Predictive risk factors for deterioration from normoglycemic state to type 2 diabetes mellitus or impaired glucose tolerance in a Tunisian urban population.

OBJECTIVE: To determine the predictive risk factors for the development of type 2 diabetes mellitus (DM) or impaired glucose tolerance (IGT) in a normoglycemic population. RESEARCH DESIGN AND METHODS: This is a ten-year prospective study in a randomly selected urban population including 1835 subjects aged >=30 years living in Tunis, 1460 were normoglycemic according to 2 hours blood glucose WHO criteria, and 701 among them attended the follow-up assessment ten years later. Subjects with impaired glucose tolerance (IGT) were excluded. Subjects underwent a physical examination including weight/height, iliac circumference (IC) and blood pressure measurements. Fasting and 2-hour venous blood sampling, after a 75 g oral glucose load, were performed for the measurement of plasma glucose (G(0), G(2h)), insulin (I(0), I(2h)), total cholesterol (TC) and glycated hemoglobin (HbA(1c)) levels. RESULTS: Out of the 701 normoglycemic subjects in 1985, 77 developed diabetes and 130 impaired glucose tolerance after 10 years, giving a mean annual incidence rate of 1.1% for diabetes and 1.85% for IGT. Univariate analysis showed that risk factors for diabetes were age, BMI, IC, SBP, G(0) and total cholesterol in both sexes, I(0) and I(2h) in men only and DBP G(2h) and HbA(1c) in women only. Risk factors for IGT were BMI, IC and G(2h) in both sexes, I(2h) in men only and G(0) in women only. Multivariate analysis revealed that BMI, G(0) and G(2h) were independent risk factors for conversion to diabetes or IGT in both sexes, but HbA(1c) and IC were risk factors only in men. CONCLUSION: Early screening and prevention of diabetes must focus on obese subjects, especially those with central fat distribution, and those with moderate increase in fasting and/or two-hour blood glucose levels within the normal range.

[Study of the effect of converting enzyme inhibitors on microalbuminuria in diabetics]. / Etude de l'effet des inhibiteurs de l'enzyme de conversion (IEC) sur la microalbuminurie chez les diabetiques.

The authors report the results of a randomised trial using a converting enzyme inhibitor in 40 microalbuminuric diabetic subjects during 18 months. In the treated group, we observed a reduction of albuminuria from 57.4 mg/24 hours to 35.4 mg/24 hours at the end of the follow up, in contrast with a non significant progression in the group who didn't receive this medication. No significant modification in the clinical and biological parameters was observed during the follow up.

A five-year study of the incidence of insulin-dependent diabetes mellitus in young Tunisians (preliminary results).

Three Tunisian districts were selected to estimate the incidence of insulin-dependent diabetes mellitus (IDDM): Beja, Monastir and Gafsa. A population-based registry for new cases of IDDM was established in 1990 in these three areas according to WHO DIAMOND project methodology. A local extension of the protocol consisted in the inclusion of children up to 19 years of age. Children with a diagnosis of IDDM discharged from general hospitals and private clinics in these areas were recorded in the corresponding registry. A secondary source of case ascertainment was provided by regional school health centers. The findings of the five-year study showed that 156 cases of IDDM were recorded among children aged 0 to 19 years in the three regions. The degree of ascertainment was estimated at 96%. The global age-adjusted incidence rates were 6.76.100,000(-1) year-1 and 6.95.100,000(-1).year-1 in the 0 to 14- and 0 to 19-year age-groups respectively. Age-adjusted incidence rates were lower in Monastir than in Beja and Gafsa, respectively 4.69, 8.13 and 8.33.100,000(-1).year-1 for subjects aged 0 to 19 years. Incidence rates showed no significant difference by gender but were lower in the 0 to 4- and higher in the 10 to 14-year age groups. No time trend was detected. Sixty-two percent of all cases were diagnosed in the cold season. The incidence rate of IDDM in Tunisia is thus close to that observed in most Mediterranean countries.