Nghiên cứu đặc điểm dịch tễ học bệnh đái tháo đường týp 2 và hiệu quả một số biện pháp can thiệp dự phòng tại tỉnh hưng yên (2013 – 2015) tt tiếng anh

In Vietnam, the research results of the NationalInstitute of Endocrinology in 2011 reported that thereare over 5 million Vietnamese people with type 2diabetes, accounting for 6% of the p

NGUYEN THI ANH

RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS

OF TYPE 2 DIABETES AND EFFECTIVENESS OF SOME PREVENTIVE INTERVENTION MEASURES

IN HUNG YEN PROVINCE (2013-2015)

SUMMARY OF DOCTORAL DISSERTATION

HA NOI-2019

Reviewer 1: Professor Truong Viet Dung

Reviewer 2: Assoc Professor Nguyen Thi Phi Nga

Reviewer 3: Professor Pham Ngoc Dinh

The dissertation was protected at the school-level council

At … (day) … (month) … ,2019

The dissertation can be found in:

1 Vietnam National Library

LIST OF PUBLISHED RESEARCH RELATED TO THE AUTHOR’S DISSERTATION

1 Nguyen Thi Anh, Dao Xuan Vinh, Dinh

Hong Duong (2018) Effect of media

interventions on nutrition and motility ofpatients with type 2 diabetes in Khoai Chaudistrict, Hung Yen province in 2014-2015

Vietnam Journal of Preventive Medicine, Vol

28(2), p.131-138

2 Nguyen Thi Anh, Dao Xuan Vinh, Dinh

Hong Duong (2018) Prevalence and factors

associated with type 2 Diabetes among Hung

Yen population aged 25-70 in 2014 Journal of Military Pharmaco-medicine, vol 43(%), p 162-

169

The World Health Organization (WHO) GlobalReport 2016 on Diabetes states that about 1.5 milliondeaths in 2012 are due to type 2 diabetes In 2014, theworld recorded that type 2 diabetes increased to 422million cases, equivalent to 8.5% of the population.According to the WHO, the incidence of type 2diabetes in 2014 is 7.1% in Africa, 8.3% in America,13.7% in the Middle East, 7.3% in Europe, 8.6% inSouth Asia, 8.4% in the Western Pacific and the globalrate is 8.5%

In Vietnam, the research results of the NationalInstitute of Endocrinology in 2011 reported that thereare over 5 million Vietnamese people with type 2diabetes, accounting for 6% of the population, theurban community is more prone to the disease than inrural areas, people with sedentary lifestyles, and thosewho abuse high-risk ready-to-eat foods stand a higherrisk The study also found that 80% of people with thedisease did not change their lifestyle and 60% hadpoor glycemic control

According to the statistics of Hung Yen PreventiveMedicine Center, in 2010, there were 15,344 patientswith type 2 diabetes who went to the provincialgeneral hospital and most had eyes and nerve

complications, kidney damage The cause is due tolate examination and detection, or by accidentaltreatment of other diseases and then found to beinfected So we do the following:

1 Describe some epidemiological characteristics and some related factors with pre-diabetes and type 2 diabetes in 25-70 year-old people in Hung Yen province (2013-2014).

2 Evaluation of communication intervention effect on nutrition, exercise and lifestyle of prediabetes in Khoai Chau district, Hung Yen province (2014-2015).

New contributions of the dissertation:

The study found that the incidence of type 2diabetes in Hung Yen was 4.7%; pre-diabetes was25.4% Five (05) factors are considered to beassociated with pre-diabetes: angina, being above 49years old, having sibling with diabetes, unknown risk,not eating peanuts Three (03) factors were associatedwith diabetes mellitus in subjects with Hypertensivesubstance (BP measurement), 49 years of age or older,with siblings with diabetes mellitus

The study used media interventions butevaluated efficacy with multidisciplinary controlevaluation criteria as guided by the Ministry of Health

The results indicate that a set of criteria can be used

to assess the control of type 2 diabetes and diabetes

in the community

Dissertation structure

A total of 133 pages including: 2-page issue set;Chapter 1: Overview of 34 pages; Chapter 2: Objectand Methodology 25 pages; Chapter 3: ResearchResults 43; Chapter 4: Discuss 26 pages; Conclusion

01 page, 01 page proposal

The thesis has: 41 tables, 1 figure and 19 charts, 102references

Chapter 1: OVERVIEW

1.1 Type 2 diabetes and related factors

1.1.1 Status of type 2 diabetes mellitus

1.1.1.1 The diabetes status in the world

According to the report by WHO in 2016, diabetesmellitus has increased steadily in recent decades.Type 2 diabetes is a global health and economic crisisthat threatens the health and wellbeing of allcountries, especially in developed countries In theglobal report on type 2 diabetes in 2016, there are 422million people worldwide with type 2 diabetes Thus,the rate of people having type 2 diabetes increased to8.5% in 2014, which was just 4.7% in 2008 About 2%

of deaths among 1.5 million people in 2012 As stated

by WHO, about 43% of deaths before the age of 70were related to high blood glucose levels, equivalent

to 1.6 million deaths High blood glucose mortality isassociated with age and the age having risk factorsranging from 50-79 years

1.1.1.2 Situation of type 2 diabetes in Vietnam

In Vietnam, type 2 diabetes is also tending toincrease with time and level of economic development,urbanization speed as well as profound changes inlifestyle, especially people in big cities such as Hanoi,

Ho Chi Minh city Motorcycles, automobiles andmechanics have almost replaced walking, bicycles andother manual work An imbalance in energy intake andenergy consumption is a risk factor for obesity,hypertension, hyperlipidaemia and diabetes In 2001,

new epidemiological studies of diabetes wereconducted in four cities: Hanoi, Hai Phong, Da Nangand Ho Chi Minh City The results showed that theincidence of diabetes in the four major cities of Hanoi,

Ho Chi Minh City, Hai Phong and Da Nang in subjectsaged 30-64 years is 4.9%, disorders of blood glucosetolerance is 5.9% , the rate of impaired fasting bloodglucose is 2.8%, the rate of people with risk factors fordiabetes is 38.5%, it is worrying that over 44% ofpeople with undiagnosed diabetes be guidedtreatment

According to research by Phan Huong Duong in

2015 in Hai Phong, the incidence of diabetes is 5.2%,pre-diabetes is 26.8% Prevalence of diabetes, pre-diabetes in the 30-39 age group was 4.2% and 21.7%;age group of 40-49 years old is 4.4 and 23.5%; agegroup 50-59 years old is 6.0% and 30.5% respectively.According to the results of the 2016 study in Kon TumProvince, the prevalence of diabetes in people aged45-69 years was 16.6%, in which diabetes was 3.5%and diabetes was 13.3%

As reported by the study results in 2017 in HungYen province, the proportion of households withdiabetes in the study was 8.6%, with a cross-sectionaldescriptive study of 1221 households People over age

60 with diabetes are 11.7% According to Nguyen ThyKhue and other authors, diabetes is a growing problem

in Vietnam and is linked to obesity, changes in dietarypatterns and other cultural transformations More

research is needed to better understand this healthissue and provide targeted interventions.

1.1.2 Risk factors for type 2 diabetes

1.1.2.1 Less effective risk factors for intervention

- Age

- A family history of type 2 diabetes (genetic factors)

- Ethnicity, race

- Factor of fetal development

1.1.2.2 Effective risk factors for intervention

- Lipid metabolism disorders and lipoprotein

- Some chemicals, pharmaceutical substances

gestational diabetes or heavy birth weight, polycysticovary syndrome.

1.2 Prophylaxis of type 2 diabetes in the community

1.2.1 Some intervention prevention of type 2 diabetes

* Da Qing Research - China

The Da Qing study was a case-control study of

577 obese individuals over a six-year period The studywas divided into four groups: nutrition, exercise,nutrition and exercise and control group For theintervention group only, subjects were advised to diet

to promote weight loss in subjects with a BMI of 25 kg /m2 to achieve 23 kg / m2

in the group taking medicine as compared with thecontrol group

* The American Diabetes Prevention Program (DPP)

The American Diabetes Prevention Program (DPP)

is a preventive intervention study of 3,234 people over25-year-olds, BMI ≥24 kg / m2 (≥22 kg / m2 for AsianAmericans) with glucose disturbance blood The studysubjects were divided into three groups: placebo,metformin 850 mg twice daily, and active lifestyleintervention Compared with the control group, thegroup had a 58% lower risk of developing diabetes andmetformin reduced the risk of developing diabetes by31%

* IDPP research

The Indian Dieabetes Prevention Program (IDPP)was conducted in 531 South Asian Americans withimpaired glucose tolerance, an average age of 46years The study was divided into four groups: controlgroups, lifestyle changes, metformin and metforminlifestyle modification After 3 years of study,cumulative incidence was 55% in the control groupand 39.3% in the intervention group

1.2.2 Preventive methods for type 2 diabetes.

Some of the method used to prevent type 2diabetes are: weight control, physical activityenhancement, blood glucose control, cardiovascularfactors control, psychological control, and adjustmentnutrition…

Chapter 2: OBJECTIVES AND RESEARCH METHODS

2.1 Object, location and time of study

2.1.1 Research subjects

2.1.1.1 Cross-sectional description of the object

The subjects selected for the study are adults,aged 25-70, who are currently living (permanently andhaving permanent residence) in 9 districts and 1 city inHung Yen province (In this study, we selected the agegroup 25-70 because of the representative characterthat was confirmed in a number of previous type 2diabetes surveys and in the Ministry of Health's Type 2Diabetes Control Program)

2.1.1.2 Object of intervention study

The subjects will be selected to participate in theintervention study of adults between the ages of 25-70currently living (permanently and having permanentresidence) in Khoai Chau district of Hung Yen province.These subjects were screened and diagnosed with pre-diabetes, type 2 diabetes in the cross-sectionaldescriptive study The study also expanded the survey

to relatives such as parents, children who masteredthe information on lifestyle, eating and living, as well

as affect the way of life of research subjects

2.1.2 Research time

2.1.2.1 Phase 1 - Cross-sectional descriptive research

Cross-sectional descriptive research was launched inFebruary 2014 and ended on May 30, 2014

2.1.2.2 Phase 2 - Intervention research

Intervention research was conducted in 9 months:+ T0 is the time of intervention initiation (June 2014)+ T3 is the time after 3 months of intervention(September 2014)

+ T6 is the time after 6 months of intervention(December 2014)

+ T9 is the time after 9 months of intervention (March2015)

2.1.3 Research location

2.1.3.1 Descriptive research sites

Cross-sectional descriptive researches wereconducted in 9 districts of Phu Cu, An Thi, Kim Dong,Van Giang, Khoai Chau, Tien Lu, My Hao, Van Lam, Yen

My and Hung Yen city

2.1.3.2 Places of intervention research

Intervention researches were conducted in 3communes in Khoai Chau district, Hung Yen province.+ Intervention group: Dai Hung commune and DongKet commune

+ Control group: Dong Ninh commune

2.2 Research Methods

2.2.1 Research design

The research design consisted of two successivestudies, namely cross-sectional descriptive researchdesign with analysis and design of community-controlled intervention studies The research wasdivided into two phases:

Phase 1: Analytical cross-sectional descriptive research

Phase 1 of epidemiological studies conductedthrough cross-sectional survey was conducted toevaluate and determine the prevalence of diabetesand pre-diabetes in subjects aged 25-70 years bymeans of laboratory tests for blood glucose analogy(rapid test), blood glucose test; weighting,anthropometric measures and knowledge assessment,practice on diabetes prevention, nutritional habits and

physical activity through pre-designed questionnaire.Identifying factors related to type 2 diabetes and pre-diabetes, such as gender, age, overweight, obesity,hyperlipidemia, lipid disorders, alcohol use, frequency

of use of food especially the lifestyle in terms ofnutrition and physical activity

Phase 2: Intervention researches

A community intervention research wasconducted in 3 communes divided into two groups.One group is intervention group: people diagnosedwith type 2 diabetes and diabetes in Dong Khoi, DaiHung - Khoai Chau district The subjects were informedabout lifestyle changes, nutritional counseling andadvocacy and prevention of type 2 diabetes in 9months The other is the control group was diagnosedwith diabetes in Dong Ninh commune, Khoai Chaudistrict This group did not have communicationintervention

Evaluation: Evaluation was carried out after 9months Evaluate the effectiveness of the intervention

by comparing it in the same group; comparingintervention group with control group Patients in bothgroups were all tested for cholesterol, triglyceride,LDLc, HDLc, plasma glucose, HbA1c, blood glucosecontrol; weighting, anthropometric measures at thebeginning, 3 months, 6 months and 9 months (T0, T3,T6, T9)

2.2.2 Sample size and sampling methods

2.2.2.1 Sample size of descriptive research

- Sample size: After calculation, the total samplesize of each age group was n = 4,333 In fact, wesurveyed 4,495 people.

- Method of selection: Select the research site:Select all 9 districts and Hung Yen city of Hung Yenprovince Select communes: Based on the list ofcommunes in each district will select 3 communes/districts to study by random method

2.2.2.2 Intervention research sample size

- Sample size: The minimum sample size wascalculated as n1 = n2 = 109 for the study and controlgroups In practice, we selected 1 control communeand 2 intervention communes and the actual number

of patients was 110 for the control commune and 220for intervention group

- Intervention selection: Select commune forintervention study: Commune selection for researchgroups is random to choose 2 intervention communes:Dai Hung, Kim Dong and one control commune - DongNinh

- Target: Selected subjects were systematicallysampled on a sample basis that included a list of alldiabetic prevalence in the district screening surveyselected for intervention and an additional selection tohave enough 330 eligible patients with pre-diabetes (3communes Dai Hung, Kim Dong, Dong Ninh)

2.2.3.6 Implement interventions activities

Control group: The subjects in the control groupwere not interfered At the time of assessment (every

3 months), subjects were also tested for blood glucose,

blood lipids, nutritional status, diet and risk factors as

in the group card

Intervention group: The subjects and theirrelatives in this group were educated actively aboutdiabetes prevention in 9 months period, after every 3months, the subjects were evaluated the bloodglucose, , nutritional status, diet and risk factors once.Interventions for lifestyle change communication,nutritional counseling, and adequate advocacy

Strengthening local organizational support fornutrition and health Incorporation of researchactivities into the activities of the steering committee

of primary health care programs in districts andcommunes that intervene in positive healthcommunication and nutrition Meetings once a monthwith key commune officials for local support andassistance including representatives from health,culture and information, women's unions, associationsFarmers, Commune People's Committee

Club organization:

Organizing the club for research participants in

2 intervention communes The club were held once aweek for the first two months Then it took place onceevery two weeks on a fixed day in the month

Participants: representatives of commune leaders,mass organizations and research subjects Particularly,for the intervention group, there are additional familymembers (spouse, children)

Each session is linked to a specific topic onissues related to diabetes prevention Preside over

these sessions are postgraduates and specialists indiabetes, nutrition and related subjects.

Developing community-based diabetesprevention media to broadcast on commune radio.Broadcast time is 10-15 minutes/time Number ofbroadcasts was 3 times per week for 9 months in 2intervention communes

2.2.2.4 Post-intervention evaluation

At the end of the intervention, participants inboth the control and intervention groups wereexamined for clinical signs, blood chemistry tests, andfrequency of food intake, exercising and properexercise following At the end of the intervention, thecontrol group also received appropriate dietarycounseling and exercise counseling to prevent type 2diabetes

2.2.3 Data processing and analysis

The results of laboratory tests, interviews, andclinical examination were processed according to thestatistical method of medicine on STATA 14.0 software.Calculate percentages with quantitative variables

Quantitative variables such as weight, height,using  and SD

Calculate the BMI, classify the nutritional statusaccording to the BMI threshold of WHO / WPRO, 2000.Use non-parametric statistical tests with quantitativevariables that do not follow the standard distributionrules Using algorithms for analyzing results such as

OR, χ2, p to determine differences and correlationsbetween factors exposed to diabetes and glucosetolerance

2.2.4 Some limitations of research and how to overcome.

There is a gender difference in the researchteam Hung Yen is a province with many industrialzones The labor force in these areas is mainly female(garment workers, leather shoes )

- Inadequate epidemiological data (from 2014) withlarge sample size, complex research index variables,and analyzing and processing data take much time

2.2.5 Ethical issues in research

There is no ethical violations in the research

Chapter 3: RESEARCH RESULTS

3.1 Epidemiological characteristics and some factors related to type 2 diabetes mellitus in Hung Yen province in 2014.

3.1.1 Epidemiological characteristics of type 2 diabetes in Hung Yen province in 2014

Table 3.6 Distribution of patients by blood glucose

status and diagnostic test

Status

Fasting glucose

Glucose tolerance Diagnose

3.146

69.9Pre-

diabetes

1.14

1.141

25.4