Building Infrastructure to Address Social, Cultural and Biological Determinants of Diabetes in Lebanon

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ABSTRACT Diabetes is a major public health problem currently affecting over 40 million people living in the Middle East and North African (MENA) region. Lebanon is one of the MENA nations with a higher prevalence of diabetes than the regional average of 9.2%, estimated at 14.6% of adults in 2017. Despite this tremendous burden, the risk determinants that contribute to the development of diabetes and its serious microvascular (retinopathy and nephropathy) and macrovascular complications are not well understood. In response to the increasing impact of diabetes on the nation, Lebanon has created an operational policy for diabetes, however, there is no comprehensive Lebanese registry of patients with diabetes, no national survey in which blood glucose was measured, and only partial implementation of evidence-based guidelines for diabetes treatment. As a result, this patient population is largely uncharacterized, and the current preventative and treatment strategies remain sub- optimal. In addition, there is a paucity of information detailing the etiological factors of patients with type 2 diabetes, the status and determinants of their outcomes, or the time trends in incidence/prevalence of diabetes or disparities in care. While it is known that diabetes knowledge, attitudes, beliefs, social determinants, and biomarkers all have individual relationship with diabetes, the incremental influence of each of these factors on diabetes outcomes in the Lebanese adult population is unknown. Combining expertise across three institutions and multiple disciplines, we seek to understand the role of a variety of factors on diabetes outcomes, disease progression, and complications in Lebanese adults with type 2 diabetes through the following specific aims: (1) Build a multi-institutional and multi-disciplinary collaboration to address diabetes and cardiovascular disease (CVD) in the MENA region. (2) Identify the role of beliefs, knowledge and attitudes on diabetes and CVD risk factor control (HbA1c, blood pressure, lipid profile). (3) Determine the role of social determinants of health on diabetes and CVD risk factor control. (4) Identify biomarkers of disease progression and complications (such as CTGF and plasma prekallikrein) in individuals with diabetes and CVD risk factors. By investigating the role of cultural, social, and biological factors influencing diabetes outcomes in Lebanese adults, this study will provide an opportunity to build research infrastructure and capacity across multiple institutions and disciplines that will facilitate an application for R01 funding to investigate epigenetics and proteomics in Lebanese adults with diabetes.