Prevalence and risk factors of type II diabetes mellitus among government employees working at Government Medical College, Latur

 

Prashant N Bade^1*, Varsharani V Kendre²

 

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

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

Email: badepn@gmail.com

 

Abstract               Background: 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. 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 large health care burden due to diabetes in India has been mostly attributed to its rising prevalence in urban area. In India, its prevalence is on the rise making our country the diabetic capital or the world. With this background the present study was conducted with the following objective. Objective: To find out the prevalence and associated risk factors of diabetes among government employees working at Government Medical College, Latur. 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 2 Diabetes Mellitus among employees working at Government Medical College. Conclusion: 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 2 Diabetes Mellitus.

Key Words: Diabetes Mellitus, Fasting Blood Glucose, Indian Diabetes Risk Score.

 

 

 

INTRODUCTION

“In every country and in every community worldwide, we are losing the battle against this cruel and deadly disease” -Jean Claude Mbanya, President of the International Diabetes Federation (IDF)¹. The term ‘Diabetes Mellitus’ describes a metabolic disorder of multiple etiologies characterized by chronic hyperglycemias with disturbances of carbohydrate, fat and protein metabolism resulting from defect in insulin secretion, insulin action or both. The effect of diabetes mellitus includes long term damage, dysfunction and failure of various organs. Diabetes mellitus is not considered a professional illness, nor is it seen as 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. Diabetes and its complications pose a major threat to public health resources and World Health Organization (WHO) has projected the maximum increase in Diabetes would occur in India. Prevalence of Diabetes is increasing day-by-day in our country. So in context of above description, the present study was under taken among Government employees working at Government Medical College in an urban area to find out the prevalence of Type 2 Diabetes Mellitus and study associated risk factors.
MATERIAL AND METHODS

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, Body Mass Index (BMI) (≥30 kg/m2 was considered obese) and 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. Those individuals having moderate or high risk score 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. 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. 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 DISCUSSION

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%), S.M KIM et al (7.6%), Arora V et al (8.1%), Ahmad J et al (6.05%), Zargar et al (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 al 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%). Also, Shanthirani et al in their study called CUPS (Chennai Urban Population study) reported the overall prevalence as 12%. Ramchandran A et al 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.

In present study we observed a significant association between Type II Diabetes Mellitus and family history of diabetes mellitus which was unanimously supported by the studies done by Arora V et al15,Menon VU et al¹⁶,Ramchandran A et al¹³Error! Bookmark not defined., Mohan V et al¹⁷.These studies reported that prevalence of type 2 diabetes mellitus was significantly higher in those who have family history of type 2 diabetes mellitus. The present study shows a significant association between alcohol consumption and type 2 diabetes mellitus. Similar type of finding was observed by Gadekar RD et al¹⁸,Chhetri MR et al¹⁹,Mooy J et al²⁰ .Also ,we noted in the present study that all the female subjects have never consumed alcohol in their life time(life time abstainers).Similar findings were reported by Agrawal S et al²¹. On the contrary, Liu et al²², Joline et al²³reported that moderate alcohol consumption decreases risk of type 2 diabetes mellitus. In present study we also noted that subjects who consumed alcohol more than 10 years had higher prevalence of Type 2 diabetes mellitus as compared to those persons who never consumed alcohol in their life, and persons who consumed alcohol less than 5 years but it was not found statistically significant(p>0.05) In our study we noted significant association between sedentary level of physical activity and diabetes mellitus (p<0.05). In many studies like Kim S et al²³, Mohan V²⁴ also found the significant relation between less physical activity and Type 2 Diabetes Mellitus. The prevalence of type 2 diabetes in persons having sedentary level of physical activity was found to be 11.11% and it decreased with increase in level of physical activity. But Patil R et al²⁵ did not find any association between physical activity and type 2 Diabetes Mellitus(p>0.05). In present study, prevalence of hypertension was found to be 20.43%. The prevalence of type 2 diabetes mellitus was found to be significantly higher among hypertensive study subjects than the non hypertensive subjects (p<0.001).Similar findings were noted in studies conducted by Iyer et al²⁶, Singh et al²⁷, Parashar P et al¹⁴, Acemoglu et al²⁸. It was observed in the present study that prevalence of type 2 diabetes mellitus was maximum in obese (18.07%) and minimum in underweight subjects(1.45%).Similar findings were reported by the studies done by Giri B et al²⁹. The prevalence of Type 2 Diabetes Mellitus was higher among smokers(Current plus Former) i.e. 10.46% as compared to non smokers i.e. 4.88(p<0.05). A study done by Cho NH et al³⁰ concluded that smoking is an independent risk factor for type 2 Diabetes Mellitus. It was observed from present study that high waist to hip ratio(WHR) was significantly associated with type 2 Diabetes Mellitus. This finding was supported by the studies of Patel DN et al³¹, Zaman FA et al³².The prevalence of type 2 Diabetes Mellitus was 9.41% in those subjects who were having mixed type of diet as compared to vegetarians(3.97%).It was found to be statistically significant(p<0.05).Similar finding was reported by Parashar P et al ¹⁴. In our study we noted significant association between sedentary level of physical activity and Diabetes Mellitus .(p<0.05).

Table 1: Distribution Of Study Subjects According to Biosocial characteristics

CONCLUSION

In present study, the overall prevalence of Type 2 Diabetes Mellitus among employees working at Government Medical College was7.05%. It was observed that as age increases, prevalence of Type 2 Diabetes Mellitus also increases, which was found to be maximum in ≥50 years age group in our study. It was observed that, Smoking habit, Mixed diet pattern and Alcoholism. were significantly associated with Type 2 Diabetes Mellitus. But, Gender, Religion, Duration of alcohol consumption And Tobaccoche wing habit of subjects were not significantly associated with type II Diabetes Mellitus. 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 the Government Medical College.

 

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