Prevalence and associated factors related to type 2 diabetes among Hung Yen population aged 25 - 70 in 2014 – Nguyen Thi Anh

Journal of military pharmaco-medicine no5-2018 162 PREVALENCE 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 Journal of military pharmaco-medicine no5-2018 163 for 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 ) (1) Z p p n DE 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 Journal of military pharmaco-medicine no5-2018 164 diabetes 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. Journal of military pharmaco-medicine no5-2018 165 Table 1: Characteristics of the studied cohort and prevalence of type 2 diabetes. Variable Total (N1 = 4,495) Diabetes (N2 = 211) n1 % n2 % n2/N1 Sex (male) Male 1,411 31.4 72 34.1 5.1 Female 3,084 68.6 139 65.9 4.5 Age groups 25 - 39 388 8.6 5 2.4 1.3 40 - 49 1,057 23.5 31 14.7 2.9 50 - 59 1,789 39.8 82 38.8 4.6 60 - 70 1,261 28.1 93 44.1 7.4 BMI BMI < 18.5 367 10.9 17 8.1 4.6 18.5 ≤ BMI < 23 2,139 63.8 92 43.6 4.3 23 ≤ BMI < 25 574 17.1 64 30.3 11.1 BMI ≥ 25 274 8.2 38 18.0 13.9 Marital status Married 4,141 92.1 187 88.6 4.5 Separated/divorced 43 0.9 1 0.5 2.3 Widow 245 5.5 19 9.0 7.8 Never married 66 1.5 4 1.9 6.1 Literacy levels Il-literacy 15 0.3 2 0.9 13.3 Reading & writing (+) 179 3.9 15 7.1 8.3 Primary school 511 11.4 26 12.3 5.1 Secondary school 2,384 53.0 115 54.5 4.8 High-school & higher 1,406 31.2 53 25.1 3.8 Occupations Office holder 296 6.6 9 4.3 3.04 Free jobs 619 13.8 23 10.9 3.71 Farmer 2,687 59.8 136 64.5 5.06 Worker 391 8.7 9 4.3 2.30 Student 4 0.1 0 0 0 Housewives 134 3.0 6 2.8 4.47 Retired 233 5.2 26 12.3 11.1 Elderly 131 2.9 2 0.9 1.52 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 Journal of military pharmaco-medicine no5-2018 166 al (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) n % n % Phucu 502 11.2 20 9.5 Anthi 501 11.1 13 6.2 Khoaichau 501 11.1 26 12.3 Vangiang 509 11.3 28 13.3 Yenmy 500 11.1 17 8.1 Vanlam 509 11.3 36 17.1 Tien Lu 357 7.9 17 8.1 Kimdong 323 7.2 8 3.8 Myhao 422 9.4 35 16.6 Hungyen city 371 8.3 11 5.2 Total 4,495 100.0 211 100.0 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 (n = 3,143) OR ** , 95%CI; p n % n % Female 139 65.9 2,178 69.3 0.9 (0.6 - 1.1); 0.30 Age > 49 118 84.9 1,363 62.6 3.36 (2.1 - 5.4); 0.00 No child 5 3.7 112 5.10 0.7 (0.3 - 1.7); 0.40 Journal of military pharmaco-medicine no5-2018 167 Newborn baby > 3.6kg 31 23.1 542 26.2 0.8 (0.6 - 1.3); 0,43 Menstrual disorder 118 84.9 1,512 69.4 2.5 (1.5 - 4.0); 0,00 Habits Smoking 29 13.7 515 16.4 0.8 (0.5 - 1.2); 0.31 Alcohol/beer drinking 34 16.1 557 17.7 0.9 (0.6 - 1.3); 0.55 Family history (brother/sister having diabetes) 31 14.7 183 5.80 2.8 (1.8 - 4.2); 0.000 Medical history Raised BP* 107 50.7 904 28.8 2.5 (1.9 - 3.4); 0.000 Raised systolic BP 85 40.3 624 19.9 2.7 (2.0 - 3.6); 0.000 Raised diastolic BP 85 40.3 774 24.6 2.0 (1.5 - 2.8); 0.000 Heart disease 103 48.8 1,426 45.4 1.1 (0.9 - 1.5); 0.33 Stroke 3 1.4 23 0.70 2.0 (0.6 - 6.6); 0.27 Angina 98 46.5 1,318 41.9 1.2 (0.9 - 1.6); 0.2 Heart failure 3 1.4 45 1.40 1.0 (0.3 - 3.2); 0.9 Overweight 180 85.3 2,842 90.4 1.4 (1 - 1,8); 0,03 (* 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. Variables Univariate analysis Multivariate analysis OR p OR p Elevated blood pressure 2.50 0.000 2.60 0.000 Age > 49 3.36 0.000 2.46 0.003 Menstrual disorder 2.50 0.000 1.23 0.490 Sister/brother with diabetes 2.80 0.000 3.07 0.000 Don’t know risk related ages 1.30 0.010 0.81 0.470 Journal of military pharmaco-medicine no5-2018 168 Don’t know overweight risk 1.30 0.001 0.98 0.900 Eating > 3 meals/day 2.20 0.010 1.67 0.260 Too much food consumption 0.50 0.010 0.54 0.102 No eating fish 1.60 0.002 1.50 0.060 No eating eggs 1.50 0.004 1.16 0.470 Less fruits consumption 1.60 0.002 1.40 0.120 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). Journal of military pharmaco-medicine no5-2018 169 CONCLUSION 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 diabetes in Quang Ngai province in 2011”, Journal of Endocrine Diabetes, 6 th 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, 3 rd 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. 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