Around 200,000 Sahrawi refugees live in refugee camps in Tindouf, Algeria.1 It has been calculated that there is a high prevalence of type 2 diabetes mellitus (DM2) in these camps.2,3 Given the healthcare limitations, it is difficult to assess the real situation and it is suspected that there may be an even higher prevalence in the form of undiagnosed DM2.4
In order to describe the prevalence of undiagnosed DM2, a 15-day screening programme was carried out in March 2018.
The population sample was collected in an opportunistic study in citizens between the ages of 20 and 90 who attended the local dispensaries in the Smara camp. A single visit was made to each dispensary and the patients were evaluated in a single clinical act. The variables recorded were: age, sex, body mass index (BMI), baseline plasma glucose, glycated haemoglobin (HbA1c), glucosuria and ketonuria.
According to the recommendations of the Standard of the American Diabetes Association (ADA) 20195 regarding screening for prediabetes and DM2 in asymptomatic adults, the test should be considered in adults who are overweight or obese and who also present a risk factor. Weight was used as a criterion for screening and physical inactivity as a risk factor.
No clinical prediction rules were used since none are validated in this population.
First, all patients were questioned about physical activity. Those who reported habitual physical inactivity were weighed and measured, and if the BMI was ≥25 a fasting plasma glucose level was performed and if the value was >100mg/dl, an HbA1c test was performed in the same medical act.
The diagnostic criteria used for DM2 and prediabetes were those published in the 2019 ADA Standards.5 Once the 2 determinations had been made, if both met the diagnostic criteria of the ADA (plasma glucose >126mg/dl and HbA1c>6.5%) patients were categorised as DM2, if HbA1c was between 5.7–6.4% they were classified as prediabetes. If HbA1c was <5.7% they were categorised as high blood glucose. Following the WHO criteria, obesity was defined as BMI≥30 and overweight as BMI≥25.
A baseline plasma glucose level ≥200mg/dl was detected in 23 patients, with negative glycosuria and ketonuria.
The mean age of patients diagnosed with DM2 and prediabetes did not differ between the sexes 68.05±1 and the same occurred with respect to the average age of obesity and overweight.
Table 1 shows 782 patients were seen, of whom 506 patients (64.7%) met the criteria: they did not know their health status regarding DM, they referred physical inactivity and the BMI≥25kg/m2.
Distribution of patients (results are expressed in absolute numbers and percentages [%]).
| Patients | Total population | Total sample (BMI>25 and physical inactivity) | Obesity (BMI>30) | Overweight (BMI>25) | Prediabetes | DM2 | HBG |
|---|---|---|---|---|---|---|---|
| Females | 399 (51.0%) | 289 (57.1%) | 214 (71.0%) | 75 (42.3%) | 48 (61.5%) | 158 (58.7%) | 24 (40.6%) |
| Males | 383 (48.9%) | 217 (42.8%) | 115 (38.2%) | 102 (57.6%) | 30 (38.4%) | 53 (22.3%) | 35 (59.3%) |
| Total | 782 | 506 | 301 | 177 | 78 | 211 | 59 |
DM2: diabetes mellitus 2; HBG: high blood glucose; BMI: body mass index (kg/m2).
The majority were women i.e. 289 (57.1%) and 48.9% men.
78 patients were detected with previously undiagnosed prediabetes, the majority were women 61.5% (n=48) versus 38.4% men (n=30).
211 patients with previously undiagnosed DM2 were detected. The majority were women, representing 58.7% (n=158) versus 22.3% men (n=53). These 211 undiagnosed DM2 patients accounted for 41.7% of the sample population and 26.98% of the entire population studied.
The study population had a distribution that was similar for both sexes, so it can be extrapolated that there is a higher prevalence of undiagnosed DM2 and prediabetes among women compared to men.
The mean HbA1c of patients with DM2 was 8.7±3.7%, the mean HbA1c of women was significantly higher than that of men (9.4±1.4 vs. 8.0±5.2; p<0.01).
The mean BMI of patients with DM2 was 34±0.1, women show significantly higher figures (37±8.7 vs. 32±7.0; p<0.01).
In general, long-term DM2 is detected, but in the case of women, they have worse clinical parameters and worse metabolic control.
This study reflects that Sahrawi women have higher percentages of overweight and obesity, which leads to a higher prevalence of undiagnosed DM2 and prediabetes in women compared to men.
As more than 25% of patients with undiagnosed DM2 were detected, a regulated screening programme and educational interventions in the Sahrawi refugee population is justified.
FundingThe work was funded by the ()?City Council of Utrera, Seville, Spain, thanks to the joint work with the humanitarian association Friends of the Sahrawi people of Utrera.
Please cite this article as: Carretero-Anibarro E, Hamud-Uedha M. Prevalencia de la diabetes mellitus tipo 2 no diagnosticada en la población saharaui de los campamentos de refugiados saharauis de Tinduf, Argelia. Med Clin (Barc). 2020;155:461–462.
