The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study.

BACKGROUND: Diabetes type 2 and obesity are well-established global epidemics and contributors to clinical, social and economic health burdens. The prevalence rates of these diseases are still on the rise among countries resulting in a corresponding public health burden. The Mediterranean island of Malta, known for it's high diabetes and obesity rates, provides a good fundamental basis to portray the economical health burden of these diseases. METHOD: A recent randomised stratified representative cross-sectional survey conducted in Malta tackling diabetes, obesity and other determinants, was used to work out the population prevalence of these diseases. The cost burden of diabetes and obesity, based on published data, was incorporated to the established population prevalence rates, in order to estimate the Maltese economical burden. Projections to the year 2050 by a bottom-up prevalence based design were performed. RESULTS: One eight of the Maltese adults (25 to 64 years) suffered from diabetes out of which approximately 10,000 adults were unaware of the disease. Alarmingly, more than a third of the Maltese population suffer from obesity. The approximate health care costs (direct and indirect) for the diabetic adult population was of €29,159,217 (€21,994,676 - €38,919,121) annually, amounting to 3.64% (2.75-4.875%) of the total health expenditure in Malta. The obesity cost burden was of €23,732,781 (€21,514,972-€26,049,204) annually contributing for 2.97% (2.69-3.26%) of the total health expenditure. The projected prevalence and costs for 2050 exhibited an estimated cost burden increase of €33,751,487 (€25,458,606-€45,048,473) for the diabetes mellitus population and €46,532,294 (€42,183,889-€51,074,049) for the obese population. These projected cost burdens are expected to increase exponentially the total health care expenditure in Malta by 2050. CONCLUSION: Having an understanding of the prevalence and the economic cost burden of diabetes and obesity within a country, along with projections of the expected burden will enable policy and public health officials to clearly visualize this growing problem. It also helps in establishing effective preventive strategies and screening programs targeting these epidemics.

Epidemiology and radiological geometric assessment of pituitary macroadenomas: population-based study.

CONTEXT: Pituitary adenomas are relatively common tumours with diverse clinical features. Epidemiological data are important to help quantify health burden. OBJECTIVE: To provide in-depth epidemiological data on macroadenomas and radiologically characterize macroadenomas. DESIGN: Population-based retrospective analysis, Prevalence as at 2014; Incidence based on data from 2000 to 2014, Retrospective analysis of baseline MRI. SETTING: The Maltese islands. PATIENTS: 173/136 patients with macroadenomas for prevalence/incidence estimates respectively, 122 baseline MRI for radiological characterization. MAIN OUTCOME MEASURES: Prevalence rates, Standardized Incidence rates (SIR), MRI findings. RESULTS: The prevalence for macroadenomas was 40·67/100 000 people and the SIR was 1·90/100 000/year. Giant pituitary adenomas (>40 mm) constituted 4·8% of the whole cohort of PAs and the SIR was 0·18/100 000/year. Giant prolactinomas constituted 4·7% of all the prolactinomas and the SIR was 0·07/100 000/year, while giant NFPA constituted 6·0% of all NFPA and the SIR was 0·12/100 000/year. There was a statistically significant difference in the degree of suprasellar extension (P < 0·001) and infrasellar extension (P = 0·028) between the different macroadenoma subtypes and in the vertical extension indices (median vertical extension index NFPA 3·0 mm; PRLoma -7·7 mm; GH-secreting PA -1·7 mm; P < 0·001). Pituitary macroadenomas with cavernous sinus invasion were statistically significantly larger than those without cavernous sinus invasion (P < 0·001). NFPA had predominantly a superior extension into the cavernous sinus (63·6%) compared to the functional PAs which had predominantly an inferior extension into the cavernous sinus (59·1%) (P = 0·032). CONCLUSIONS: The various macroadenoma subtypes' epidemiological data are presented and differences between growth patterns among the various subtypes are highlighted.

A composite risk assessment model to screen for gestational diabetes mellitus among Mediterranean women.

OBJECTIVE: To determine whether clinical risk assessment for gestational diabetes mellitus (GDM) may preclude the need for universal screening with an oral glucose tolerance test (OGTT) in situations of economic restraint. METHODS: Women with either GDM (n=119) or normal glucose tolerance (n=1249) were recruited from centers among 11 Mediterranean countries between August 1, 2010, and May 31, 2011. Outcome measures included anthropomorphic and biological data, obstetric outcomes, and infant outcomes. RESULTS: Significant risk factors for GDM included maternal age of 30 years or more; elevated body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters); elevated diastolic blood pressure; previous history of macrosomia; and family history of diabetes mellitus. These factors each had high specificity but low sensitivity for predicting GDM; however, when used in combination, sensitivity increased but specificity fell. Fasting blood glucose (FBG) level had high sensitivity (73.9%) and specificity (90.2%) for predicting GDM. Sensitivity was further increased by combining FBG measurement with maternal age and BMI (96.6%). CONCLUSION: Use of a composite model to prescreen women for GDM risk may reduce the need for universal screening with the OGTT among centers facing health-cost pressures.