the situation of diabetes, pre-diabetes to the khmer in hau giang province and an evaluation of the efficacy of some interventional methods

It is essential to determine the prevalence of diabetes, pre-diabetes of the Khmer, find proper methods to prevent the disease.. To determine the rate of pre-diabetes, diabetes and some

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF PUBLIC HEALTH

NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY

NGUYEN VAN LANH

THE SITUATION OF DIABETES, PRE-DIABETES

TO THE KHMERIN HAU GIANG PROVINCE AND AN EVALUATION

OF THE EFFICIENCY OF SOME INTERVENTIONAL METHODS

Major in: Hygiene Sociology and Health Organization

Code: 62 72 01 64

SUMMARY OF MEDICINE PhD THESIS

HA NOI – 2014

PROJECT WAS FINISHED AT NATIONAL INSTITUTE OF HYGIENE AND

EPIDEMIOLOGY

Supervisor

1.Reader A/Prof PhD Nguyen Van Tap

2.Reader A/Prof PhD Nguyen Duc Trong

Referee 1: A/Prof PhD Ngo Van Toan, Hanoi Medical University

Referee 2: Prof PhD Le Van Nghi, Military Medical Academy

Referee 3: A/Prof PhD Do Thi Khanh Hy, Central Hospital of Gerontology

Thesis will be defended at Academic Committee of the Institute discussing at National Institute of Hygiene and Epidemiology

ABBREVIATION

BMI Body Mass Index Chỉ số khối cơ thể

CDC Center of Disease Control Trung tâm kiểm soát dịch bệnh Mỹ

EASD European Association for the

Hội tim mạch Châu Âu

FFAs Free fat acides Các axit béo tự do

FINDRISC Finnish Diabetes Risk Score Thang điểm nguy cơ đái tháo đường

Phần Lan GDNG Impaired Glucose Tolerance

(IGT)

Giảm dung nạp glucose

HbA 1 c Hemoglobine A 1 c Hemoglobine A 1 c

HDL.C High Density lipoprotein

Liên đoàn đái tháo đường quốc tế

LDL.c Low Density lipoprotein

cholesterol

Lipoprotein gắn cholesterol có tỷ

trọng thấp

NPDNG Oral Glucose Tolerance Test Nghiệm pháp dung nạp glucose

TG Triglycerid

THCS Junior High School Trung học cơ sở

THPT Senior High School Trung học phổ thông

TCYTTG World Heath Organisation Tổ chức y tế thế giới

TĐTĐ Prediabetes Tiền đái tháo đường

INTRODUCTION

Diabetes is not a contagious disease, has an upward trend It effects

on the health of working-age people in all over the world In 2003, there are 171,4 million people suffered from diabetes, it is predicted to be double in 2030 Every day, there are about 8700 people die because of diabetes

The prevalence of diabetes is different from each continents and areas In Singapore, the rate is 8,6%, Malaysia is 3,1%; that of Kampomg Cham, Cambodia (2005) of over 25-year-old people is 11%

In Viet Nam, Ngo Thanh Nguyen said that, at Bien Hoa (2011), the prevalence of diabetes of over 30-year-old people is 8.1%, including, the diagnosis is about 69,1% Huynh Nhan Hai, (2012), at Vinh Long, the prevalence of diabetes is 19,4%, type 2 diabetes is 7,4% Diabetes is still

a burden to economic and society However, the disease can be prevented and managed to have treatment, if it is consulted and treated early Moreover, a balance diet and proper exercises can help reduce the risk of prevalence and complication

In Hau Giang, a rice production place of Southwest Vietnam, still a poor province in urbanization Khmer make up 22% of the population They have their own habit, particulars; but have narrow knowledge about diabetes and how to prevent it Through a survey at Nga Bay County Town, in 2009, it is found that the prevalence made up 11,8% and it trends to increase However, there is no research related to the prevalence

of diabetes of the Khmer in our country

It is essential to determine the prevalence of diabetes, pre-diabetes of the Khmer, find proper methods to prevent the disease Moreover, it is to determine the risk of disease for Khmer and have methods to help medical station to manage diabetes It is shown through the 2 following purposes of the research project:

1 To determine the rate of pre-diabetes, diabetes and some factors related to diabetes of Khmer from 45 years old to over at Hau Giang Province in 2011

2 To evaluate the effect of some preventive methods of diabetes of Khmer from 45 years old to over at the research area

New points of science and reality value of the topic

- It is a research which can determine the prevalence of diabetes of the Khmer

There are 130 references, in Vietnamese (64), in English (66)

CHAPTER 1 OVERVIEW 1.1 Overview of diabetes

1.1.1 Concepts of type-2 diabetes

According to American Diabetes Association (ADA), in 2006, “Type 2 diabetes is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency”

According to International Diabetes Foundation (IDF), in 2010,

“Diabetes is a group of metabolic disorders of carbohydrate metabolism characterized by high blood glucose levels and usually resulting from insufficient production of the hormone insulin or an ineffective response

of cells to insulin Type-2 diabetes is characterized by insulin resistance and relative insulin deficiency, one of the two dysfunctions can occur at the time of clinical symptoms of diabetes”

“Pre-diabetes is a condition of glucose transformation deficiency which includes Impaired Fasting Glucose – IFG and Impaired Glucose Tolerance – IGT”

1.1.2 Diagnosis and classification of diabetes

1.1.2.1 Diagnosis of diabetes:

Standards for diagnosis of diabetes and blood sugar disorder of WHO – IDF in 2008 updated in 2010 and the diagnosis standards of ADA/WHO in 2010:

- Diabetes

Fasting blood glucose ≥ 7mmol/l (≥ 126mg/dl)

Random blood glucose or after 2-hour glucose tolerance (≥ 11,1 mmol/- ≥200mg/dl l), Or the patient was diagnosed and being treated diabetes

Or the concentration of HbA 1c ≥ 6,5%

2-Or the concentration of HbA 1c is from 5,7% - < 6,5%

- Normal Fasting blood glucose is < 5,6 mmol/l

- Type 2 diabetes: It is characterized by insulin resistance, relative insulin deficiency, and increased production of glucose by the liver, abnormal fat transformation Obesity caused from visceral fat or central obesity

- Other specific types: Diabetes due to absent beta cell function or absent insulin action due to genetics

- Gestational diabetes: occur while being pregnant

1.1.3 Factors related to Type 2 diabetes

In recent years, people have proved that there are many factors related to diabetes According to American National Institute of Health, factors that can cause Type 2 diabetes include:

- People ≥ 45 years old, 90-95% suffers from Type 2 diabetes

- Overweight (BMI ≥ 23 for Asian people) male pattern obesity (waist size ≥ 90 cm to male and ≥ 80 to female, high WHR)

- Blood pressure 140/90 mmHg or higher

- Have a family prehistory of diabetes

- Having high rate of cholesterol or triglycerides

- Less physical activities

Besides that, people also record other factors such as: high rate of beer consumption or smoking are also be the causes of diabetes

1.2 Intervention model to prevent diabetes

The Resolution 42.36 of WHA has introduced a development of Diabetes Prevention Program within national level, engagement of countries to prevent diabetes United Nations (2006) published the Resolution UN61/225 on the prevention of diabetes with the message: Developing policies to treat, prevent and taking care of diabetes International Diabetes Foundation (IDF) has designed a national diabetes prevention program which focuses on enhancing the awareness of community through communication and education Level-1 prevention is

to reduce the prevalence of diabetes It is also to change the behaviors and

to have early detection of the disease to reduce complications, fatality and enhance the quality of life for people

In Viet Nam, Ministry of Health has developed some programs for preventing some infected diseases in the period of 2010-2020 with the purpose to reduce the prevalence and death of diabetes With the following activities:

Organizing communication to change behaviors: to propaganda to

enhance the awareness of people about the risk of diabetes to prevent Specifically, it is to change bad behaviors, help people to know how to prevent and detect diabetes Therefore, they can avoid complication

Organizing evaluation in the community:

Previous studies affirmed that diabetes can be managed and prevented

We have intervened to prevent diabetes for Khmer at medical station by method as follows:

Change our diet: it is recommended to change our habit to reduce the disorder of blood lipids including the decrease of fat, cholesterol, the increase of protein with low fat, fiber

To reinforce physical activities: doing exercise regularly can prevent Type 2 diabetes because exercising help reducing the resistance

of insulin It is also easy to transform glucose to reduce plasma glucose

A scientific Exercising can fresh our mind, reduce stress and avoid

insulin resistance An increase of physical activities can reduce the risk of

obesity and eliminate some factors caused diabetes It is encouraged to

lessen drinking hard and stop smoking

CHAPTER 2 SUBJECTS AND RESEARCH METHODS

2.1 Subject

The Khmer who are 45 years old and over, living in Hau Giang

Province within the study period

2.2 Location: Residents live in: Long My, Chau Thanh A District and

Vi Thuy District, Hau Giang Province

2.3 Period: From 09/2011 to 10/2013 The first period is for

investigation and the second period is for intervention research (2 years)

2.4 Research methods

2.4.1 Cross-sectional descriptive study and community intervention

2.4.2 Cross-sectional descriptive study

- Sample size With single random sampling formula:

N = Z²(1-α/2) x p(1-p) x DE

d² Including: Z(1-α/2) = 1,96, with the accuracy of 95% d=0,03 is

selected odd Design coefficient DE = 2 p = 0,15 p is the rate of diabetes

and pre-diabetes under the study on Khmer in Cambodia in 2005 n = 1100

- Sampling: Random sampling of 3 districts /7 districts, county

town, Hau Giang Province are: Long My, Chau Thanh A District and Vi

Thuy District Two communes will be selected from each district,

Sample size is 1100 people /4792 people /6 communes The list of Khmer

who are over 45 years old will be selected from each commune which

corresponds with k

2.4.3 Community intervention

+ The research sample size is calculated by the following formula

- n: Minimum sample size for each group (intervention and control group)

- p1: Estimation rate of pre-diabetes, diabetes for the intervention group is

0,2

- p2: Estimation rate of pre-diabetes, diabetes for the control group is

0,2982

- α: Statistical significance with the accuracy of 95% (α=0,05)

- β: Probability of the II error With β=0,2

- Z² (α,β) = 7,9

The rate of pre-diabetes , diabetes desired 10% reduction compared

to pre-intervention ( 29.82 % ) The rate of pre-diabetes , diabetes

mellitus after intervention was 20 % So ( p2 ) is estimated to 0,2982 % , due to the rate pre-diabetes , diabetes does not change or less change Placing into the above formula, we have the minimum sample size

is 302

So, the sample size after 2-year taking intervention at 2

communes has the smallest n with 302 in the community of and-over Khmer At the 2 control commune, we also choose the smallest sample size 369 to investigate after taking intervention

Sampling: taking random sampling at the two intervention communes are Cai Tac and Bay Ngan of Chau Thanh A District For that

of control group are Vi Thuy Commune and Vinh Trung Commune of Vi Thuy District

- To evaluate the efficiency of intervention model

Efficiency index (CSHQ)

CSHQ (%)= │p1 – p2│

x 100 │p1│

p1 is the rate of pre-intervention

p2 the rate of post-intervention

The efficiency of intervention (HQCT)

HQCT (%) = CSHQ intervention – CSHQ control

2.5 Officials in charge

Graduate student is the project’s director, directly manage, ordinate with the staff of Health Department, District medical center, medical office, commune medical station, collaborator of hamlet medical station

co-2.6 To minimize research errors

To manage, reduce research errors through: sampling, investigator, gathering information, tools, machines and medical equipment, standardizing data

2.7 Data processing

EPI-INFO software 3.5.3, Excel 2003 and Epi 6.0 are used for analyzing through testing χ2, OR, Multivariate Regression Analysis

CHAPTER 3 RESEARCH’S RESULT 3.1 THE PREVALENCE OF PRE-DIABETES, DIABETES AND SOME RELATED FACTORS 3.1.1 The prevalence of pre-diabetes, diabetes to the Khmer

Table 3.2 The prevalence of pre-diabetes and diabetes to the subjects

Through a survey of 1000 people, the prevalence of pre-diabetes was 17,9%, diabetes is 11,9%, including 9,4% of the new detection, The rate of new detection made up 78,6%

3.1.2 Knowledge, attitude, practice on preventing diabetes to Khmer

41,1% has knowledge about the disease symptoms; 38,1% for the risk factors; the consequence of disease is 54,1%; 45,9% for preventive methods; 41,1% know how to detect the disease 61,9% has bad attitude

for the prevention of diabetes; the good one is 38,1%

The percentage of people doing exercises is 32,5%, 35,2% is for balancing nutrition of daily meal, acquiring the advices and health communication, 32,5% takes periodical health examination and 41,1% do

not abuse beer or cigarettes

3.1.3 Some factor related to Khmer who get diabetes

Table 3.10 The relationship

The prevalen

ce of diabetes

between demography and diabetes

The prevalence of diabetes of male is 11,4% while that of female is 12,3%, Age group has the smallest prevalence of diabetes is 45 – 54 made up 10,2%, the highest is over 65 with 16,5 % The prevalence of diabetes of people who live in the countryside is 12,7 % The prevalence

of diabetes of farmers is 13,1%, that of hired labor is 13,3%

The prevalence of diabetes of literacy people is 18,8%; 12,4% is of people who has high school level It does not have statistical significance

to economic life

1 high sugar

0,0

1 Yes

421 65 15,4 Physical

0,0

4 Yes

590 72 12,2

1,16 -4,25 0,01

After multivariate regression analysis, it shows that:

People who have a high sugar consumption diet may double the risk

of diabetes in comparison with people who have a low sugar consumption diet (p< 0,05)

People who do not eat after 20 o’clock has the risk of diabetes as 0.6 times as that of people who eat after 20 o’clock (p< 0,05)

People who do physical activities has the risk of diabetes as 1.7 times as that of people who do not do physical activities ( p<0,05)

People who do not drink alcohol during the day has the risk of diabetes as 0.5 times as that of people who drink alcohol during the day (p<0,5), There is a link between diabetes and smoking with p<0,05

People who have high blood pressure has the risk of diabetes as 1,7

as that of people who have normal blood pressure (p< 0,05)