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

摘要 糖尿病是一个主要的公共卫生问题，目前影响着生活在中东的4000多万人和 北非(中东和北非)地区。黎巴嫩是中东和北非地区糖尿病患病率高于 地区平均水平为9.2%，估计2017年成年人的比例为14.6%。尽管有这种巨大的负担，但风险 导致糖尿病及其严重微血管(视网膜病变和 大血管并发症)和大血管并发症还不是很清楚。为了应对日益严重的 关于糖尿病的国家，黎巴嫩已经制定了可操作的糖尿病政策，然而，没有 黎巴嫩糖尿病患者综合登记，没有血糖为 有节制的，仅部分实施了以证据为基础的糖尿病治疗指南。因此，这一点 患者群体在很大程度上没有特征，目前的预防和治疗策略仍然低于 最好的。此外，缺乏详细描述2型患者病因的信息。 糖尿病，其结果的状况和决定因素，或糖尿病发病率/患病率的时间趋势 或医疗保健方面的差距。虽然众所周知，糖尿病的知识、态度、信念、社会决定因素和 生物标志物都与糖尿病有个体关系，这些因素中的每一个对糖尿病的增量影响 黎巴嫩成年人口中的糖尿病结果尚不清楚。将三个机构的专业知识结合起来 和多个学科，我们试图了解各种因素对糖尿病预后、疾病的作用 黎巴嫩成人2型糖尿病的进展和并发症通过以下具体目标：(1) 建立多机构和多学科协作，以应对糖尿病和心血管疾病 (CVD)在中东和北非地区。(2)确定信念、知识和态度对糖尿病和心血管疾病风险的作用 因子控制(HbA1c、血压、血脂)。(3)确定健康的社会决定因素对 糖尿病和心血管疾病危险因素控制。(4)确定疾病进展和并发症的生物标志物(例如 有糖尿病和心血管疾病危险因素的个体的CTGF和血浆前激肽释放酶)。通过调查 文化、社会和生物因素影响黎巴嫩成年人的糖尿病结局，这项研究将提供 跨多个机构和学科建设研究基础设施和能力的机会 协助申请R01基金，以研究黎巴嫩成年人的表观遗传学和蛋白质组学 糖尿病。

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.