Prevalence of chronic kidney disease in Tunisian diabetics: the TUN-CKDD survey.

BACKGROUND: In Tunisia, the prevalence of diabetes mellitus increased from 15.5% on 2016 to 23% by 2023. While Chronic Kidney Disease (CKD) stills the most dreaded complications of diabetes, studies on the prevalence of chronic kidney disease non-dialysis diet are scarce. The aim of this study was to assess the prevalence of chronic kidney disease among the Tunisian diabetic population based on investigators' specialty, demographic criteria (gender, age, duration of diabetes and geographic distribution) and diagnosis criteria (albuminuria and/or eGFR). METHODS: This observational, multicentric, and cross-sectional study enrolled all diabetic subjects from all regions of Tunisia with at least 3 months of follow-up before the inclusion date, from 09 January to 08 February 2023. CKD diagnosis was established based on the KDIGO guidelines. The study was carried out at medical departments and ambulatory clinics of different healthcare providers. Baseline data were collected by investigators using an electronic case report form (eCRF). Continuous variables were described by means, median, standard deviation, and quartiles. Categorical data were tabulated in frequencies and percentages. RESULTS: The overall prevalence of CKD among the 10,145 enrolled patients with diabetes mellitus was 38.7% with a 95%CI [37.8-39.6%]. 50.9% were male, with a mean age of 67.5 (± 11.3) years. The mean diabetes duration was 16.1 years (± 8.9). The highest CKD prevalence was noted among nephrologists (82.2%), while it was similar between the cardiologists and the primary care physicians (30.0%). CKD prevalence was highest among males (43.0% versus 35.1%) and increased proportionally with patients' age and diabetes duration. CKD was more frequent in the Mid-East Area when compared to other regions (49.9% versus 25.3 to 40.1% in other regions). Albuminuria was present within 6.6% of subjects with CKD, and it was found an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² within 13.3% of subjects wit h CKD. 18.9% had both criteria. CONCLUSIONS: In Tunisia, CKD among diabetics had a prevalence of 38.7%, approaching European prevalence. The prevalence discrepancy worldwide of CKD can be improved with a larger population size and by implementing standardized practices.

Incidence of maternal and fetal outcomes in women with gestational diabetes.

INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with both maternal and fetal complications related to maternal hyperglycemia. AIM: The aim of the study was to describe the incidence of maternal and fetal complications associated with GDM in a reference maternity hospital in the Tunis (2019-2020). METHODS: We conducted a prospective longitudinal descriptive and analytical study including 220 patients followed for GDM at the research unit «Diabetes and pregnancy¼ of the C department of the National Institute of Nutrition of Tunis. The patients were followed during pregnancy and until post partum, for a period of 18 months (July 2019-December 2020). The patients were divided into two groups Group1(G1) including women treated with insulin therapy (n=68) and Group 2(G2) including women treated with diet only (n=152). RESULTS: In the current study, 63,6% of patients delivered by cesarean section and 5% developed gestational induced hypertension. Neonatal outcomes were dominated by macrosomia (13.5%) and transient respiratory distress (11.4%). Insulin-treated women had a higher incidence of gestational induced hypertension (G1:11,9% versus G2: 2,1%;p=0,03). There was no significant difference between the two groups in the incidence of fetal outcomes including macrosomia (G1:17.6% versus G2:11.2%; p=0.203),transient respiratory distress (G1:11.8% versus G2: 10.5%; p=0.781) and prematurity (G1:7.4% versus G2:4.6%; p=0.452). CONCLUSION: Our study showed that Insulin-treated women had a higher incidence of gestational induced hypertension. However, there was no significant difference between the two groups in the incidence of fetal complications.