Objectives: To investigate prevalence and factors associated with type 2 diabetes among Hungyen population aged 25 - 70 in 2014. Subjects and method: A cross-sectional study was carried on 4,495 subjects aged 25 - 70 of Hungyen province, from 1st February to 30 May 2014 to find out prevalence and factors associated with diabetes.
Trang 1PREVALENCE AND ASSOCIATED FACTORS RELATED TO
TYPE 2 DIABETES AMONG HUNGYEN POPULATION
AGED 25 - 70 IN 2014
Nguyen Thi Anh*; Dao Xuan Vinh**; Dinh Hong Duong**
SUMMARY
Objectives: To investigate prevalence and factors associated with type 2 diabetes among Hungyen population aged 25 - 70 in 2014 Subjects and method: A cross-sectional study was carried on 4,495 subjects aged 25 - 70 of Hungyen province, from 1 st February to 30 May 2014
to find out prevalence and factors associated with diabetes After obtaining written informed consent, a structured questionnaire was used to collect socio-demographic, lifestyle, and medical information; anthropometric measurements were taken, and blood samples from finger tips were drawn to determine glucose level Association of type 2 diabetes with socio-economic and lifestyle-related factors was performed using multivariate logistic regression analysis Results: Prevalence of type 2 diabetes among Hungyen population was 4.7% Of 211 diabetes cases, 139 (65.9%) were female, 118 (84.9%) were over 49 years of age, 118 (84.9%) had a menstrual disorder, 29 diabetes subjects (13.7%) smoked, 34 (16.1%) consumed alcohol/beer,
31 subjects (14.7%) had at least one brother/sister living with diabetes, 107 (50.7%) raised their blood pressures, 98 (46.5%) had the history of angina, and 103 (48.8%) had the heart disease The association of diabetes with elevated blood pressure, age, and having a family history of diabetes was statistically significant in multivariate analysis Conclusion: Approximately 4.7% of the studied population lived with type 2 diabetes Elevated blood pressure, age > 49, and having
a family history of diabetes were statistically associated with diabetes The intervention or/and control strategy should be focused on people over 49, or having elevated blood pressure, or/ and a family history of diabetes
* Keywords: Type 2 diabetes; Associated factors; Hungyen; People aged 25 - 70; 2014
INTRODUCTION
Type 2 diabetes, a global epidemic with
a high socioeconomic cost, is the 4th cause
of mortality among non-communicable
diseases worldwide It could cause the
reduction of human average lifespans
from 5 through 10 years, the decrease of
life quality, and it also causes blind, kidney
failure, and loss of limbs for the patients [1, 2]
In 2012, approximately 422 million people (8.5% of global population) suffered from, and 1.5 million deaths related to type 2 diabetes [1] The prevalence of type 2 diabetes can be varied according
to countries and geographic regions,
*
**
Corresponding author: Nguyen Thi Anh (nguyenthianhgd.2016@gmail.com)
Date received: 08/03/2018
Date accepted: 23/05/2018
Trang 2for example, 1.4% in France, 6.6% in the
US, 8,6% in Singapore, 3.5% in Thailand,
and about 3.01% in Malaysia [2] The
prevalence of this disease is increasing
gradually, particularly in low and
middle-income countries Overweight and obesity
are proven to be important risk factors for
type 2 diabetes [1, 2]
In 2011, approximately 5 million
Vietnamese people lived with type 2
diabetes, equivalent to 5.0% of the total
population with higher prevalence in
urban regions, a sedentary population
with the habit of eating junk-food or
fast-foods Currently, Vietnam ranked 10th
highest prevalence of diabetes in the
world with a prediction of 8 million cases
in 2025 [3, 4]
Hungyen province, including 9 countryside
districts and only one city, has a
population of approximately 1.2 million In
recent years, numbers of type 2 diabetes
people are more frequently recorded in
health facilities According to Hung Yen
provincial preventive medicine center,
nearly 15,344 people were diagnosed
with type 2 diabetes, most of them had a
complication of eyes, neurological system,
lesion of limbs, and kidney damages due
to delayed examinations and treatments
Thus, this study was conducted to:
Fully understand the prevalence and
associated factors of type 2 diabetes
among the population in Hungyen in 2014,
and look for the opportunities of intervention
and control in the future
SUBJECT AND METHODS
1 Subject and sample size
A total of 4,495 participants, aged from
25 -7 0, was invited to participate in this study All of them agreed to sign the consent form, and 4,495 completed profiles were done
The descriptive sample size calculation formulation was used:
2
1 / 2
2
(1)
d
n: Sample size; 1-: Confidence level, with 1- = 95%, we got Z1- /2 = 1.96; p:
Anticipated population proportion, we chose p = 6% [3]; d: Absolute precision required, we chose d = 0.01; DE: Design effect (DE = 2); calculated sample size
n = 4,333 In reality, we invited 4,495 people to participate in this study
* Place and time: This study was
carried out in 9 districts and 01 city of Hungyen province, Vietnam from 1st
February to 30 May 2014
2 Methods
A cross-sectional study was carried on 4,495 subjects aged 25 - 70 of Hungyen province, from 1st February to 30 May
2014 to find out prevalence and factors associated with diabetes After obtaining written informed consent, a structured questionnaire was used to collect socio-demographic, lifestyle, and medical information; anthropometric measurements were taken, and blood samples from finger tips were drawn to determine glucose level Association of type 2
Trang 3diabetes with socio-economic and
lifestyle-related factors was performed
using multivariate logistic regression analysis
* Anthropometrical measurements:
Body weight is measured to the
nearest 0.1 kg using SECA scale, and
height is measured to the nearest 0.1 cm
by using a wooden ruler BMI is
calculated as weight (kg) divided by
height (m) squared (kg/m2), it can be
classified as BMI < 18.5 underweight,
18.5 ≤ BMI < 25.9 normal, 26 ≤ BMI
< 29.9 overweight, BMI ≥ 30 obesity
* Glucose concentration: Concentrations
of glucose were determined by an
auto-analyzer (Accu-Check)
* Questionnaire: The structured
questionnaire is composed of closed
questions with regard to socio-demographic
profiles (age, sex, and occupations),
lifestyle-related factors (alcohol/beer
consumption, smoking, physical activities,
and dietary/nutrient status), and medical
history (dyslipidemia, elevated blood pressure,
heart diseases, and obesity status)
* Data analysis: Data were managed
by using Epi.info 7.0 and all statistical
analyses were carried out by using
STATA v.14 (STATA Corp)
Data were summarized by using
frequency and proportion for categorical
variables, and mean and standard
variation/median and interquartile range
for continuous variables
After checking for normal distribution,
independent - sample t-test or Mann -
Whitney U test was used as appropriate
to compare continuous variables Pearson’s
χ2 test or Fisher’s exact test was performed
to compare frequencies of categorical variables
Univariate logistic regression analysis was used to assess potential factors associated with diabetes, and multivariate logistic regression analysis was performed
to test the associations of type 2 diabetes
with potential associated factors Data are
expressed as odds ratios with 95 percent confidence intervals (95%CI) A p-value of
< 0.05 is considered statistically significant
* Ethical issue: Ethical approval has
been obtained from the Ethical Review Board of the Military Medical University
RESULTS AND DISCUSSION
* The characteristics of study population:
- Sex: 1,411 (31.4%) were male; female: 3,084 (68.6%)
- Age: 1,789 people (39.8%) aged from
50 - 59
- Marital status: 4,141 (92.1%) were married
- BMI: 574 people (17.1%) were overweight
- Occupations: 2,687 people (59.8%) were farmer, 619 people (13.8%) did not have a permanent job, and 391 people (9.7%) were workers
- Literacy levels: 2,384 participants (53%) finished secondary school, and 1,406 (31.2%) had high-school or higher level of literacy
Trang 4Table 1: Characteristics of the studied cohort and prevalence of type 2 diabetes
(N1 = 4,495)
Diabetes (N2 = 211)
Sex (male)
Age groups
BMI
Marital status
Literacy levels
Occupations
Prevalence of type 2 diabetes in Hungyen was 4.7% It was about 4.5% in the female, and slightly higher, about 5.1% in the male group According to Phuong P.H et
Trang 5al (2012), the prevalence of diabetes was 5.5% of the population aged from 30 - 69 (5.9% in males versus 5.1% in females) [5] Dang T.H et al (2005) found that 5.7% of females and 2.9% of males in Quynhon city were suffering from diabetes [6] The number of females acquired type 2 diabetes is increasing gradually due to the risk of obesity, and female hormones as well
Regarding age groups, we found that the prevalence of diabetes raised accordingly
to age It was 1.3% in group from 25 - 39, 2.9% in group 40 - 49, 4.6% in group 50 - 59, and 7.4% in group 60 - 70 Differences between age groups regarding diabetes’ prevalence are statistically significant (p < 0.01) Our results are similar in compared with findings of other studies on diabetes in Vietnam [7, 8]
Table 2: Geographic distribution of studied participants
Districts/City
Total (n = 4,495)
Diabetes (n = 211)
Regarding geographic distribution, Vanlam and Myhao districts had the highest rate
of type 2 diabetes, at nearly 17.1%, followed by Khoaichau and Vangiang districts (approximately 13%) The low rates of diabetes were seen in Kimdong district (3.8%) and Hungyen city (5.2%)
Table 3: Association of type 2 diabetes with some socio-demographic, lifestyle,
medical, and family history factors
Variables
Diabetes (n = 211)
No diabetes
, 95%CI; p
Trang 6Newborn baby > 3.6kg 31 23.1 542 26.2 0.8 (0.6 - 1.3); 0,43
Habits
Family history (brother/sister
Medical history
(* BP - blood pressure; **: OR: Odds ratio)
Among diabetes population, 139 (65.9%) was female, 118 (84.9%) over 49 years of age, 118 (84.9%) had a menstrual disorder which higher than those in non-diabetes group (p < 0.05) Approximately 29 diabetes subjects (13.7%) smoked, 34(16.1%) consumed alcohol/beer, 31 subjects (14.7%) had at least one brother/sister living with diabetes There were 107 diabetes people (50.7%) who raised their blood pressures,
98 (46.5%) had a history of angina and 103 (48.8%) had a heart disease
It can be seen obviously that female, over 49 years of age, menstrual disorder, and raised blood pressure are associated with type 2 diabetes The differences were statistically significant (p < 0.05)
Table 4: Association between type 2 diabetes and some factors in univariate and
multivariate logistic regression analysis
Trang 7Don’t know overweight risk 1.30 0.001 0.98 0.900
Besides heart diseases and metabolic
syndrome, type 2 diabetes is proven to be
highly associated with lifestyle factors
(smoking, drinking alcohol/beer, lack of
physical activities), dietary (too much food
consumption, particularly, fatty and skin of
animals, less eating fishes, using cooking
oils, and eating fewer vegetables/fruits),
and family history of diabetes
Approximately 13.7% diabetes people
smoked cigars, and 16.1% of them drank
beer/alcohol Our results show that they
(diabetes people) prefer using animal oils
in preparing foods, eating meat plus skins,
they ate fewer fishes, bean, and
vegetables in comparison with
non-diabetes people It is suitable with the
finding of Binh T.V (2007), people with a
habit of eating animal fat have 6 times
higher risk of getting type 2 diabetes
compared to those who did not have that
habit [8]
In our study, overweight and obesity
people had 1.4 times higher risk of
acquiring type 2 diabetes compared to
normal BMI group, 95% CI (1 - 1.8),
p < 0.001 People with elevated blood
pressure have 2.5 times higher risk of
being diabetes 95%CI (1.9 - 3.4);
p < 0.001 People who have a family
member (brother or sister) living with diabetes will have 2.8 times higher risk of developing diabetes, 95%CI (1.8 - 4.2), p
< 0.001 According to the result of Phuong C.M’ study, 46.8% of diabetes people have at least one family member suffering from diabetes, much higher than those without, just 28.2% [4]
Regarding female population with diabetes, we found that 97.2% of women had a history of having new-born baby’s
weight > 4,000 grams Chien H.V study’s result on 1,880 subjects in Thaibinh province, found that 22.2% of women with
a history of giving baby over 4,000 grams suffered from diabetes [9]
We also found that type 2 diabetes is significantly associated with following factors such as elevated blood pressure, age > 49, the menstrual disorder, a family history of diabetes, lacking of knowledge about risks of diabetes (age, overweight), eating > 3 meals/day, too much food consumption, no eating fish and eggs, and less fruits consumption, with p < 0.05 The multivariate regression analysis proved that elevated blood pressure, age
> 49, and having a family history of diabetes were significantly associated with type 2 diabetes (p < 0.005)
Trang 8CONCLUSION
There was about 4.7% of the studied
population living with type 2 diabetes, of
those, the farmer was accounted for
64.5%, about 84.9% was over 49 years of
age, and 50.7% had raised blood
pressure Multivariate analysis proved
that elevated blood pressure, age > 49,
and having a family history of diabetes
were significantly associated with diabetes
The intervention or control strategy should
be focused on the group of people over
49 years, having high blood pressure, and
having the family history of diabetes
REFERENCES
1 WHO Global report on diabetes, Geneva
2016
2 Center for Disease Control and Prevention
Get the facts on diabetes CDC - Info, Atlanta,
GA 30333 USA 2011
3 Lanh N.V Diabetes in the age group of
40 - 69 in Ngabay town, Haugiang province
Vietnam Practical Medicine Journal 2011, No
5, pp.124-126
4 Phuong C.M Results of
population-based intervention on diabetes type 2 in
Caungang district, Travinh province Ph.D thesis Hue University 2012
5 Phuong H.P, Toa L.Q et al
Pre-diabetes and type 2 Pre-diabetes in Quang Ngai
province in 2011”, Journal of Endocrine Diabetes, 6th National Endocrine Diabetes conference Hue, 2012,1(6), pp 48-57
6 Dang T H., Thuan H X., et al
Prevalence of diabetes among Quynhon people aged over 30 in 2005 The full text of scientific topics, 3rd Vietnam Endocrine and Metabolism Conference Medicine Publisher
2005, p.648
7 Hai T.V, Xuan N.M et al Risk factors of
diabetes among out-patients of Thanhnhan Hospital, Hanoi Vietnam Practical Medicine Journal, 2006, No 548, pp.93-94
8 Binh T.V, Huyen N.T.N et al
Assessment of the prevalence of diabetes and risk factors in an urban district and a countryside district in Hanoi The full text of scientific topics, 3rd Vietnam Endocrine and Metabolism Conference Medicine Publisher
2007, pp.617-627
9 Chien V.H et al Prevalence and
associated factors of type 2 diabetes in some regions of Thaibinh province The full text of scientific topics, 3rd Vietnam Endocrine and Metabolism Conference Medicine Publisher
2007, p.490