title: Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model.
abstract: BACKGROUND
  Most projections of type 2 diabetes (T2D) prevalence are simply based on demographic change (i.e. ageing). We developed a model to predict future trends in T2D prevalence in Tunisia, explicitly taking into account trends in major risk factors (obesity and smoking). This could improve assessment of policy options for prevention and health service planning.
  
  
  METHODS
  The IMPACT T2D model uses a Markov approach to integrate population, obesity and smoking trends to estimate future T2D prevalence. We developed a model for the Tunisian population from 1997 to 2027, and validated the model outputs by comparing with a subsequent T2D prevalence survey conducted in 2005.
  
  
  RESULTS
  The model estimated that the prevalence of T2D among Tunisians aged over 25 years was 12.0% in 1997 (95% confidence intervals 9.6%-14.4%), increasing to 15.1% (12.5%-17.4%) in 2005. Between 1997 and 2005, observed prevalence in men increased from 13.5% to 16.1% and in women from 12.9% to 14.1%. The model forecast for a dramatic rise in prevalence by 2027 (26.6% overall, 28.6% in men and 24.7% in women). However, if obesity prevalence declined by 20% in the 10 years from 2013, and if smoking decreased by 20% over 10 years from 2009, a 3.3% reduction in T2D prevalence could be achieved in 2027 (2.5% in men and 4.1% in women).
  
  
  CONCLUSIONS
  This innovative model provides a reasonably close estimate of T2D prevalence for Tunisia over the 1997-2027 period. Diabetes burden is now a significant public health challenge. Our model predicts that this burden will increase significantly in the next two decades. Tackling obesity, smoking and other T2D risk factors thus needs urgent action. Tunisian decision makers have therefore defined two strategies: obesity reduction and tobacco control. Responses will be evaluated in future population surveys.
authors.affiliation: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia. olfa.saidi@yahoo.fr.
authors.forename: Olfa
authors.initials: O
authors.lastname: Saidi
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK. M.OFlaherty@liverpool.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.affiliation: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia. nadiabmy@gmail.com.
authors.forename: Nadia Ben
authors.initials: NB
authors.lastname: Mansour
authors.affiliation: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia. docaissi@gmail.com.
authors.forename: Wafa
authors.initials: W
authors.lastname: Aissi
authors.affiliation: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia. olfalassoued30@gmail.com.
authors.forename: Olfa
authors.initials: O
authors.lastname: Lassoued
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK. capewell@liverpool.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK. jcritchl@sgul.ac.uk.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Critchley
authors.affiliation: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia. mdhafer.ticv@gmail.com.
authors.forename: Dhafer
authors.initials: D
authors.lastname: Malouche
authors.affiliation: Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of medicine of Tunis, Tunis, Tunisia. habibabr@yahoo.fr.
authors.forename: Habiba Ben
authors.initials: HB
authors.lastname: Romdhane
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult