Behavioural Indicators as Risk of Diabetes Mellitus: A Community based Study in Manipur

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Diabetes Research
Open Journal http://dx.doi.org/10.17140/DROJ-2-124
Diabetes Res Open J
ISSN 2379-6391
Behavioural Indicators as Risk of Diabetes
Mellitus: A Community based Study in
Manipur
Nilupher Feroz, MPhil*; Meenal Dhall, PhD; Satwanti Kapoor, PhD
Department of Anthropology, University of Delhi, Delhi 110007, India
Research
*Corresponding author
Nilupher Feroz, MPhil
Department of Anthropology
University of Delhi
Delhi 110007, India
E-mail: nilupher12@gmail.com
Article History
Received: April 27th, 2016
Accepted: June 23rd, 2016
Published: June 24th, 2016
Citation
Feroz N, Dhall M, Kapoor S. Behav-
ioural indicators as risk of diabetes
mellitus: A community based study in
Manipur. Diabetes Res Open J. 2016;
2(1): 8-13. doi: 10.17140/DROJ-2-124
Copyright
©2016 Feroz N. This is an open
access article distributed under the
Creative Commons Attribution 4.0
International License (CC BY 4.0),
which permits unrestricted use,
distribution, and reproduction in
any medium, provided the original
work is properly cited.
Volume 2 : Issue 1
Article Ref. #: 1000DROJ2124
Page 8
ABSTRACT
Background: Diabetes Mellitus (DM) has become a major health issue all over the world.
Lifestyle factors may affect the health of the patients with diabetes directly or indirectly. Fam-
ily history of diabetes was given importance in various studies of this aspect of metabolic
syndrome.
Aim: The present study was conducted to nd out the effect of lifestyle indicators and family
history of diabetes among the diabetic Muslim population of Manipur.
Materials and Methods: Cross-sectional method was used for the study in which individuals of
both sexes in the age group from 20-45 years. The respondents were taken from two districts in
Manipur. Information was gathered by using a structured proforma.
Results: Chi-square test showed signicant p-values for stress level, family history, physical
activity and Quality of Life (QoL) of the participants. All these lifestyle indicators including
breakfast habit and family history of diabetes were found to be signicant except quality of life
on multinomial logistic regression analysis.
Conclusion: Lifestyle had greatly inuenced on the life of the diabetic Muslim people of Ma-
nipur in which it needed to give more awareness to them.
KEYWORDS: Diabetes mellitus; Family history; Lifestyle; Manipur.
ABBREVIATIONS: QoL: Quality of life; DM: Diabetes Mellitus; CMHA: Canadian Mental
Health Association; WHO: World Health Organization; BMI: Body Mass Index; CDC: Centre
for Disease Control and Prevention; HRQL: Health Related Quality of Life.
INTRODUCTION
Diabetes mellitus, a metabolic disease is increasing rapidly in almost all regions of the world.
India stands at the topmost position in the world with the highest number of people with dia-
betes mellitus of about 31.7 million in the year 2000 followed by China with 20.8 million in
second and the United States 17.7 million in the third place.1 The maximum increase of the
prevalence of diabetes in India will contribute largely to the global increase from 171 million
in 2000 to 366 million in 2030.1 India is experiencing an alarming increase in the incidence
and prevalence of type 2 diabetes mellitus (T2DM)2 both in rural3 and urban areas4 with higher
prevalence in South than in North India.5 A higher risk of diabetes has been reported from few
Southern and North-eastern states while several northern and central states were at lower risk
after adjusting for individual characteristics and place of residence.6
Family history of diabetes is considered as a positive factor if either or both the parents
have diabetes.7 Two to three times higher risk of developing glucose intolerance is associated
with those individuals who have family history of diabetes. It has been recognized that family
history of type 2 diabetes is one of the important risk factor of the disease.8,9 Individuals who
have a family history of diabetes can have two to six times the risk of type 2 diabetes compared
with individuals with no family history of the disease.8,10 The causes of type 2 diabetes are quite
complex, family medical history provides valuable genomic information. Hence, this informa-

Diabetes Research
Open Journal http://dx.doi.org/10.17140/DROJ-2-124
Diabetes Res Open J
ISSN 2379-6391
Page 9
tion represents the combination of inherited genetic susceptibili-
ties and shared environmental and behavioural factors.11
Physical inactivity is also another major behavioural
risk factor of type 2 diabetes. Sedentary habits of the individuals
developed higher prevalence of the disease.12 Quality of life of
people with diabetes is seriously threatened.13 The present study
was therefore conducted to examine whether these lifestyle indi-
cators affected the diabetic Muslim population of Manipur.
MATERIALS AND METHODS
All the participants studied were from Muslim community of
Imphal-East district and Thoubal district and were under medi-
cal supervision. A cross-sectional research method was used.
Among a total of 400 participants, 200 were diabetics and 200
were non-diabetics of both sexes. The purpose of the study and
techniques to be used were explained to each participant. Only
those participants who gave written consent were included for
the study. Ethical permission was taken from Institutional Ethi-
cal Committee (IEC) prior to the eldwork. Direct interview
method was used. Detailed information of the participants was
collected using standardized proforma. Stress level of the par-
ticipants was assessed by using standardized questionnaires
given by Canadian Mental Health Association (CMHA).14 Total
stress level was calculated and classied according to its cut-off
points (14-22=considerably above average, 10-13=above aver-
age, 9-0=average). QoL was assessed by using the World Health
Organization (WHO) Quality of life-BREF (WHOQL-BREF)
questionnaire.15 Statistical analysis of all the data collected were
analysed by using 17.0 version of SPSS. Cross tabulations were
carried out to nd out the frequencies, percentages and chi-
square values. Risk factors of the variables were determined by
using multinomial logistic regression.
RESULTS
The basic characteristics of the population under study are dis-
played in Table 1. The numbers of subjects were 200 each for
both males and females. Mean values of age, height and weight
were more for the patients with type 2 diabetes. Table 2 shows
cross tabulation of different stress levels among patients with
type 2 diabetes and non-diabetic participants. All the stress level
percentages were higher among patients with type 2 diabetes as
compared to non-diabetic participants. Chi-square value was
found to be statistically signicant at p<0.001. Distribution of
patients with type 2 diabetes according to family history of dia-
betes has been displayed in Table 3. Maximum number of dia-
betic subjects (60%) was found to have a family history of type 2
diabetes mellitus and 4.5% subjects had type 1 family history of
this disease. But the corresponding values were comparatively
less among non-diabetic participants. Statistical signicance
was found for this factor at p<0.001 .
Table 4 displays the cross tabulation of physical ac-
tivity status. It was found from the study that more number of
patients with type 2 diabetes were physically inactive as com-
pared to non-diabetics. Most of the non-diabetics were found to
be physically more active (98%). However, 77% patients with
type 2 diabetes were active for physical activity. Marked differ-
Characteristics Mean±SD
Sex Male (N=200) Female (N=200)
Diabetic Non-diabetic Diabetic Non-diabetic
Age (years) 41.2±4.16 32.8±6.97 40.6±4.79 31.8±6.90
Height (centimetre) 160.1±5.10 158.6±5.53 151.8±4.64 149.7±5.24
Weight (kilogram) 63.3±8.78 60.1±9.52 61.6±9.84 52.8±10.04
Stress level Diabetic N(%) Non-diabetic N(%) Total no.(%) χ²
Considerably above average 80(40.0%) 24(12.0%) 104(26.0%)
Above average 49(24.5%) 29(14.5%) 78(19.5%) 61.7***
Average 71(35.5%) 147(73.5%) 218(54.5%)
Total 200(100.0%) 200(100.0%) 400(100.0%)
Family history of diabetes Diabetic N(%) Non-diabetic N(%) Total no.(%) χ²
Type 1 9(4.5%) 1(0.5%) 10(2.5%)
Type 2 120(60.0%) 41(20.5%) 161(40.3%) 78.2***
Not applicable 71(35.5%) 158(79.0%) 229(57.3%)
Total 200(100.0%) 200(100.0%) 400(100.0%)
Table 1: Distribution of participants under different characteristics.
Table 2: Cross tabulation of different stress levels.
Table 3: Cross tabulation of family history of diabetes.
N: Number of participants.
N: Number of participants.
***p<0.001.
N=Number of participants.
***p<0.001.

Diabetes Research
Open Journal http://dx.doi.org/10.17140/DROJ-2-124
Diabetes Res Open J
ISSN 2379-6391
Page 10
ence with statistically signicance (p<0.001) was also observed
for physical activity status among patients with type 2 diabetes
and non-diabetic participants. In the present study, maximum
subjects had their breakfast regularly (93% diabetic and 98%
non-diabetic). Five percent diabetic and 1% non-diabetic took
breakfast irregularly. Two percent diabetic and 1% non-diabetic
were not taking breakfast at all. The differences in the various
categories were found statistically non-signicant (Table 5).
The median of the total score of QoL was calculated
and it was found to be 77. It was categorized as <77 as low qual-
ity of life and ≥77 as good quality of life. It was found from the
scores of quality of life of the participants (Table 6) that 54.5%
of them had low QoL out of which proportionately larger num-
ber were diabetic (66.5%). Only 42.5% non-diabetics had low
quality of life. Good quality of life was comparatively more in
number among non-diabetics (33.5% diabetic and 57.5% non-
diabetic). The difference in distribution of participants in the
quality of life categories was statistically signicant (p<0.001) .
Multinomial logistic regression of lifestyle indicators
and family history of diabetes was found out to the risk factors
for each category as given in Table 7. The patients under the cat-
egories of considerably above average level of stress and above
average level of stress were 6.9 times and 3.8 times more risk
of having diabetes respectively. Patients with family history of
Physical activity status Diabetic N(%) Non-diabetic N(%) Total no.(%) χ²
Inactive 46(23.0%) 4(2.0%) 50(12.5%)
Active 154(77.0%) 196(98.0%) 350(87.5%) 40.3***
Total 200(100.0%) 200(100.0%) 400(100.0%)
Breakfast consuming pattern Diabetic N(%) Non-diabetic N(%) Total no.(%) χ²
Irregular 10(5.0%) 2(1.0%) 12(3.0%)
Absent 4(2.0%) 2(1.0%) 6(1.5%) 6.3
Regular 186(93.0%) 196(98.0%) 382(95.5%)
Total 200(100.0%) 200(100.0%) 400(100.0%)
Quality of life categories Diabetic N(%) Non-diabetic N(%) Total no.(%) χ²
Low quality of life 133(66.5%) 85(42.5%) 218(54.5%)
Good quality of life 67(33.5%) 115(57.5%) 182(45.5%) 23.2***
Total 200(100.0%) 200(100.0%) 400(100.0%)
Lifestyle indicators Categories Exp(B) CI(95%)
Stress level
Considerably above average 6.9 (3.6, 13.3)
Above average 3.8 (2.0, 7.4)
Average 0ª
Family history of diabetes
Type 1 diabetes mellitus 20.5 (2.2, 186.7)
Type 2 diabetes mellitus 7.1 (4.2, 12.1)
Not applicable 0ª
Physical activity Inactive 13.2 (4.2, 41.6)
Active 0ª
Breakfast
Irregular 6.5 (0.9, 43.9)
Absent 8.1 (1.4, 45.5)
Regular 0ª
Quality of life Low quality of life 1.5 (0.9, 2.5)
Good quality of life 0ª
Table 4: Cross tabulation of physical activity status.
Table 5: Cross tabulation of breakfast consumption pattern.
Table 6: Cross tabulation of quality of life categories.
Table 7: Multinomial logistic regression of various lifestyle indicators.
N: Number of participants.
***p<0.001.
N: Number of participants.
N: Number of participants.
***p<0.001.
Note
CI: Condence Interval.
0ª: Reference (normal).
Diabetic: Dependent category.
Non-diabetic: Reference category.

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type 1 and type 2 diabetes mellitus were 20.5 times and 7.1 times
more likely to have risk of diabetes respectively. Those patients
who were less active in physical activity were 13.2 times more
at risk to develop diabetes compared to the active group. Irregu-
lar breakfast consumers and none breakfast consumers were 6.5
times and 8.1 times more at risk of developing diabetes respec-
tively. Patients with low quality of life had 1.5 times more risk
to suffer from diabetes.
DISCUSSION
Stress level, physical inactivity, breakfast consumption pattern,
quality of life, etc. do indicate the health status of an individual.
The present study was conducted to determine whether these
indicators affected the health of the diabetic and non-diabetic
Muslim population of Manipur. It was observed from the pres-
ent study that most of the patients with diabetes were found to
have stress and it was identied as one of the risk factor of dia-
betes. This was consistent with the results of earlier studies16 and
was suggestive of direct or indirect negative impact of stress on
blood glucose level through the release of stress hormones or by
disrupting self-care practices.
Indian population were commonly seen to have famil-
ial aggregation of diabetes with a high prevalence among very
close relatives and was transmitted vertically through more than
two generations.17 A study conducted among the South Indian
population showed the development of diabetes to be earlier
among the subjects with family history of diabetes as compared
to subjects without family history. Further, it was demonstrated
by which study that glucose intolerant subjects with family his-
tory were 7 years younger than subjects without a family history
of diabetes.18
In a self-reported study among US adults, family his-
tory of diabetes was shown to be a signicant predictor of diabe-
tes. The study estimated that those adults with a family history of
diabetes on their parents or siblings had four times more risk of
having diabetes than adults without a family history of the dis-
ease, after adjusting for gender, age, race, and body mass index
(BMI).19
The risk of type 2 diabetes was six times higher among
the women with family history of diabetes as compared with
individuals without a family history of the disease.10 Further-
more, the study conducted by Centre for Disease Control and
Prevention (CDC)20 demonstrated that the risk of having diabe-
tes among adults with two diabetic parents was more than twice.
In the present study, it was clearly found that patients
with type 2 diabetes had 60% type 1 and 4.5% type 2 family his-
tories of diabetes respectively. However, the risk of developing
diabetes was more among those who had type 1 diabetes family
history. Similarly, in a recent clinic based study among patient
with diabetes of Western Indian population, it was reported that
57.7% had positive family history out of which 37.0% had single
parent with diabetes, 10.5% had both parents with diabetes and
26.7% had near relatives suffering with diabetes which showed
high familial aggregation of T2DM in the Western Indian popu-
lation.21
Sedentary lifestyle adversely affected the health of the
people that might contribute to the increase in body weight, a
major risk factor of diabetes. Maintaining exercise regularly and
active physical work could contribute in improving the health
of the diabetic patient. Regular physical exercise whether aero-
bic or resistance was proved to be effective in the reduction of
degree of obesity and the incidence of metabolic results such as
type 2 diabetic individuals.22 Wing et al.23 suggested walking as
a form of exercise and prescribed an increment of exercise. In
the present study, it was found that the percentage of physically
inactive individuals was more among diabetics as compared
to non-diabetics and the difference between the two was also
statistically signicant. Moreover, it was marked that the physi-
cally inactive persons were 13 times more likely to be at risk of
diabetes. This nding was consistent with the study by Dowse
et al,24 that there was an association between physical inactivity
and risk of non-insulin dependent diabetes mellitus and impaired
glucose tolerance.
The present study among the Muslims of Manipur
showed relative risk between irregular or absence of breakfast
consumption and diabetes. Maximum percentage of patients
with diabetes had regular breakfast and very few them did not
consume breakfast at all. The risk of diabetes was found 8.1% on
patients not taking breakfast and 6.5% among regular consum-
ers. This result was consistent with a large prospective study by
Mekary et al,25 that the risk of type 2 diabetes might be decreased
among men by breakfast consumption. Breakfast omission was
associated with an increased risk of type 2 diabetes mellitus in
men even after adjustment for BMI which needed further stud-
ies to elucidate this association in women and in other ethnic
and racial groups and to conduct an in-depth analysis of specic
breakfast foods.
Marked signicant difference in the QoL between pa-
tients with diabetes and non-diabetic participants was revealed
in the present study. However, in multinomial logistic regression
analysis, it showed less difference and statistically non-signi-
cant. It could be due to social conditions and lifestyle of the peo-
ple which adversely affected their physical and psychological
domains. Similarly, this type of difference was found in Health
Related Quality of Life (HRQoL) of both genders in a study con-
ducted in Iran.26 Eljedi et al27 in their study on the diabetic pa-
tient living in refugee camps in the Gaza strip analyzed HRQoL
in comparison with gender and age matched non-diabetic con-
trols from the same camps. They reported that all the domains of
the WHOQL-BREF was negatively affected by diabetes and its
complications that had greatest effects on the physical health and
psychological domains but the effects was weaker for the social
relationships and environmental domains. Further, interactions
between gender and disease status between diabetic patients and

Diabetes Research
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Diabetes Res Open J
ISSN 2379-6391
Page 12
non-diabetic were also strong. However, this nding could not
be explained fully because the situation of the female patient
was worse which showed the evidence for gender inequalities.28
Another study29 found the deterioration of the QoL of
patients with type 2 DM by the presence of depression. This
nding resulted on the conclusion that the QoL of the subject
could be made better by treating depression.
CONCLUSION
The family history of diabetes as well as lifestyle indicators such
as stress level, physical activity, breakfast consuming pattern
and quality of life among Muslim males and females of Mani-
pur played crucial role in the life of patients with diabetes. The
present study demonstrated these parameters as risk factors of
this metabolic disease. Thus, there is a need to make efforts for
improving the lifestyle which might help in the reduction of this
disease.
ACKNOWLEDGEMENTS
The authors are thankful to all the participants of the Muslim
community of Imphal-East district and Thoubal district for their
full cooperation in the present study. Nilupher Feroz is grate-
ful to the University Grants Commission for nancial assistance
during the study under the Non-NET fellowship scheme.
CONFLICTS OF INTEREST
The authors declare that they have no conicts of interest.
CONSENT
The participants have been properly, made aware about the ob-
jectives, relevance and purpose of the research study. The partic-
ipants have been told that the anthropological information col-
lected from them will be utilized for the real purpose of research
and academic activities. They are also made to understand that
no money will be charged from them for any of the tests, and
they can withdraw from the study at any time, but will keep get-
ting counselling benets till the duration of the project.
All the participants consciously gave their consent to participate
in the above research study.
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