Diabetes Day that the Tunisian Association for Assistance, Integration and Support for People with Renal Impairment (Ataisir) organized an awareness, information and awareness campaign on November 14, 2024 at the Khaznadar Youth House. screening for diabetic disease and its complications.
Material and methods
This open day took place in a 50 square meter tent allowing a team made up of 7 dieticians, 5 nurses and 5 volunteer doctors to welcome visitors from 9 a.m. to 5 p.m. Several kidney failure patients on dialysis, kidney transplant recipients and parents of patients who actively participated in the organization of this event were also present.
A certain number of sites were previously established with a well-defined circuit used by citizens, structured around 2 fundamental axes. Information and awareness about diabetic disease and its complicationsstarting with the projection on screen of a short 6 minute film explaining in a very simple way and in dialect Arabic the diabetic disease, from definition to prevention and treatment, including classification, clinical signs and complications; visitors are then directed to the group of dietitians and nutritionists.
Screening for diabetes, associated pathologies and complications : after registering, citizens in possession of a data collection form will benefit from screening, firstly for the stigma of kidney damage by looking for a proteinuria or a hematuria to the analysis of urine using reactive strips (Labstix), then overweight and obesity by measuring the weight, height and abdominal circumferencediabetes by measuring the finger blood sugar by noting the time of the last meal and finally the high blood pressure (HTA) by manual measurement of blood pressure in a seated position carried out by doctors who will note the personal and family history as well as any treatments followed.
Results and data analysis:At the end of this, and after analyzing all the sheets and collecting all the data contained therein, a very large amount of valuable information was collected:
- the influx of visitors was absolutely remarkable, reaching 277 people distributed between 122 women et 155 men;
- middle age of visitors is 55 ans with extreme ranging from 18 years to 84 yearsTHE 3/4 of them being in the age range between 40 and 70 years;
- environ 1 person/5 East smoking with a proportion of 1 woman for 6 men. 10 cases of passive smoking were noted in women suffering from active smoking by their spouse;
- based on the anthropometric markersthe population surveyed seems very high cardiovascular risk : near the half of the visitors have a poids > 80 Kgs with extremes up to 118 kg in a man 46 years old and 134 kg in a woman 52 years old; 3/4 of people explored are in overweight (42.2%) or obese (28.9%) with 2 women presenting a morbid obesity grade III et 1 femme suffering from super-obesity or massive obesity likely requiring treatment for bariatric surgery; more than 80% of women and near the half of the men have a pathological abdominal circumferencewith everything the pejorative impact abdominal fat and therefore visceral fat on the occurrence of chronic diseases as high blood pressure or the type 2 diabetes and on the cardiovascular risk.
- Regarding the targeted screening for high blood pressure and diabetes who happen to be the main causes of chronic kidney disease (MRC) and dialysis: discovery of 33 new hypertensive patients;
- Of the 66 hypertensive patients known, 1/3 patients do not receive treatment; the 1/3 of people treated are not controlled (poorly balanced BP); 1/4 of hypertensives known have a proteinuria; potential diabetes has been discovered in 22 visitors;
- Of the 142 diabetics known: Only 1/3 diabetics receive treatment; 2/3 of patients treated have a poorly controlled diabetes with high post-prandial finger blood glucose levels (> 1.6 g/l), reaching for a 40-year-old patient on insulin the value of 5.63 g/l (patient referred to the emergency room of the Charles Nicolle hospital);
- Moreover, 22 visitors are both hypertensive and diabetic known: 1/4 of them have a poorly controlled high blood pressure with blood pressure figures reaching 170/110; half have a poorly controlled diabetes with postprandial fingerstick blood glucose levels reaching 3.78 g/l; 1 patient/5 presents both a uncontrolled high blood pressure and diabetes;
- As for urine analysis : 15% of consultants have proteinuria 3/4 of whom are men; 4 proteinurics/10 have a known high blood pressure or diabetes; 1 hypertensive/3 on examination presents a proteinuria; 1 visitor/5 having a pathological postprandial finger blood sugar (> 1.6 g/l) presents a proteinuria and they are all men; finally, a microscopic hematuria is noted in approximately 1/4 of cases with a slight female predominance
Of the nominal lists with addresses and telephone numbers of the people screened were established to ensure follow-up; about fifty connecting letters were also written and given to the patients concerned for treatment in public health structures.
Discussion and conclusion
With the discovery of 33 new cases of arterial hypertension, or 12% of the people explored, 8% of new cases of potential diabetes, or 22 out of the 277 consultants, 15% of patients with proteinuria, 25% with hematuria and 197 visitors, or nearly 75%, are overweight or obese, there is no doubt that such events constitute the cornerstone of all program for the prevention and screening of chronic diseases, in particular diabetic disease, which has been silent for a long time, whose rapid progression and the considerable negative impact of its numerous complications on public health no longer need to be demonstrated; this amply justifies the need to multiply and decentralize these information and screening campaigns in order to target the greatest number of citizens.
Furthermore, given the large number of hypertensive or diabetic patients without treatment (1 hypertensive or diabetic/3 stopping treatment), most often due to the unavailability of certain medications at local dispensaries, or poorly controlled despite treatment (1 hypertensive /3, 2/3 of diabetics), significant efforts must be made in the management of these formidable chronic diseases, both in terms of health education and hygiene-dietary advice with a return without delay to our traditional gastronomy and the famous Mediterranean diet which has proven itself by ensuring a healthy and balanced diet, while banning «fast-food» and other unhealthy places and favoring home catering as much as possible, as well as in terms of medical control and continued availability of a quality therapeutic arsenal in local public health structures to meet all the challenges involved.
* Retired medical professor, nephrologist.
