RISK FACTORS OF PRE-DIABETES IN ADULTS AGED 45 YEARS AND OLDER

IN CAU NGANG DISTRICT, TRAVINH PROVINCE

Cao Mỹ Phượng

Đinh Thanh Huề

Nguyễn Hải Thủy

1. INTRODUCTIONTra Vinh is a province in the south of Vietnam. There’re 7 dictricts and city in the province. Khmer people: 30%.

X

Pre-diabetes is a condition in which blood glucose levels’re higher than normal but not high enough to diagnose diabetes.

Diabetes is associated with aging. Diabetes has tended to happen in the

youngers, especially from the age of 45.

Most of researches’ve demonstrated risk factors to elevate blood sugar such as:

1. Overweight/obesity,

2. Hypertension

3. Lack of physical activities

4. Malnutrition

5. Having a family background of diabetes

6. Giving birth to a baby weighting more than 4 kg.

The complications of diabetes mellitus have been producing in the stage of pre-diabetes.

People with pre-diabetes are also at increased risk for developing cardiovascular diseases.

For a long period of time before diabetes detected, the degree of hyperglycemia above sufficient to cause pathologic and functional changes in various target tissues without clinical symptoms.

A cross – sectional study in Cau Ngang district, Tra Vinh province in December 2009 has pointed out the prevalence of pre-diabetes in participants aged 45 years and older is 19.5%, which seems slightly high.

What risk factors have processed to this percentage? This research is designed to answer that question.

2. RESEARCH METHOD AND SUBJECTS

2.1. Subjects

The population sample is the group ones from the age of 45 being permanent residences and living at Cau Ngang district, Tra Vinh province.

2.2. Research method

a case – control study

- Sample: Using the formula of Schlesselman [1]:

2

3

2

33βα

pf

qpf1fZu12uZn

With:

1ORf1

OR1f

2

1u ;

1ORf1

fORp3

; 33 p1q ;

Predicted: f = 0.30; OR = 2.5; accepted: = 0.05; = 0.10; → n 100.

A random sample selected from a cross sectional study in Cau Ngang district with a sample size n = 1226 (239 pre – diabetes subjects found).

The case group: 100 ones randomised from 239 pre-diabetes subjects.

The control group: 200 ones ramdomised from 872 subjects with normal blood sugar levels.

1 pre-diabetes subject matched 2 control subjects in 7 factors:

1. Age

2. Sex

3. Ethnic group

4. Place of living

5. Standard of living

6. Having a family member with diabetes

7. Giving birth to a baby weigh ≥ 4kg.

Data analysis:

Epi-info version 3.5.1 (2008).

Data is presented in the 2x 2 table for each related factor:

Using 2 of Yates, p = 0.05

Case Control

Expose A C M1

Non-expose B D M2

n1 n2 n

3. RESULT AND DISCUSSION

3.1. Factors related to present health HypertensionCase Control

Expose 50 90 140Non-expose 50 100 150

100 200 300

Hypertension is able to happen in a metabolic syndrome. Hypertension is also considered as a risk factor of diabetes. However, this research has not showed clearly that hypertension relates to pre-diabetes (OR = 1.2, p > 0.05).

Waist circumferences (cm)

Case Control

Expose 66 101 167Non-expose 34 99 133

100 200 300

o There is a relation between a waist circumference index based on the Asian standard and pre-diabetes. o The group who have high waist circumference index (male ≥ 90 cm, female ≥ 80 cm) approximately get 1.9 times greater risk of pre-diabetes than the normal waist circumference group (OR = 1.9; p < 0.01). o Therefore, the high waist circumference is a clearly risk factor of pre-diabetes in this community.

Body mass index (BMI)

Case Control

Expose 38 50 88Non-expose 62 150 212

100 200 300

Obesity is one of risk factors which may reach to diabetes. BMI is a measured tool to diagnose obesity. Based on the Asian standard of BMI, this research also shows that the group of overweight/obesity with high BMI (≥ 23 kg/m2) is probably at risk of pre-diabetes 1.8 times higher than the group with low or normal BMI (OR= 1.8, p < 0.05).

Case Control

Expose 74 109 183Non-expose 26 91 117

100 200 300

Body fat percentage Index (%)

According to Nguyen Thi Kim Hung, the subject who gains a high body fat percentage index would have more 2.5 times risks of elevating blood sugar. The result of this study has been showed that the body fat percentage index dramatically relate to pre-diabetes. The group people with slight high or high body fat percentage index would get more 2.4 times risks of pre-diabetes than the other. Hence, the body fat index is presented as one of the risk factors of pre-diabetes (OR = 2.4, p < 0.001).

Case Control

Expose 15 24 39Non-expose 85 171 256

100 200 300

Visceral fat index

The result of our study has not been demonstrated that the group with the high visceral fat index have more risks of pre-diabetes than the group with the normal visceral fat index (OR = 1.3, p > 0.05).

3.2. Factors related to health behavior SMOKING

Case Control

Expose 23 34 57Non-expose 77 161 238

100 200 300

Smoking may increase insulin resistances and excite to produce stress hormones – Both factors elevate the blood sugar level. In this research, smoking seems not to be related to pre-diabetes (OR = 1.4, p > 0.05).

Case Control

Expose 19 30 49Non-expose 81 170 251

100 200 300

Excessive alcohol drinking habit

The excessive beer and alcohol intake for a long time should increase insulin resistance. The study shows that in this community, the excessive alcohol drinking habit has not presented to be related to pre-diabetes (OR = 1.3; p > 0.05).

Case Control

Expose 42 57 54Non-expose 58 143 246

100 200 300

Sweet drinking – eating habit

The number of authors said that the sweet drinking – eating habit doesn’t relate directly to diabetes. The subjects with sweet drinking – eating habit have more 1.8 times at risk of pre-diabetes than the others (OR = 1.8; p < 0.05). It may be supposed that people with sweet drinking – eating habit would have frequently eaten and drunk sweet food and drink including high calories, which would have a reserve of excessive energy leading to obesity and insulin resistances. The relation of over carbohydrate consumption with the increase of obesity – a risk factor of diabetes – has been proved previously.

Case Control

Expose 34 34 49Non-expose 66 166 251

100 200 300

Daily excessive sugar consumption

There’s a relation between daily excessive sugar consumption with pre-diabetes. The ones with daily excessive sugar intake have more 2.4 times risks of pre-diabetes than the other group (OR = 2.4, p < 0.01).

Case Control

Expose 34 34 49Non-expose 66 166 251

100 200 300

Excessive fatty food intake

Ta Van Binh (2007) who researched in 1200 subjects living in Ha Noi announced that people with excessive fatty food eating habit may gain a percentage and risks of diabetes more 4 times than the control group. In our research, people with excessive fatty food eating habit approximately get 2.8 times greater risks of pre-diabetes than the control group (OR = 2.8; p < 0.01).

Case Control

Expose 31 64 95Non-expose 69 136 205

100 200 300

Daily vegetable intake

According to Ta Van Binh (2007), the prevalence and risk of diabetes is high in people without daily vegetable intake habitIn this study, risk of pre-diabetes in people with and without daily vegetable intake habit is not significantly different (OR = 0.9; p > 0.05). It may be supposed that the population of this study is living in the countryside so that vegetable is frequently a part of their daily food.

Case Control

Expose 7 14 21Non-expose 93 186 279

100 200 300

Eating after 8 P.M. habit

Eating after 8 P.M. probably leads to grow blood sugar level at night and in the morning. This research shows that eating after 8 P.M. habit is not a risk factor of pre-diabetes (OR = 1.0; p > 0.05).

Case Control

Expose 41 80 121Non-expose 59 120 179

100 200 300

Physical activity ≥ 30’/day, > 5 days/week

Physical activity is significantly related to diabetes. A lifestyle lacking of physical activities is demonstrated to be a risk of pre-diabetes. The result of this research has not been presented that the risk of pre-diabetes is different between people with or without physical activities ≥ 30’/day, >5 days/week (OR = 1.0, p > 0.05). It may be supposed that the studied population contains most of physical labors in the countryside therefore this factor has not effected clearly.

Case Control

Expose 18 24 42Non-expose 82 176 258

100 200 300

Stress

The insulin resistance caused by stress may lead to diabetes. Stress gives an increase of catecholamine and steroid cortisol in blood which may lead to overweight and obesity. However, stress has not been showed as a pre-diabetes risk factor in this study (OR = 1.6, p > 0.05).

5. CONCLUSIONS

The risk factors of pre-diabetes in this community include:

Overweight/Obesity (OR = 1.8) High waist circumferences (OR = 1.9) High body fat percentages (OR = 2.4) Sweet drinking – eating habit (OR = 1.8) Daily excessive sugar consumption

(OR = 2.4) Daily excessive fatty food intake (OR = 2.8)

Thank you for your attention!