A cross sectional study among government employees working at Government Medical College, Latur using Indian diabetes risk score (IDRS)

Prashant N Bade¹, Vimal M Holambe^2*

¹Assistant Professor, Department of Community Medicine, SRTRGMC, Ambajogai, Maharashtra, INDIA.

²Associate Professor, Department of Community Medicine, Government Medical College, Latur, Maharashtra, INDIA.

Email: badepn@gmail.com

Abstract               Background: The number of people with Diabetes Mellitus has more than doubled globally, making it one of the most important public health challenges. Increasingly sedentary life styles and poor eating habits have contributed to the simultaneous escalation of Diabetes and Obesity, which some have called the Diabetes epidemic. The Indian Diabetes Risk Score is a simple, cost-effective, convenient tool which can be used by the community health workers to screen the high risk population. With this background the present study was conducted with the following objectives. Objective: To find out the prevalence of Diabetes Mellitus among government employees working at Government Medical College, Latur. To study the risk profile of study subjects for Diabetes Mellitus using Indian Diabetes Risk Score (IDRS) Methodology: A Cross-sectional study was conducted and all the employees fulfilling inclusion criteria (n=695) were studied. Along with collecting information about their biosocial characteristics, their weight, height, blood pressure, Indian diabetes Risk Score and Fasting Blood Glucose was measured and recorded. Data was analyzed by SPSS 21 for Windows. Statistical test employed was Chi-square test for proportions. Results: Prevalence of diabetes mellitus was found to be 7.05%. The factors like age ≥ 40 years, Higher Group of employee reflecting higher socioeconomic status, Family history, Sedentary level of physical activity, Hypertension, Body Mass Index ≥ 25.0 kg/m 2, Increased waist to hip ratio were found to be significantly associated with Type 2Diabetes Mellitus among employees working at Government Medical College Conclusion: This study provides a use of Indian Diabetes Risk Score for identifying undiagnosed high risk for diabetic subjects in Indian population. Indian Diabetes Risk Score being a non invasive, cost effective, easy to use screening tool can be used for large population.

Key Words: Diabetes Mellitus, Indian Diabetes Risk Score, Employees.

INTRODUCTION

Diabetes mellitus is not considered a professional illness, nor is it seenas specific to health workers. The lifestyle these workers adopt, however, can enhance the appearance of the disease. In many cases, workers assume long workdays, multiple jobs, shift work, entailing difficulties to adopt healthy life habits, without mentioning that the nature itself of health work confronts its workers with stress and anxiety on a daily base. These have been evidenced as harmful to people’s health, making them susceptible to chronic health problems.¹ Over the past three decades, the number of people with Diabetes Mellitus has more than doubled globally, making it one of the most important public health challenges.1 Type II Diabetes has already been described as the epidemic of new millennium.2 The large health care burden due to diabetes in India has been mostly attributed to its rising prevalence in urban area.3 Early identification of the high risk individuals would help in taking appropriate intervention in the form of dietary changes and increasing physical activity, thus helping to prevent, or at least delay, the onset of diabetes.4 The Indian Diabetes Risk Score is a simple tool which can be used by the community health worker to screen the high risk population. The IDRS has a sensitivity of 72.5% and specificity of 60.1% and is derived based on the largest population based study on diabetes in India CURES (Chennai Urban Rural Epidemiology Study). The advantage of IDRS are its simplicity, low cost and is easily applicable for mass screening programmes. So in context of above description, this study was undertaken among Government employees working at Government Medical College in an urban area to study the risk profile along with prevalence of Type 2 Diabetes Mellitus.

MATERIAL AND METHODS

Study Design: A Cross-Sectional Observational Study.

Study Duration: From February 2013 to July 2014

Study Population: All Government employees above 20 years of age, working at Government Medical College.

Inclusion Criteria

1. Employees with age 20 years and above.
2. Employees willing to participate in the study.

Exclusion Criteria

1. Pregnant women and lactating women up to 12 weeks.
2. Persons with type 1 diabetes mellitus.
3. Employees not willing to participate in the study

Study Sample: Non probability convenience sampling method was used for the present study. All Government employees working at Government medical college who satisfied inclusion criteria were selected as the study population. Approval from Institutional Ethical Committee was obtained beforehand. An informed written consent was obtained prior to data collection After explaining the respondents about the study procedure, information regarding their biosocial characteristics, their type of diet, and family history of diabetes was recorded in a predesigned and pretested format. Also their weight, height, blood pressure was measured and recorded. Blood pressure was classified on the basis of Seventh Joint National Committee on Hypertension (JNC-VII) criteria. For measuring blood pressure three readings were taken and the lower reading was recorded (mercury sphygmomanometer was used). Subjects having Systolic Blood Pressure ≥ 140 mm Hg and/or Diastolic Blood Pressure ≥ 90 mm Hg or on anti-hypertensive medications were classified as hypertensive (JNC-VII). For classifying obesity, Waist circumference (for males ≥102cm and for females ≥88 cm was classified as obese).4 Also, at same time, Indian Diabetic Risk Score was used to categorize the individuals into low, moderate and high risk category. Individuals were evaluated for fasting blood sugar level, for the diagnosis of Diabetes Mellitus and were given health education regarding the causation, consequences, diagnosis, prevention and control of Diabetes Mellitus stressing the importance of diet and regular exercise. The study subjects who were known cases of diabetes mellitus or were already on medication for diabetes mellitus were not tested further by blood sugar levels but classified as having type 2 Diabetes Mellitus. They were informed regarding the importance of diet, exercise, regular medications and follow up. Diabetes was defined by current use of medications for diabetes (insulin or oral hypoglycemic agents) and/or fulfillment of criteria laid down by the WHO/IDF Consultation Group Report (2006), i.e., capillary fasting blood glucose ≥126 mg/dl or 2 h capillary post-glucose value ≥200 mg/dl. Impaired fasting glucose was defined based on WHO criteria, i.e., if fasting capillary blood glucose ≥110 and <126mg/dl. Those subjects who were newly classified as having diabetes mellitus after fasting glucose measurement were referred to the Diabetes Out Patient Department under Department of Medicine for further evaluation and management. Fasting was defined as no calorie intake for at least last 8 hours.

Table 1: Indian Diabetes Risk Score

Table 2:

Statistical Analysis: Data was entered in MS Excel and analyzed using the software SPSS 21 for Windows. Discrete data was analyzed using Pearson's Chi-square test for difference in proportions. Two tailed p-values less than 0.05 were considered significant.

RESULTS AND OBSERVATIONS

Table 3: Distribution of study subjects according to various elements of Indian Diabetes Risk Score

Table 4: Cross tabulation of IDRS and Biochemically tested subjects

Highest prevalence of Diabetes was seen in subjects ≥ 50 years (28.95%) followed by 35-49 year group (07.89%) and least in subjects <35years (01.59%); (p<0.001). 27 (17.76 %) study subjects with high waist circumference were Diabetic. Around one fifth of the study subjects (17.76) were Diabetic with waist circumference (F>90; M>100) followed by 07.17% with waist circumference (F 80-89; M 90-99) The results were statistically significant (p<0.001). Maximum prevalence of type 2 diabetes mellitus i.e. 24 (11.11%) was found in study subjects having sedentary level of physical activity and minimum i.e. 06 (3.12%) in those subjects having vigorous or heavy level of physical activity. When higher prevalence of type 2 diabetes among subjects with sedentary level of physical activity was compared with prevalence in moderate and vigorous/heavy level of physical activity together, the difference was found to be statistically significant (p < 0.05) 276(39.72%) of subjects were in moderat risk IDRS category while 217 (31.22%) were in low risk and only 202 (29.06%) were in high risk IDRS category. Prevalence of Diabetes Mellitus was highest in high risk IDRS category i.e17.97%, followed by moderate risk category i.e. 3.62% and and no patients from low risk IDRS category. Table 4 is a 2×2 table which shows that the sensitivity of IDRS was 79.59% in the present study and a specificity of 72.45%. The prevalence of Diabetes in present study was found to be 80.2%. It was revealed in the present study, that the overall prevalence of type 2 diabetes mellitus was 7.05 % which reaches around the findings of Levitt NS et al(7.1%)7, S.M KIM et al (7.6%)8, Arora V et al (8.1%)9, Ahmad J et al1⁰ (6.05%), Zargar et al¹¹ (6.14%).The prevalence of already diagnosed cases type 2 Diabetes Mellitus among these study subjects was 4.46%,while, the prevalence of newly diagnosed subjects during the study was 2.59%.Pramono LA et al¹² found the prevalence already diagnosed cases of type 2 diabetes mellitus as 1.5% while it was 4.1% among the previously undiagnosed subjects. Epidemiological data from different parts of India shows a rising prevalence of diabetes in urban area. As compared to present study, higher prevalence of diabetes mellitus was observed in southern states of India as described by the results of CURES (Chennai Urban Rural Epidemiology Study) by Deepa M et al (15.5%)1³. Also, Shanthirani et al¹⁴ in their study called CUPS(Chennai Urban Population study)reported the overall prevalence as 12%.Ramchandran A et a1¹⁵ also reported a high prevalence of diabetes in six metropolitan cities in which the prevalence of diabetes mellitus was found to be higher among southern states (13.5% in Chennai,12.4% in Bangalore and 16.6% in Hyderabad) as compared to eastern India (11.7% in Kolkata),Northern India(11.6 in New Delhi) and western India (9.3% in Mumbai). Parashar P et al reported 20% prevalence of Diabetes Mellitus among Bank Employees working in urban area of Meerut.

CONCLUSION

This study provides a use of Indian Diabetes Risk Score for identifying undiagnosed high risk for diabetic subjects in Indian population. Indian Diabetes Risk Score being a non invasive, cost effective, easy to use screening tool can be used for large population. It is essential to implement the simple IDRS tool in the community for mass screening so that proper intervention can be carried out to reduce the burden of Diabetes.

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