TÓM TẮT TIẾNG ANH LUẬN ÁN TIẾN SĨ Y TẾ CÔNG CỘNG: THỰC TRẠNG MẮC BỆNH ĐÁI THÁO ĐƯỜNG TYPE 2 Ở NGƯỜI LAO ĐỘNG THƯỜNG XUYÊN PHẢI LÀM CA, THÊM GIỜ VÀ MỘT SỐ YẾU TỐ NGUY CƠ

In the world there are a number of studies on the incidence of type 2 Diabetes in workers that shows a relationship between occupational risk factors such as shift work, overtime .... In

MINISTRY OF EDUCATION MINISTRY OF HEALTH

Major: Public Health

Code: 62720301

SUMMARY OF PUBLIC HEALTH DOCTORAL

DISSERTATION

HÀ NỘI - 2021

THIS WORK IS COMPLETED AT HANOI MEDICAL

- Central medical Library

- Library of Hanoi Medical University

DANH MỤC CÁC CHỮ VIẾT TẮT

ADA Hội đái tháo đường Hoa Kỳ American Diabetes Association BMI Chỉ số khối lượng cơ thể Body Mass Index

FPG Glucose huyết tương lúc

IFG Rối loạn glucose lúc đói Impaired Fasting Glucose IGT Rối loạn dung nạp glucose Impaired Glucose Tolerance

NPDNGĐU Nghiệm pháp dung nạp

glucose đường uống

Pre-diabetes Tiền đái tháo đường

RLĐHLĐ Rối loạn đường huyết lúc

đói

RLDNG Rối loạn rối loạn dung nạp

UNICEF Quỹ nhi đồng Liên hiệp

WDF Quỹ Đái tháo đường thế

WHO Tổ chức Y tế Thế giới World Health Organization

In the world there are a number of studies on the incidence of type 2 Diabetes

in workers that shows a relationship between occupational risk factors such as shift work, overtime

In Vietnam, there have been many epidemiological studies on the prevalence and risk factors of type 2 diabetes in the community, but few studies related to the prevalence of diabetes in workers such as shift work, overtime So is working overtime or shift work a risk of diabetes in employees? This is an urgent issue that needs to be studied and identified To find out this issue, we conducted research at 3 facilities: Duc Giang Garment Joint Stock Company is

an organized facility for employees to work overtime; Proconco forage factory organized for shift workers and overtime; Son Nam Textile and Garment Company organizes for employees to work shifts with the research topic:

"Current situation of type 2 diabetes among workers who regularly have to work shifts, overtime and some risk factors", with specific objectives:

1 Determine the current situation of glucose tolerance disorder and diabetes prevalence rate per employee in shift and/or overtime at Proconco Animal Feed Factory, DucGiang Garment Joint Stock Company, Son Nam Textile and Garment Joint Stock Company, 2014-2017.

2 Analysis of the relationship between the rate of impaired glucose intolerance, diabetes with some factors in shift workers, overtime at three companies and factories

New contributions of the thesis

The dissertation has determined the rate of glucose tolerance disorder and the prevalence of diabetes in workers working in shifts and overtime The thesis also specifies the health characteristics, diseases, and occupational diseases as

2 well as the effects of work-shift related to health and the occurrence of diabetes

on employees

The thesis layout

The thesis consists of 136 pages (Introduction: 03 pages; Chapter 1: Document overview 42 pages; Chapter 2: Subject and research method 14 pages; Chapter 3: Research results 37 pages; Chapter 4: Discussion 36 pages; Conclusions and recommendations 04 pages) There are 24 tables, 03 charts, 02 maps and 02 diagram References: 122 (Vietnamese: 45, English: 77) The appendix includes sample research papers, some data tables and identification of study participants

Chapter 1 OVERVIEW 1.1 Diabetes mellitus

1.1.1 Definition

Diabetes is a group of metabolic conditions characterized by hyperglycemia due to impaired insulin secretion, impaired insulin activity, or both Chronic hyperglycemia in Diabetes will damage, dysfunction or impair many organs, especially the eyes, kidneys, nerves, heart and blood vessels

1.1.2 Diagnosis of diabetes according to WHO and ADA

1.1.2.1 Determined Diagnosis of diabetes

Criteria for diagnosis of Diabetes - WHO; IDF - 2012, based on one of the criteria:

- Fasting plasma glucose level ≥7,0mmol / L (≥126mg / dl) Or:

- Plasma glucose level ≥ 11.1mmol / L (200mg / dl) 2 hours after the oral glucose tolerance test Or:

- HbA1c ≥ 6.5% (48mmol / L according to the International Federation of Clinical Biochemistry-IFCC)

1.1.2.2 Diagnosis of prediabetes

- Impaired Glucose tolerance (IGT): if plasma glucose at 2 hours after oral glucose tolerance test from 7.8mmol / L (140mg / dL) to 11.0mmol / L (200mg /dL)

3

- Impaired Fasting blood glucose (IFG): if fasting plasma glucose (8 hours after meals) is from 5.6mmol / L (100mg / dL) to 6.9mmol / L (125mg / dL), and plasma glucose At 2 hours of the test, blood glucose tolerance is below 7.8mmol /L (<140mg / dL)

- The HbA1c level is from 5.6% to 6.4%

1.1.2.3 Steps to diagnose the disease

- Step 1: Screening by question, selecting risk factors

- Step 2: Diagnosis determined according to WHO, IDF-2012 standards

Note:

* Reconfirm the diagnosis if the initial fasting blood glucose is 5.6-6.9mmol / L

or any blood glucose of 5.6-11.0mmol / L According to the American Diabetes Association, impaired fasting blood glucose when fasting blood glucose ranges from 5.6 to 6.9mmol / L

** If fasting plasma glucose is less than 7.0 mmol / L, oral glucose tolerance test is performed If blood glucose is ≥ 7.0mmol / L, the diagnosis is diabetes People who are diagnosed with diabetes or IFG / IGT without being re-identified will have to have the test again after 1 year and based on the test results after 1 year to determine the next test

1.1.3 Several factors related to diabetes

Currently, the world has found a number of factors related to diabetes such as:

- Genetic factors

- Anthropological causes (gender, age, race)

- Factors related to behavior, lifestyle: obesity, less physical activity, diet and other factors such as stress due to work; environmental factors (lifestyle changes)

Metabolic factors and intermediate types of risk

+ IFG and IGT

+ Factors related to pregnancy (birth status, gestational diabetes, uterine environment)

+ Hypertension

4 + Insulin resistance

+ Other factors: polycystic ovary syndrome, androgen hypertonic

1.2 Impaired glucose tolerance, diabetes mellitus situation in some countries in the world and in Vietnam

1.2.1 In the world

Currently, the proportion of people with diabetes is increasing rapidly in the world The prevalence of diabetes in the world was 171 million people in 2000,

194 million people in 2003 and 246 million people in 2006, it is forecasted that

by 2025 it will increase to 380 - 399 million people According to a study by Shaw JE et al (2010) conducted on 91 countries to determine the prevalence of diabetes for all 216 countries and predicted 2030 based on the standards of the World Health Organization and the Association PASS THE ROAD America, group from 20-79 years old The results show that: the rate of REMOVING SUGARS worldwide is 6.4% (285 million people) and increases to 7.7% (439 million people) in 2030

Diabetes is considered a disease that is plagued as a "pandemic", one of the most important public health problems in the world and in Vietnam due to the constantly increasing number of new patients Worryingly, this disease is attacking even young people of working age The study of Sofia Carlsson (2019) on 201,717 employees of 30 common occupations in Sweden showed that: the rate of type 2 diabetes in men is higher than in women (5.2% in men and 3.2% in women); The incidence of diabetes varied significantly between occupational groups In men, this proportion was highest for production workers (9.41%) and professional drivers (9.32%) and lowest for university teachers (3.44%) Among women, the incidence was highest among production workers (7.20%) and cleaning workers (6.18%) and lowest among those working in physiotherapists (2.20%)

1.2.2 In Vietnam

In Vietnam, after many years of reform, social life has been improved Economic development has helped people's lives change drastically, people's

5 living needs are increasing In addition, work is gradually modernized, machinery has gradually replaced manual labor, cars, motorcycles have almost replaced bicycles this is also the cause of the development of obesity, hypertension and diabetes mellitus

1.3 Research on risk factors for impaired glucose tolerance and diabetes

Currently, the world has many studies on the risk factors for diabetes such as gender, age, family history of the disease, a history of hypertension, dyslipidemia, waist / waist circumference, BMI abnormal Recently, there are studies on working subjects, especially those who work shifts, overtime such as: Christopher Morris's study (2016) shows: glucose level has a change between working day and working night; Research has concluded that night shift can reduce glucose tolerance and increase insulin levels, and long-term decrease in glucose tolerance leads to diabetes mellitus

In Vietnam, researches on diabetes are mainly concentrated in the community, not many studies have been mentioned about diabetes in workers, especially those who work in shifts and part-time jobs hours According to research by

Vu Xuan Trung (2016), over 1009 employees regularly work shifts and overtime at 4 factories, the company shows that: the rate of diabetes is 2.3%, pre-diabetes is 15.1%

Chapter 2 SUBJECTS AND METHODOLOGY

2.1 Research subjects

Are employees of companies and factories, where they work in shifts and office hours but often work overtime

2.2 Research selection criteria

2.2.1 Criteria for selecting research subjects:

Employees working at three companies and factories voluntarily participating

in the study are aged from 25 to 55 years old for female and from 25 to 60 years old for male workers;

- Occupational age at least 1 year or more

- Work shift or overtime

6

- Agree to participate in research

2.2.2 Exclusion criteria:

- The employee was not present at the facility during the time of the study

- Subjects do not remember or provide answers in the research questionnaire

- Are using drugs: Corticosteroids, Thiazid,

- Having an acute illness

2.3 Study sites and time period

- Time: from October 2014 to April 2017

- Study sites:

+ DucGiang Garment Joint Stock Company, Hanoi

+ Son Nam Textile and Garment Joint Stock Company, Nam Dinh

+ Proconco Animal Feed Factory, Hai Phong

2.4 Study design: cross-sectional descriptive study

2.5 Sample size and sampling method:

1 ( 1 )

d

P P

2.5.2 Sampling method:

In the study, we performed a multistage sampling process, including:

Table 2.1 Companies are selected according to research criteria

No Name of study sites Working organization

1 DucGiang Garment Joint Stock

Company, Hanoi

Working by office hours and overtime

2

Textile Garment Joint Stock

Company Nam Nam, Nam

Dinh

Work shift

3 Proconco Animal Feed Factory,

- Phase 2: Selecting study subjects from selected study sites, we compiled a list

of qualified workers to participate in the study, and then used the single random sampling technique to select subjects to participate in research Because companies and factories have different numbers of subjects in the study area,

we use PPS (proportional to sample population size), to determine sample size

Table 2.2 Distribution of research subjects according to study sites

DucGiang Garment Joint Stock

Company, Hanoi

Son Nam Textile Garment Joint

Stock Company, Nam Dinh

8

2.6 Variables- studyindicators

* General characteristics of study subjects: gender, age, occupation age, medical history, smoking and smoking history, working time, working posture, overtime

* Prevalence of impaired glucose tolerance and diabetes mellitus: by sex, age group, occupational age, gender, medical history, smoking and smoking history, , BMI, work organization, working overtime hours

* The relationship between impaired glucose tolerance, diabetes and some factors in regular shift workers and overtime:

2.7 Method of gathering information

- Direct interview through research records on age, gender, occupation age, family history, overtime, shift work

- Blood glucose test:

+ Equipment used: fast blood glucose meter ONE TOUCH SURESTEPS of Jonhson&Jonhsoncompany (the machine uses photometric technology and is used by the Central Endocrine Hospital in national investigation programs) + Capillary blood glucose test: all study subjects

All were tested for total capillary blood glucose under the same conditions and tested for glucose tolerance (not tested for glucose tolerance solution for subjects with relatively high blood glucose test results (≥ 7mmol / L)

+ Glucose tolerance test (performed in subjects with fasting blood glucose from 5.6mmol / L to 6.9mmol / L): after the first capillary blood glucose test, subjects were given 75 gram of glucose type glucose, then subject to rest, no heavy physical activity, after 120 minutes of a second capillary blood glucose test

+ The research participants are informed one day in advance and fasted for breakfast before examining and testing capillary blood glucose

2.8 Data processing methods

The data from the research records after being collected were checked carefully before entering the data Full medical records will be entered into Epidata3.1

9 software Data are simultaneously entered into two computers to check the accuracy of data entry After checking that there were no errors between the two computers, the data was transferred to SPSS 22 software for processing according to the requirements of the thesis The way to code in the data file is

as follows: having diabetes is encoded as 1, without diabetes is encoded as 0 For objective 1: calculate the frequency and percentage by gender, age, occupation age, medical history prevalence of diabetes, impaired glucose tolerance

For objective 2: univariate logistic regression analysis according to research indicators For each research characteristic such as anthropological characteristics, medical history, work organization, overtime

2.9 Control of errors

- In order to minimize systematic errors when studying, researchers are trained

in interviewing techniques, weighing techniques, height measurement, waist circumference and buttocks Technique of serum glucose test using ONE TOUCH SURESTEPS

- Blood glucose meter and paper must be the same brand, same code (Johnson

& Johnson company)

- use a diurnal scale with the accuracy of 0.1mg

- The study subjects were carefully explained the testing procedures and the method of hyperglycemia before conducting the test

- Subject must fast for more than 8 hours, if the subject has had breakfast, it will not have a blood glucose test

- Checking and entering data into two computers with pre-installed data entry check program to avoid system error due to data entry

2.10 Author's role in research

The author is a person directly participating in the study with the Center for Occupational Health under the Institute of Science of Occupational Safety and Hygiene; selection of research subjects, face-to-face interviews, participation in physical examination and capillary glucose tests Glucose tolerance test

10 subjects or fasting dysglycemia were advised to test glucose tolerance by the medical staff in the factory, the company and the author

Supervising the subjects participating in the study to follow the procedure such

as direct interviewing the subjects, weighing, measuring blood pressure, After having the data, the author input data, analyzes and writes the thesis

2.11 Ethics in research

The research was approved by the Medical Ethics Council of Hanoi Medical University in the process of defending the doctoral thesis; get the support and active support of factories and companies Employees voluntarily agree to participate

Chapter 3 RESEARCH RESULTS 3.1 The prevalence of IGT, diabetes of employees who often work shifts and overtime

3.1.1 The prevalence of IGT, diabetes by gender

Table 3.1 Prevalence of IGT, diabetes by gender (n=1755)

196

3

12

86,0 1,3 5,3

213

3

13

86,6 1,2 5,3