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IntroductionDiabetesmellitushasbecomeaserious threattohumansintheworld.In2003,the WHOestimatesthat194millionpeopleor 5.1%ofthe3.8billionpeopleintheworld suffersfromdiabetesaged20-79yearsand in2025isexpectedtoincreaseto333 millionpeople(Madina,2011). Epidemiologyofdiabetesduringthelast20 yearsshowsaremarkabledevelopment,the current global epidemic of diabetes become. Countries of low and middle income face thegreatestburdenofDM.WorldHealth Organization (WHO) predicts an increase in thenumberofpeoplewithdiabetesin Indonesiafrom8.4millionin2000to around 21.3 million in 2030 (Perkeni, 2006). Theprevalenceofdiabetesishigherin individualswhohavemoreweightand obese,thehypertensivegroupandinthe groupswithlessphysicalactivity (Directorate NCD, 2008). A B S T R A C TThe prevalence of type 2 diabetes is increasing in all populations worldwide. TheresearchaimedtoanalyzetherelationshipriskoftheType2DM.This study was a cross sectional study. Samples in the research were 300 samples from eligible population.Data collection was carried out through interviews, antropometrymeasurementanduptakeofbloodsugar.Thedatawere analyzedbyusingaChisquaretestandmultivariateanalysis withthe logisticregressiontestwithAlfa5%.Theresultshowedthatcentralobesity (p=0,000),vegetableandfruitconsumption(p=0,000),physicalactivities (p=0,033),smoking(p=0,000)andstress(p=0,021)havetherelationship withtheoccurrenceofType2DM.Logisticregressionshowedthatthe consumptionofvegetableandfruitisthemostinfluentialfactorsonthe occurrenceofType2DM(p=0,000).Recommendationstudyexpectedthat policymakersdevelopdiabetescontrolprograms,especiallyinhigh-risk populations. Its need to manage of weight and improving of vegetables and fruit consumption. And for communities to controlblood glucose regularly. KEYWORDSRisk factors,early detection,Type 2 DM Diabetic Mellitus Type 2 in Wajo South Sulawesi, IndonesiaRidwan Amiruddin1*, Stang2, Jumriani Ansar1, Dian Sidik1, andAnna Widiastuty Rahman31Dept. Epidemiology Faculty of Public Health, Hasanuddin University, Makassar, Indonesia 2Dept. Biostatistics Faculty of Public Health, Hasanuddin University, Makassar, Indonesia 5Health District Office, Wajo District, South Sulawesi, Indonesia *Corresponding author

ISSN: 2347-3215 Volume 2 Number 12 (December-2014) pp. 1-8 www.ijcrar.com

2 BasedHealthResearch(Riskesdas)2007, Theprevalenceofdiabetesismultiplerisk factors,suchascentralobesity18.8%, GlucoseIntolerance10.2%,23.7% smokinghabits,lessfruitandvegetable consumption 93.6%,4.6%alcohol drinkinghabitsandlessphysicalactivities suchassports48.2%(Agencyfor HealthcareResearch&DevelopmentHealthDepartment,RepublicofIndonesia. 2008). InBonedistrictpeoplewithtype2diabetes areknownmostlyattheageof45-49years (22.1%)(Ramlah,2009)andresearch conductedRatnaningsih(2009)in Yogyakartaisknownthatrespondentswith aged40-59yearsismostwereencountered, i.e.52.4%,followedbythefinaladult respondentswas43.5%,thedataobtained showed that diabetes mellitus is more widely experiencedbymiddleagedadultsandlate adult(40yearsandabove)(Ratnaningsih, 2009).Beingoverweightisamajorriskfactorfor diabetes,anothercontributingfactoris physical inactivity, the less physical activity thatisdonethegreatertheriskfor developingdiabetes,physicalactivityhelps apersontocontrolweight.Research by Arief(2009)suggestsphysicalactivityisa risk factor for type 2 diabetes with OR 3.27, whileresearchXu,Weili,et.al(2005) showedobesityincreasestheriskoftype2 diabetes (OR = 3.39). This is consistent with studies inFinlandfoundthat central obesity associatedwithglucosetolerance (Lindstrom, et.al, 2003).Anotherfactorissmokingcausesspasms andconstrictionofbloodvessels.The researchers say that smoking can also lead to conditionsthatareresistanttoinsulin. Peoplewhosmoked 20cigarettes/day had a higher incidence of diabetes than non-smokers(OR2.66)(Gabrielle,Capri,et.al, 2005). In addition to the high stress levels of 1.59timestheriskofdevelopingdiabetes than those who rarely stress (Fitrawati, Gita, 2010).Epidemiologically,type2diabetesoftengo undetected and say onset or start of diabetes was7yearsbeforethediagnosisismade earlysothatmorbidityandmortalityoccur incasesthatarenotdetected(FK-UI, 2011).Severalstudieswereconductedwith across-sectionalstudydesignfoundthat patientswithtype2diabeteshavenotbeen diagnosedwithdiabetesknowshimself higherthanDMpatientswhohadbeen diagnosedpreviously(Xu,Weili,et.al, 2012).Oneof thesecond-level prevention isearly diagnosisthroughscreeningprogram (screening)whichisanearlydetectionofa diseaseoranattempttoidentifythedisease ordisorderisnotclinicallyapparentby examinationorprocedureusingaspecific testthatcanbeusedtoquicklydistinguish thoseapparentlyhealthybutactuallysuffer fromadisorder.DMscreeningisusefulfor capturingpatientswithtype2DMandDM withoutapreviousdiagnosis(Noor,NN, 2008).Theprevalenceofdiabetesdiagnosisby health professionals in South Sulawesi is 0.8 %andWajoranks9thoutof23districts, namely0.9%.Thissuggeststhatthe prevalenceishigherthantheprevalence Kab.WajoSouthSulawesiProvince (AgencyforHealthcareResearch&the DevelopmentDepartmentofHealth,2008). Theincreaseincasesofdiabetesoccurs everyyearinWajo.TheprevalenceofDM in 2010-2012 in a row is a 12:23 %, 12:25 % and0.3%.In2012,casesofDMwere highestintheDistrictofTempeby0.5% (DHO Wajo, 2012). 3 Materials and MethodsThisstudyhasbeenconductedinWajo district,SouthSulawesiIndonesia.Typeof studyisanobservationalstudywithcross sectionaldesign.Thepopulationinthis studywasallresidentsoftheDistrictof Wajo.Thesamplewereresidentsinthe VillageSiengkangDistrictWajo.300 sampleswereobserved, amongothers,aged40-59years,andiswillingtobethe subjectofstudybysigninganinformed consent,womenwhoarenotpregnantand do not suffer from other chronic diseases.Thedatacollectionwasdonebydirect interviewswithselectedrespondentsby using a questionnaire about, food frequency, physicalactivity,smoking,stress(Holmes scale)andthequestionofearlydetection (modificationscoreofAUSDRISK).In addition,primarydataobtainedthrough anthropometric measurements and collection ofcapillarybloodplasma(bloodglucose levelsofAs).Thisstudyhasexaminedby ethiccommissionboardofHasanuddin university in 2013.ThedatawereprocessedusingSTATA program.Univariateanalysistodetermine thecharacteristicsofrespondents.Bivariate analysis with Chi square test to examine the relationshipofvariablesthatinclude independentvariablesandthedependent variable.Multivariateanalysiswithlogistic regressiontodeterminewhichvariablesare mostassociatedwiththeincidenceofType 2DiabetesMellitus.Andavaliditytestfor screening.Result and DiscussionTable1showsthecharacteristicsof respondentsBasedontheincidenceofDM, 35.67 % of respondents suffer from diabetes. Study found that sex distribution of the most abundant in the female sex as many as 56.33 %.Then,studyfounddistributionof respondentsbyagegroupmostareinthe agegroupof55-59yearsasmuchas27.67 %.Distributionofrespondentsbylevelof education are most numerous in the level of high school education is as much as 32.33 % andrespondentswhoneverwenttoschool asmanyas2:00%.Distributionof respondentsbasedontheworkofthemost housewiveis36.67%andatleastthe respondents who a job as a laborer had been 1.67 %.InTable2theresultsshowedthatthe incidenceofType2DiabetesMellitusin centralobeserespondents(abdominal circumference>80cminwomenand>90 cminmen)is46.29%(n=81).Statistical testshowedassociationbetweencentral obesitywiththeincidenceofType2 DiabetesMellitus(p=0.000).The prevalenceratioobtainedfor2.23.This means that the incidence of Type 2 diabetes inthosewhoarecentralobese2.23times more than those who are not central obese.Distributionofrespondentsbasedonthe consumptionofvegetablesandfruits showedthatrespondentswithlessfiber number Type 2 diabetes mellitus is 50.92 %. Statistical test results showedan association withfruitandvegetableconsumption incidenceofType2DiabetesMellitus(p= 0.000).Theproportionofincidenttype2 diabeteshasbeen2.91timesmoreoftenin those who consume less fruit and vegetables thanthosewhoconsumeenoughvegetables andfruit(prevalenceratio=2.91).The incidenceofType2DiabetesMellitus occursinlessphysicalactivity,respondents with39.71%.Thetestresultsfounda statisticalrelationshipofphysicalactivity withtheincidenceoftype2diabetes mellitus(p=0.033).Theratioofthe prevalence rate was 1.47. 4 TheincidenceofType2DiabetesMellitus occursin68.49%lightsmokerswith smokingseverity1-199rodwhile respondentswithmoderatesmokers(200-599stems)withtype2diabetesmellitusby 54.55 %. The number of respondent who do not smoke and do not suffer from diabetes at is66.07%.Statisticaltestresultsshowedno associationbetweensmokingandthe incidenceofType2DiabetesMellitus(p= 0.000).Understress,thestressesof respondentswhosufferfromDMby42.18 %and57.82%ofrespondentswhodonot suffer from stress Type 2 diabetes. Based on statistical tests that have been done show no correlationwiththeincidenceofstress DiabetesMellitus,Type2(p=0.021).The proportionofincidenttype2diabeteshas been1.43timesmoreofteninthosewith their stress with no stress.Multivariateanalysisintable3shows that statisticallysignificantbasedontheresults ofthelogisticregressionanalysis,the variablemostrelatedtotheincidenceof Type2DiabetesMellituscentralobesity(p = 0.000).Obesityisanimportantindicatoroffat distributioninthebody,especiallythe abdomenshowednometabolicchanges includinginsulinresistancebymeasuring the abdominal circumference. Statistical test resultsshowednoassociationbetween central obesity with the incidence of Type 2 Diabetes Mellitus (p = 0.000). Lofgren, et al. (2004)foundthatthesizeoftheabdominal circumference(waistcircumference)is associated with insulin levels.Abalanceddietisthefoodconsumedmust meetqualityandquantity,andconsistsofa sourceofcarbohydrates,animaland vegetablesourcesofprotein,fatanda sourceofvitaminsandminerals.Statistical testresultsshowednoassociationwithfruit andvegetableconsumptionincidenceof Type2DiabetesMellitus(p=0.000)and multivariatetestbased,consumptionof fruitsandvegetablesarethemostvariable associatedwiththeincidenceoftype2 diabetesmellitusamongothervariables. Thisisconsistentwithresearchconducted byHandyetal.(2007)andSoetiarto, Farida,etal.(2010)whofoundno associationoffiberintake(fruitsand vegetables) to occurrence DM. In contrast to otherresearch,thefindingsWaridiyati (2006)inMagelangTidarGeneralHospital showednoassociationoffiberintakewith theincidenceoftype2DM.According Sukardji,Kartini(2009),peoplewith diabetesareencouragedtoconsume20- 35grfibersofvariousfoodstuffs.In Indonesia,advocacyisapproximately25 gr/1000calories/daywithemphasison soluble fiber.Physicalactivityisallthebodymovement that burns calories, such as sweeping, up and downstairs,ironing,gardeningand exercisingcertain.Aerobicexercise followedaseriesofirregularmotionwill strengthen and develop muscles and all parts ofthebody.Theseincludewalking, swimming,cycling,joggingorgymnastics (Tandra,2007).Theanalysisshowedthat theassociationofphysicalactivitywiththe incidenceoftype2diabetesmellitus(p=. 0332.Thestudyisconsistentwithresearch conductedAnani,Sri,etal(2012)in hospitalsArjawinangunKab.CirebonIndonesiawithcross-sectionalstudies indicatethatphysicalactivityassociated withbloodglucoselevels(p=0.012). Smokingisaglobalproblem.The prevalence of smoking is still quite high and therisksrelatedtothediseaseandthehigh mortality rate (Hariadi S, 2008). 5 Table.1 Distribution Characteristics of Samples in the Village District of Tempe Sengkang Wajo In 2013VariableN% DM Not cases casessex 193 107 64.33 35.67 Male12541.67 Female17558.33 Age group 40-44 45-49 50-54 55-59 Education level 63 82 72 83 21.00 27.33 24.00 27.67 Never school Un finish elementary6 33 2.00 11.00 Elementary6822.67 Junior high school6822.67 Senior high school9732.33 University289.33 Occupation

Not work Housewife 35 110 11.67 36.67 government private sector Labor 59 70 19.67 23.33 51.67 Retired217.00 Total253100,0 Table.2 Relations Obesity , Fruit and Vegetable Consumption , Physical Activity , Smoking and Stress with incident Type 2 Diabetes Mellitus in Sub Sengkang District of Tempe in 2013DM Type 2 DMNon DM Total Risk Factors n%n%n% Central obesity Obesity8146.394 175100.0 pNot Obesity2620.89979.2125100.0 Vegetable consumptionLess fiber8350.98049.1163100.00.000 Enough fiber2417.511382.5137100.0 Less activity19387.72712.3220100.0 0.033 Enough activity2472.7927.333100.0Smoking Heavy smoker1100.000.001100.0 0.000 Mild smoker1254.551045.4522100.0 Light smoker5068.492331.5173100.0 Non smoker4433.9316066.07204100.0 StressStress6242.28557.82147100.00.021 Not stress4529.410870.59153100.0 6 Table.3 Multiple Logistic Regression Diabetes Mellitus, Type 2 in SengkangTempe Wajo district 201395% CI VariableCoefficient zOR LLUL P Central obesity 1,4684,574,342,3118,1480,000 Vegetable consumption 1,4614,754,312,3587,8740,000 Physical activity0,9352,812,551,3284,8820,000 Smoking1,3575,533,882,4016,2830,005 Const.-3,654 Statistical test results showed no association between smoking and the incidence of Type 2DiabetesMellitus(p=0.000).Thisisin linewithresearchGabrielle,Capri,et.al (2005) showed that there is a relationship of smoking to the incidence of Type 2 diabetes mellitus(p=0.001)withORabout2.66. NeitherstudybyHoustonalsofoundthat currentsmokershada76%higherriskof developingType2diabetesthanthosenot exposed(Irawan,2010).Smokingdirectly improvesinsulinresistance.TheInsulinis responsetoanoralglucoseloadmorein smokersthannon-smokers.Smokershave thecharacteristicoftheinsulinresistance syndrome, including increased fasting blood sugar (Chiolero 2008 in Jafar, 2011).Mostpeopledonotrealizetheimpactof stressontheincidenceoftype2diabetes. Stresscanoccuratalmostalllevelsofage and even older people can also experience it. Based on statistical tests that have been done shownocorrelationwiththeincidenceof stressDiabetesMellitus,Type2(p= 0.0210).Theresultsareconsistentwith researchTrisnawati,etal(2013)foundthat thereisasignificantrelationshipbetween stressandtheincidenceoftype2diabetes mellitus.Thebody'sresponsetoemotional,mental healthisahormoneandneurotransmitter secretionofhormones,includingthemost dominantadrenalineisspendingthatwill triggerbloodsugarneeds.Inaddition,the increasedriskofdiabetesinthestress condition caused by excessive production of thehormonecortisolwhenaperson experiencesstress(Siagian,2012in Trisnawati, 2013).Severalquestionnaireshavebeendeveloped to capture undiagnosed diabetics and include symptomsandriskfactors.Ifapersonhas anyofthesymptomsofdiabetes(thirst, polyuria)anddiabetesmellitusconfirmed thediagnosisprocessisnotscreening.The maingoalofscreeningistodetectthose whowereasymptomaticandundiagnosed DMsothatthequestionnairebasedon symptoms not included in the screening tool (WHO, 2003).Conclusions Riskfactors(centralobesity,fruitand vegetableconsumption,smokingandstress) associatedwiththeincidenceoftype2 DiabetesMellitus.Recommendationstudy 1.Expectedthatpolicymakersdevelop diabetescontrolprograms,especiallyin high- risk populations so that early treatment canbeperformedonpatientswithdiabetes mellitustypesocialization2.Need managementofweightloss,especiallyin womenandmobilizationconsumptionof vegetablesandfruits(especiallylocal vegetables and fruits) and education patterns of food consumption on the incidence of the riskoftype2DiabetesMellitusinthe community.ForpatientswithDiabetes7 Mellituscanbemoredisciplinedindisease management,includingcontrolofblood sugarandregulartreatmenttoprevent complicationsAcknowledgementBasefortheimplementationofthisstudy, ourresearchteamwouldliketothankthe HeadoftheDistrictHealthDepartment Wajo,headofthehealthcenterof SalewangengWajoandtoallrespondents who have been active in this study. There is alsoourgratitudetotheUniversityof Hasanuddin due through Operational BudgetforHigherEducation Hasanuddin University2014fundssothatthisresearch can be held.ReferencesAgencyforHealthcareResearch& DevelopmentDepartmentofHealth, RepublicofIndonesia.(2008).National reports Riskesdas 2007. Anani,Sri,etal.(2011).Relationship betweenBehavioralControlDiabetes BloodGlucoselevelsOutpatient Diabetesmellituspatients(CaseStudy inHospitalArjawinangunCirebon). IndonesianJournalofMedicineVol.20: 466 - 478 4. Arief, M.I. (2009). Risk Factors for Diabetes MellitusinGenesisHospitalDR. WahidinSudirohusodo.Unpublished thesis.Makassar:GraduateHasanuddin Univerity. Brows,Ross,CandPetiti,DianB(Ed). (1998).AppliedEpidemiologyTheory ToPractice.OxfordUniversityPress: New York. DiseaseRiskinOverweightWomen premenopausal.J.Nutrition134:1071-1076. Fitrawati,Gita.(2010).AnalysisofRisk FactorsforDiabetesMellitusDisease OccurrenceinSoutheastSulawesi ProvinceGeneralHospitalin2010. The thesis was not published. 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