Research on Type 2 Diabetes in Lebanon.

Diabetes is an increasing public health burden and an important cause of morbidity and mortality in the Middle East and North Africa Region (MENA). Of all the regions in the world, the sharpest rise (25%) in diabetes is expected to be in the Middle East. Lebanon, a middle-income country experiencing rapid urbanization, population growth and ageing, presents a case study to investigate the epidemiology of diabetes. According to the WHO, the prevalence of Type 2 Diabetes reached around 11% in the adult population in 2004 thereby placing Lebanon on the forefront of the epidemiological transition.  Using the WHO STEPwise approach, the Nutrition and Non-Communicable Disease Risk Factor (NNCD-RF) survey was conducted in Lebanon, between 2008 and 2009 on a nationally representative sample of Lebanese adults. Previous studies documenting the prevalence of diabetes and its classical risk factors were all hospital-based. This study was the first nation-wide study to investigate the dimensions of the diabetes problem among the general population, while focusing on non-classical risk factors, and using a comprehensive face to face questionnaire covering information on socio-demographic characteristics, tobacco and alcohol use, dietary intake, physical activity pattern, general health status and health seeking behaviour. Sampling was done based on random area probability multi-stage sampling. The final sample included 2386 adults 18 years and above, however for comparability purposes, 2195 adults aged 25 and above were included in the analysis.

Two forthcoming manuscripts stem out of this study; the first manuscript entitled “Physical activity in adults with and without diabetes: from the “high-risk” approach to the “population-based” approach of prevention is currently in the submission phase.  This paper aimed to determine the prevalence and correlates of physical activity, a major control measure in diabetes prevention and management, in the general population and among individuals with and without diabetes in Lebanon. The second manuscript aims to elucidate associated risk and socioeconomic factors for developing diabetes in the general population, as well as to determine characteristics of preventive care among diabetics and the extent of complications arising from diabetes. Findings from both studies provide further evidence on the social determinants of health and call for the need to better understand the contextual barriers and facilitators while implementing population-based approaches in preventing and controlling diabetes.