The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.

A prevalence survey of diabetes mellitus was carried out in Tunisia on two random samples of households. The first sample (3826 adult subjects) was drawn from the Gouvernorat of Tunis, the second one (1787 adult subjects), was drawn from a rural area, the Gouvernorat of Siliana. The families were investigated at home and diabetes assessed on the basis of an interview (to determine known cases) and of fasting blood glucose level in subjects having no personal history of diabetes (new cases). Prevalence rates were estimated considering known cases and newly found ones together. Overall, the age-standardized prevalence rate was found to be much higher in the urban sample compared to the rural one, especially for women (4.6% versus 2.3% in men, 3.5% versus 0.6% in women). Diabetes was often associated with obesity, especially in men. Within the urban sample, the prevalence rate was similar in subjects born in Tunis and in those born in the rest of the country, thus mainly of rural extraction. In contrast, a family history of diabetes was more often reported in the former group. The results are consistent with other epidemiological findings, showing that a dramatic increase in diabetes morbidity parallels the rapid westernization of urban centres in developing countries.

This was an open-label, randomised 26-week study to determine the effects of adding 4 mg rosiglitazone (Avandia) daily to existing sulphonylurea (SU) therapy in patients with type 2 diabetes from India, Brazil, The Philippines, Thailand, Argentina and Tunisia. Of the 348 patients, 175 received 2 mg rosiglitazone twice daily plus SU (RSG+SU) and 173 received SU alone (at their normal dose). The RSG+SU group showed a significant reduction in HbA1c (mean HbA1c 9.05% at baseline, 7.92% at 26 weeks, mean change -1.13 (95% Cl -1.37, -0.89)). Mean HbA1c essentially remained unchanged in the control group (8.9 to 9.0%). The RSG+SU group showed a significant decrease in fasting plasma glucose concentration (FPG) (mean FPG 198.7 mg/dl at baseline, 160.3 mg/dl at 26 weeks, mean change -38.4 (95% Cl -47.1, -29.7)) while the controls showed a non-significant increase from 194 to 200 mg/dl. Significantly more patients in the RSG+SU group achieved FPG < 140 mg/dl, > or = 0.7% decrease in HbA1c, and > or = 30 mg/dl decrease in FPG between baseline and week 26 than the controls (p = 0.0001 in each case). Adverse events were similar in both groups; more patients in the RSG+SU group reported hypoglycaemia, but most cases were mild. This study shows that adding rosiglitazone to existing SU treatment improves glycaemic control and is well-tolerated in patients with type 2 diabetes from a wide range of non-Western countries.

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