Childhood obesity in Tunisia: Prevalence and risk factors.

INTRODUCTION: Obesity in children is currently a major public health problem in Tunisia. AIM: To determine the prevalence of obesity among pre-schoolchildren in the city of Bardo and to identify risk factors. METHODS: We carried a cross-sectional study of 220 children between 4 and 6 years of age, recruited from kindergartens in the city of Bardo. Children with endocrinal, tumoral or genetic diseases causing secondary obesity, children on corticosteroids and children with two illiterate parents were not included. The weight status of the children was defined according to the curves of the international obesity task force. A parent is considered obese if his BMI>30 Kg/m². RESULTS: The average age was 4.65±0.77 years. A female predominance was noted (55.9% girls and 44.1% boys). The average BMI of the children was 16.93±2.46 kg/m². The prevalence of overweight among all children was 10.9% and that of obesity was 11.4%. The frequency of overweight (including obesity) was 22.3%. In multivariate analysis, factors independently related to childhood obesity were child age, child medical history and hospitalization, parental obesity, parental dyslipidemia, snack type and snacking. CONCLUSIONS: Overweight is common in pre-school children. It should be detected at an early age, especially if risk factors are present.

Audit of glycemic control of diabetic patients on insulin analogues: about 2915 insured persons of the CNAM (Tunisia).

BACKGROUND: Insulin analogues are increasingly prescribed in Tunisia. These molecules, covered by the National Health Insurance Fund (CNAM) in Tunisia under certain conditions, have an important and constantly increasing cost. AIM: To audit the diabetes control among insured in the Northern district of the CNAM (Tunisia), treated with insulin analogues in 2019 and to assess factors associated with good glycemic control. METHODS: Retrospective observational study including patients with diabetes who applied for renewal of insulin analogues between March and April 2019 in the northern district of the CNAM. RESULTS: Our study included 2915 diabetic insured. The sex ratio was 1.08. The mean age was 56.5 ±18.56 years. More than half of the diabetic insured were followed by a specialist physician (44% by endocrinologists, 7% by internists, 6% by nutritionists and 4% by other specialists). The average duration of treatment with insulin analogues was 5 years ± 1.41. Almost three quarters (74%) of the diabetic insured were type 2 diabetics. The mean daily dose of rapid-acting, short-acting and premixed insulin analogues were 30±15.49 IU/d, 38±18.36 IU/d and 65±19.38 IU/d respectively. HbA1c targets were achieved in 8% of the diabetic insured. In univariate analysis, the variables significantly associated with diabetes balance were follow-up by a physician specializing in endocrinology (OR=3.14, 95% CI [0.98-10.08]), internal medicine (OR=5.06, 95% CI [1.49-17.21]) or nutrition (OR=2.06, 95% CI [0.54-7.77]), type 1 diabetes (OR=1.67, 95% CI [1.26-2.22]) and basal insulin therapy regimen (OR=1.88, 95% CI [1.39-2.54]). In multivariate analysis, the independent and significant factors associated with glycemic control were type 1 diabetes (ORa=1.81, 95% CI [1.37-2.39]) and basal insulin therapy regimen (ORa= 1.77, 95% CI [1.30-2.40]). CONCLUSION: This study showed that the majority of diabetic insured on insulin analogues had a poor controlled diabetes. Type 1 diabetes and basal insulin therapy regimen were the two factors associated with good glycemic control after multivariate analysis. A review of criteria for reimbursement of insulin analogues by the National Health Insurance Fund is necessary in order to rationalize the expenses related to these molecules.