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Dear Editor
We would like to bring to your attention our study, which investigated the prevalence of type 2 diabetes in a sample of the southwestern Albanian adult population. Stratified random sampling was used to select 3709 volunteers (1966 males and 1743 females) from southwestern Albanian towns and villages, in the years 2005 and 2006. This region has a total population of 278 000.
The subjects were evaluated at the Internal Medicine Department of the Military Hospital of Gyrocaster in Albania, which is run by both Greek and Albanian military health personnel. Serum glucose, lipids (total cholesterol, triglycerides) were measured enzymatically on a Technicon RA-XT analyzer (Technicon, Dublin, Ireland). The personal information, medical history and the somatometric values of the subjects were obtained by the hospital's medical staff. The diagnosis of type 2 diabetes was established using the 1999 WHO criteria1. Results were analyzed using SPSS v12 software (SPSS Inc, Chicago, IL, USA).
The mean ± SD age of the studied subjects was 49.2 ± 18.1 years with a range of 20 to 103 years. Of the 3709 subjects, 155 (4.17%) were found to have type 2 diabetes (interestingly, 47 participants (30.3%) in the diabetic group had undiagnosed diabetes). The mean known duration of diabetes of those who had known diabetes was 7.8 ± 6.7 years. The mean age of onset in the group of subjects with type 2 diabetes was 56 ± 13 years. The mean values of total cholesterol and triglycerides of this group were 229 ± 55 mg/dL and 197 ± 94 mg/dL, respectively, while the mean value of fasting blood glucose was 210 ± 90 mg/dL (11.66 ± 5 mmol/L).
The prevalence of type 2 diabetes in southwestern Albania was found to be 4.17%. This rate was very close to the International Diabetes Federation's (IDF) Diabetes Atlas rates published in 2003 (3,8%)2, showing only a small, but possibly expected increase. According to other recent studies, the prevalence of diabetes in urban areas of Albania was much higher3,4. We would like to emphasise that our study participants came from a rural part of the country, with less exposure to the western lifestyle and nutritional habits than those in urban areas. This probably explains the difference in diabetes rates between rural and urban areas in Albania.
The difference of diabetes prevalence in Albania compared with other European countries, according to data provided by the IDF2, may be explained by a difference in nutritional habits and lifestyle in the Albanian population. Albania's economy, especially in rural areas, is mostly based on agriculture and cattle raising. Thus, the physical activity of the population is much higher than in other European countries.
The increase in the prevalence of type 2 diabetes in Albania during the last 3 years is probably explained by the adoption of a western lifestyle and nutritional habits. An increasing trend in the prevalence of type 2 diabetes is frequently reported in other developing countries3,4 and possibly reflects changes in culture, physical activity and nutrition.
John Doupis, MD1,2
Nicholas Tentolouris, MD, PHD2
Antonios Mastrokostopoulos, MD1
Alexander Kokkinos, MD, PHD2
Chris Doupis, BSci1
Agim Zdrava, MD1
Alkiviadis Kafantogias, MD1
1Military Hospital of Gyrocaster, Albania
2Athens University Medical School, Laiko General Hospital, Athens
References
1. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. WHO: Geneva, 1999.
2. International Diabetes Federation. Diabetes atlas 2003. Available: http://www.eatlas.idf.org/Prevalence/index.cfm?data=table&tableId=13 (Accessed 25 June 2007).
3. Shapo L, McKee M, Coker R, Ylli A. Type 2 diabetes in Tirana City, Albania: a rapid increase in a country in transition. Diabetes Medicine 2004; 21: 77-83.
4. Shapo L, Coker R, McKee M. Tracking diabetes in Albania: a natural experiment on the impact of modernization on health. Diabetes Medicine 2002; 19: 87-88.