The Power of ‘Sahhtek’ – a national survey on diabetes

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With the third-ever national diabetes survey now underway, the Head of the Department of Public Health at the University of Malta, Dr Julian Mamo, explains just how important the data collected will be to the nation’s well-being.

Julian Mamo
Dr Julian Mamo

Diabetes is a metabolic disease many of us have heard of and discussed. That should come as no surprise since Malta has among the highest prevalence of diabetes in the Mediterranean, with around 38,000 people estimated to suffer from the affliction at any one time – more than 9% of the population and growing, in fact.

Even so, surveys about the disease are rare and, to date, only two large ones have been performed: One in 1963, which was coordinated by Dr Joe Zammit Maempel and funded by the Royal University of Malta, and another between 1981 and 1982, backed by the World Health Organization (WHO).

“The first one was an early attempt at measuring how common the disease was, though the methodology that followed does not allow one to conclude this,” explains Dr Julian Mamo, the Head of the Department of Public Health at the University of Malta. “The second had more recent science behind it as well as the backing of the WHO. This provided better information.

“However, since 1982, the population of Malta has changed in many ways. We have become more multicultural, with many people of different ethnicities and from various countries living here. In addition, recent years have seen Malta’s population become increasingly older and more overweight – both of which affect the frequency of diabetes,” he continues.

Now, Dr Sarah Cuschieri, under the supervision of Dr Mamo, has undertaken the titanic task of conducting a national survey and to determine the most recent prevalence of the disease in Malta (proportion at each age and gender group) and understand how gender, lifestyle, diet, blood pressure, being overweight, genetics and other factors affect the disease. (View an earlier blog  dedicated to Dr Cuschieri on the The Quest to Quantify Diabetes).

“Dr Cuschieri showed me her initial PhD proposal four years ago, and seeing the determination and capacity of her will, the idea behind Saħħtek was born,” says Dr Mamo. “Our first problem, so to speak, was that of getting different experts onboard. Now, apart from myself working on epidemiology, there is Professor Josanne Vassallo working on diabetes and Dr Neville Calleja working on medical statistics. Professor Alex Felice and Dr Nikolai Pace from the databank are our experts from the genetics side

“The pilot for this project was launched in September 2014,” adds Dr Mamo, “and we’ve just made our changes and set off on the main fieldwork.  Dr Cuschieri finished the data collection phase last November with a total of 47% of the selected applicants (or approximately 1,800 people) responding to the call. That’s 7% more than the expected average – which was very good, especially given the fact that blood is also taken and that this puts many off.”

Sarah Cuschieri
Dr Sarah Cuschieri

In order to ensure that the study truly reflects the population of Malta, Dr Cuschieri and her team went to numerous local clinics all over Malta and Gozo, calling up selected applicants from the locality to attend for their appointment.

“One thing that hasn’t changed since 1963 is the reliance on University rather than national resources,” explains Dr Mamo. “Dr Zammit Maempel’s survey was funded mostly by the (then Royal) University of Malta – as is ours. We did, however, get the support of the hospital lab and the use of the local clinics all over Malta (the Bereġ). In fact, because funding is not easy, Dr Cuschieri is conducting the Oral Glucose Tolerance tests, as well as much of the genetic tests herself.

“Thankfully, this project has been greatly supported by medical students at UoM, who helped us collect the data. In fact, Dr Cuschieri has had a dedicated group who remained with her for a year and a half. We are also very grateful to several companies who have donated money to make this possible.”

As Dr Mamo tells us, this project has cost in access of €330,000; €200,000 of which came directly from University (various sources) and with the Alf Mizzi Foundation as a major funder. Several others lent their support, headed by the Atlas Insurance investing heavily in the project. Even so, this still wasn’t enough to completely fund the project, but following a meeting with Mr Wilfred Kennely, the CEO of RIDT, Dr Mamo and Dr Cuschieri got the final amount that was required to kick-start this project.

“While I feel happy to have set things off by appointing Dr Cuschieri in this direction, it is still a dream come true for me. This epidemiological project will be a great gift to Malta in the years to come, particularly for the healthcare sector, as we need to make policies based on up-to-date evidence and this project is a step in that direction.

“Dr Sarah Cuschieri has very ably led the survey and, together, we have overcome seemingly insurmountable obstacles to see it through. I believe that public health in Malta owes much to the sheer strength, determination, energy and perseverance of Dr Sarah Cuschieri,” Dr Mamo concludes.

You too can be part of this fascinating world of research by supporting researchers in all the faculties of the University of Malta. Please click here for more information on how to donate to research through the Research Trust (RIDT).



The Quest to Quantify Diabetes

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What is the link between the Maltese lifestyle and diabetes type 2? And how will figuring this out help health professionals and the general public? Here, Dr SARAH CUSCHIERI MD explains the thought-process and the implications of The University of Malta’s Health and Wellbeing Study, SAĦĦTEK.

Sarah CushchieriIn 1981 a diabetes mellitus type 2 prevalence study was conducted; its findings are still used to predict the diabetes burden on Malta’s healthcare system today.

But life and lifestyle in Malta have changed greatly since then – and, with more of us eating a westernised diet (as opposed to the more-Mediterranean oriented one back then), and fewer of us exercising, among other factors, that study has now become almost obsolete.

And that’s where SAĦĦTEK comes in.

Over the years ‘it is expected that the diabetes and obesity frequencies in Malta have increased,’ reads the project’s official document. ‘The increase in diabetes also comes from the strong family history of diabetes mellitus type 2 in Malta.’

‘[Moreover], there has never been a representative survey covering the prevalence of obesity, hypertension, physical activity, smoking and alcohol consumption in Malta [and], therefore, the burden of this disease has been based on estimations.’

Now, the University of Malta’s Health and Wellbeing Study, SAĦĦTEK, is looking to rectify the situation and Dr Sarah Cuschieri MD, with the help of Dr Julian Mamo, the Head of the Department of Public Health, is at the helm of this ambitious project.

“When we first started, my assumptions were that we would find a small percentage of the population that was diabetic,” explains Dr Cuschieri, an assistant lecturer at the Department of Anatomy within the Faculty of Medicine and Surgery. “The actual preliminary results, however, have shown that a large percentage of the sample population is diabetic (newly diagnosed, as well as already-known), and that the majority of them are either overweight or obese, too.”diabetes-treatment-abroad

Dr Cuschieri’s role in this project is manifold, and ranges from taking care of the logistics, all the way to calling participants with abnormal results. And the results – good or bad – are what makes this project such a valuable one.

“The results have many factors that need to be analysed and compiled, which include an update of the prevalence of type 2 diabetes among adults and the prevalence of pre-diabetes (those prone to becoming diabetic), obesity, hypertension, physical activity, smoking and alcohol consumption, among others,” she says.

“We also assess the risk factors affecting the Maltese population that are contributing to the development of type 2 diabetes, pre-diabetes and obesity, as well as the analysis of a number of diabetic genetic Single Nucleotide Polymorphism, (which is a DNA sequence variation occurring commonly within a population) within the normal, pre-diabetic and diabetic population,” she continues.

The benefits of doing all this are many, and there are several different sectors that will benefit from this project. On the one hand, participants will benefit from having their measurements taken (blood pressure, weight, etc) while also learning about their predisposition to developing diabetes and high-blood pressure.

On the other, policy makers will now know what the current situation is with regards to the frequency of diabetes type 2, pre-diabetes, obesity, high blood pressure, smoking and alcohol habits among the population. Moreover, the study will also identity the risk factors that lead to these diseases, giving them an idea of how they could be managed. Indubitably, what helps the policy makers will also help take care of the nation’s health.

As a project, SAĦĦTEK has the financial backing of the Alfred Mizzi Foundation as the main sponsor; while support of the Faculty of Medicine and Surgery, Atlas Insurance, the Ministry for Energy and Health through the Parliamentary Secretary for Health, and the Research Trust is also notable. “RIDT has been of great help to this project,” explains Dr Cuschieri. “It not only provided substantial financial support but also helped in the initial PR of the project and launch.”

The project has commenced again in September and the team behind SAĦĦTEK will contact people living in the towns that have not yet been screened. While there’s no doubt that this project is a mammoth task, once compiled, it will prove to be extremely important for Malta’s public and private health sectors, as well as for the many who are prone to suffer from diabetes type 2. We urge all those who receive an invitation to participate and join us in understanding the health of the Maltese population.

You can be part of this fascinating world of research too by supporting many other researchers in all the faculties of the University of Malta. Please click here for more information on how to donate to research of this kind through the Research Trust (RIDT).Sahhtek – Health and Wellbeing Study