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Indian Journal of Community Medicine

Risk Factor Assessment for Type II Diabetes Mellitus in a Tertiary Hospital in Kolkata

Author(s): D. Dutt, G. Roy, P. Chatterjee

Vol. 29, No. 4 (2004-10 - 2004-12)

Abstract

Research question: What are the risk factors of type II Diabetes Mellitus (DM) among patients attending SSKM hospital Kolkata.

Objectives: To identify the locally relevant risk factors for type II DM.

Design: Case-control study.

Setting: Diabetes clinic of SSKM Hospital, Kolkata.

Participants: 75 cases and 75 controls (age and sex matched) attending diabetes clinic between Nov. 1998 and April 1999.

Statistical analysis: Odds Radios (OR) and 95% Confidence Intervals (CI), Chi-square tests and tests of proportions using Epi Info 6 software.

Results: The following were found to be significant risk factors for type II DM : family history of diabetes (OR 35, lower limit of confidence interval LLCI 24.1, P<0.001), income upper middle or more (OR 4.6, LLCI 2.2) urbanization within the last 25 years (OR 6.7, LLCI 2.8), self perceived stress (OR 4.3, LLCI 0.9) and alcohol consumption (OR 2.9 LLCI 0.9. The association between type II DM and religion, marital status, educational and occupational classes was not statistically significant.

Conclusion: Identified risk factors need to be addressed in prevention and control strategies in this area.

Key words: Diabetes Mellitus type II, Risk factors, Obesity, Sedentary lifestyle.

Introduction

The 42nd World Health Assembly (WHA) noted that Diabetes Mellitus (DM) is "already a significant public health concern" and the problem is growing especially in the developing countries1. Recognizing that the disease is chronic, debilitating, and costly and is attended by severe complications the WHA invited member countries to formulate preventive and control strategies, and guidelines for control programs were developed2. Though the incidence and prevalence of type I and type II DM and the relative contribution of these two major types of DM show differences in general it is observed that 85% of all DM cases are of the type II diabetes3. Both genetic and environmental (external) factors are important in the development of type II DM4,5,6. These external factors are modifiable and there is evidence that correction of these factors can bring down the risk of type II diabetes by upto 91%7,8. Thus, it would be important and worthwhile to determine the role of the various risk factors in the causation of type II diabetes in the local epidemiological set up so that appropriate local risk factor interventions can be planned.

Material and Methods

The study was conducted in the diabetic clinic of SSKM hospital, Calcutta. Cases were new patients (diagnosed within the last year) suffering from type II DM attending the diabetic clinic between November 1998 and April 1999. Controls were non-diabetic patients attending the surgery and ENT department (out-door) during the same period. 75 cases were pair matched for age (+ 5 years) and sex with 75 controls. Data on risk factors for DM were collected through interviews, examinations and investigations as relevant. Education and occupation were categorized as per Kuppuswamy's scale10, Income was categorized as per classification used by National Council of Applied Economic Research11, Obesity was defined as Body Mass Index (BMI) > 30 for males and >28.6 for females12, physical activity was categorized as per categories for sedentary, moderate and heavy work13.

Odds Ratio (OR) and the 95 percent Confidence Intervals (CI) were calculated for risk estimation using EPI INFO 6 software. Chi-square tests and tests of proportions, as relevant, were done for testing of statistical significance.

Results

A total of 75 cases and 75 controls were selected. The two groups had similar age distribution, which is expected, since the groups wer matched for age. There were 45 males and 30 females in both cases and controls.

Family history of diabetes was found to be insignificant risk factor (Table I) OR 35, Lower Limit of 95 percent Confidence Interval (LLCI) 24.1, P<0.001. Though the OR for patients belonging to Hindu religion was more than one, the factor was not statistically significant (LLCI = 0.7, p &gt; 0.05). Similarly though the OR for married patients, patients belonging to higher educational group (&gt;High School) and higher occupational group (&gt;semi professional) were more than 1 these factors were not statistically significant (LLCI&lt;1 and P&gt;0.05). Income, upper middle or more, had significantly increased risk for type II diabetes (OR 4.6, 2.2 and P&lt;0.001). Urbanization (within the last 25 years) carried significant risk (OR 6.7, LLCI 2.8 and P&lt;0.001) Obesity (OR 7.3 LLCI 3.2), Sedentary activity

Table I: Risk factor assessment for type II diabetes mellitus

Risk Factor Cases, N=75 Control, N=75 Odds Ratio 95% Confidence Interval x2 P
Family History of Diabetes 37 (90.2) 2 (5.3) 35,  24.1 - 1589.5 59.6 <0.001
Religion
Hindu vs Others 69 (92.0) 62 (82.6) 2.4,  0.7 - 7.6 2.9 >0.05
Marital Status
Married vs Others 64 (85.3) 62 (82.6) 1.2,  0.5 - 3.2 0.2 >0.05
Education
> High School vs. < High School 32 (42.7) 25 (33.3) 1.5,  0.7 - 3.1 1.4 >0.05
Occupation
> Semi-Professional vs < Semi Professional 14 (18.7) 6 (8.0) 2.6,  0.7 - 2.6 1.3 >0.05
Income Class
> Upper Middle vs < Upper Middle 47 (62.7) 20 (26.7) 4.6,  2.2 - 9.8 19.6 <0.001
Urbanization* 38 (50.7) 10 (13.3) 6.7,  2.8 - 16.3 24.0 <0.001
Obesity 47 (62.7) 14 (18.7) 7.3,  3.2 - 16.3 30.1 <0.001
Sedentary Activity 49 (65.3) 20 (26.7) 5.2,  2.4 - 11.1 22.5 <0.001
Self Perceived Stress 42 (56.0) 17 (22.7) 4.3,  2.0 - 9.4 17.4 <0.001
Alcohol Consupmtion 15 (20.6) 6 (8.0) 2.9,  0.9 - 8.9 4.5 >0.05
Smoking 39 (52.0) 27 (36.0) 1.9,  0.9 - 3.9 3.9 >0.05
Past Surgery 29 (36.8) 8 (10.6) 5.3,  2.1 - 13.9 15.8 <0.001

(OR 5.2) LLCI (2.4), self perceived stress (OR 4.3; LLCI 2.0) and history of surgery in the past (OR 5.3; LLCI 2.1) were significant risk factor P<0.001. Among habits, smoking (OR 1.9, LLCI 0.9) and alcohol consumption (OR 2.9, LLCI 0.9) were also important risk factors (P<0.05).

Discussion

The risk factors for type II DM were investigated through an age and sex matched case-control study. Family history of Diabetes was found to be a very important risk factor. It has been generally accepted that there is a strong genetic predisposition for type II Diabetes Mellitus.

Higher economic class was found to be a significant risk factor and probably influences the occurrence of DM indirectly, through affluence, causing a change in diet, the amount of food consumed and life style as has been found elsewhere6.

Obesity was a significant risk factor. Several studies have established that obesity is a significant5,16,17 and independent5 risk factor for DM II. In one study obesity was found to increase the risk of type II DM by 28 times compared to non-obese individuals17. Sedentary habits were by significantly associated with Diabetes in our study. Sedentary life style is known to be an important risk factor for type II DM4,8,9.

In our study smoking and alcohol consumption were identified as significant risk factors for type II DM (P, 0.05). Though there is strong evidence that smoking increases the risk of myocardial infarction and complications of peripheral vascular disease in those with DM it is uncertain whether smoking increases the risk of DM per se18,19. In our study self reported stress, history of trauma and history of surgery were found to increase the risk of type II DM (P<0.05). It has been suggested that chronic moderate stress leads to development of DM20,21. However more research is needed in these areas to elucidate the consistency and the specific nature of the cause-effect relationship of these factors with type II DM.

In our study univariate analysis of the data has identified several risk factors for type II DM. In other studies multivariate models have identified genetic predisposition, over nutrition, obesity and sedentary life style to be the important independent risk factors for type II DM9,14. Preventive strategies have identified that correction of over nutrition, obesity and increase in physical activity can reduce the risk of type II DM by a remarkable 91 per cent among those without a family history of diabetes and by 88% in those with a family history of diabetes7,8. Thus preventive strategies are effective and should not only be recommended for high risk individual but can also be considered for primordial prevention in view of rapid urbanization, changes in diet and in life style9.

Conclusion

Family history of diabetes, obesity, sedentary life style, urbanization, stress, smoking and alcohol consumption were identified as the important risk factors for type II DM in the local epidemiological set up in Kolkata city. These factors need to be addressed in prevention and control strategies in this area.

References

  1. Handbook of resolutions and decisions of the World Health Assembly and executive board, Vol. III, 3rd edition. Geneva, World Health Organization 1993:131-132.
  2. Reiber G, King H. Guidelines for development of national programmes for diabetes mellitus, Geneva, World Health Organization 1991.
  3. World Health Organization (WHO). Diabetes Mellitus. Report of a WHO study group. WHO Technical Report Series (TRS) 727. Geneva WHO. 1985:7-98.
  4. Zimmet P. Type 2 (Non Insulin Dependent) diabetes. An epidemiological overview. Diabetologica 1982;22:399-411.
  5. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Cosegregation of obesity with familial aggregation of type 2 diabetes mellitus. Diabetes Obes. Metab 2000;2(3) : 149-154.
  6. Bennett PH, Rushforth NB, Miller M. LeCompte PM : Epidemiologic studies of diabetes in the Pima Indians. Recent Prog Horm Res 1976;333-376.
  7. Pinkey J, Prevention and care of type 2 diabetes. BMJ 2002; 325:232-233.
  8. Hu FB, Manson JE, Stampfer MJ, Colditz G, Tiu S, Solomon CG et al Diet lifestyle and risk of type 2 diabetes mellitus in woman. N. Engl J Med 2001;345:790-797.
  9. Ramchandran A. Shehalata C, Latha E, Mantoharan M, Jijan V. Impact of urbanization on the life style and on the prevalence of diabetes in a native Asian Indian population. Diabetes Res Clin Pract 1999; 44(3):207-213.
  10. Kuppu Swamy B. Manual of Socio-economic status scale (urban) Mansayan, 32 Netaji Subhas Marg, Delhi. 1976.
  11. Statistical outlines of India (1995-96) TATA Services Ltd. Department of Economics and Statistics 1997.
  12. FAO/WHO/UNU. Energy and protein requirements. Technical Report Series No. 724. 1985.
  13. Gopalan C, Rama Shastri BV, Balasubramanian SC. Nutritive values of Indian foods. National Institute of Nutrition. Indian Council of Medical Research, Hyderabad 1991. pp. 10.
  14. Reardon W, Rose RJM, Sweeney MG : Diabetes mellitus associated with a pathogenic point mutation in mitochondrial DNA. Lancet 340:1376-1379, 1992.
  15. Tuomilehto-Wolf E, Tuomilehto J, Cepaitis Z, Lounamaa R, DIME Study Group : New susceptibility haplotype for Type I diabetes Lancet 1989:299-302,1989.
  16. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001 2001; 286:1195-2000.
  17. Colditz G, Willett WC, Stampfer MJ, Manson JE. Hennekens CH. Arky RA et al. Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990;231:501-513.
  18. Lacroix AX, Long J, Scherr P et al : Smoking and mortality among older men and women in three communities, N Engl J Med, 1991; 324:1619-25.
  19. Palumbo PJ, O'Fallon WM, Osmundson PJ : Progression of peripheral vasuclar and arterial disease in diabetes mellitus. What factors are predictive ? Arch Intern Med. 1991, 151 : 717-21.
  20. Lehman CD, Robin J. McEwen B, Brinton R : Impact of environmental stress on the expression of IDDM Behav Neurosci 1991;105:241-5.
  21. Stein SP, Charles ES : Emotional factors in juvenile diabetes mellitus. A study of early life experience of 8 diabetic children Psychosom Med, 1995, 37:237-44.

Department of Public Health Administration,
All India Institute of Hygiene and Public Health,
110 Chittaranjan Avenue, Kolkata-700 073.
E-mail : [email protected]

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