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EPRAInternational Journal of
Published By :
EPRA Journals
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Multidisciplinary
Research
ISSN (Online) : 2455 - 3662
SJIF Impact Factor :4.924
Monthly Peer Reviewed & Indexed
International Online Journal
Volume: 4 Issue:9 September 2018
www.eprajournals.com Volume: 4 | Issue: 9 | Septembe r 2018
114
EPRA International Journal of
Multidisciplinary Research (IJMR)
Volume: 4 | Issue: 9 | September 2018 SJIF Impact Factor: 4.924 ISSN (Online): 2455-3662
DIABETES MELLITUS AND ITS RISK FACTORS
L N Liyanage
University of Kelaniya,
Dalugama, Kelaniya,
Sri Lanka
ABSTRACT
Prevalence of diabetes mellitus has raised faster in low and
middle income countries than in high income country.
Diabetes Mellitus is a cardiovascular metabolic condition
with characteristics of chronic high blood glucose levels
and a high risk of difficulties like, eyes damage, kidneys
damage, nervous system damage, hearing deficiency,
Alzheimer and cardio vascular diseases. There were 1.16
million cases of diabetes in Sri Lanka in 2016. There are
numerous risk factors of diabetes mellitus. But the majority
of the humankind is unaware of the factors of the
prevalence of this. Therefore the main purpose of this
study was to determine the factors effecting for diabetes
mellitus. The data were obtained from a cross sectional
survey conducted through a structured questionnaire using
100 participants chose from cluster sampling and simple
random sampling. Descriptive statistics including mean,
standard deviation, frequency, proportion, and percentage
and inferential statistics comprising
χ
2 test, factor analysis,
and discriminant analysis were used to analyze the data
using SPSS and Excel. Prevalence of diabetes mellitus in
females was higher than in males. Higher educated
population had a less prevalence of the disease. Diabetes
mellitus showed a positive relationship with age, less
physical activity, and BMI value. Among these diabetic
patientss, 56.9% had family history of diabetes; and
47.10% were performance sedentary work. There was a
significant association between diabetic community and
BMI
χ
2 (3) = 31.041, p = .000. Therefore, measures must
be taken to implement health policies to aware the society
about the diabetes mellitus.
KEY WORDS:
Diabetes Mellitus, Economic Burden,
Risk Factors
EPRA International Journal of Multidisciplinary Research (IJMR) | ISSN (Online): 2455 -3662 | SJIF Impact Factor: 4.924
www.eprajournals.com Volume: 4 | Issue: 9 | September 2018
115
I. INTRODUCTION
According to Brunner et al. (2008), diabetes
mellitus influence on all kind of socio-economic countries
but the low-income countries are more influenced. In low
and middle-income countries, the number of diabetic
patients in urban areas is 186.2 million while 126.7 million
live in rural areas (International Diabetes Federation,
2015).
People tend to use more high sugar food and do
sedentary work with the changing lifestyles, as a result of
globalization and industrialization. With that Diabetes
Mellitus has increased (Kolb & Mandrup-Poulsen, 2010).
Abegunde et al. (2007) mentioned that governments
should take actions to control Diabetes Mellitus in
countries; specially the low and middle-income countries
possess an enormous economic burden due to diabetes
mellitus. In the WHO South-East Asia Region, the number
of diabetic patients has been increased from 17 million in
1980 to 96 million in 2014 (Ramachandran et al., 2010).
According to them, lack of physical activity is the main
reason for the rise of Diabetes Mellitus in the region.
Nearly 9% of the adult population of the WHO South-East
Asia Region has Diabetes Mellitus. It is the second highest
WHO Diabetes prevailing region, after the Eastern
Mediterranean Region (WHO, 2016).
According to Begic et al. (2016), diabetes mellitus
has some risk factors including hyperglycemia, irregular
fat profiles, changes in seditious mediators and clotting. It
has been detected that type 2 diabetes mellitus is
matrimonial; there is a high chance that children will have
type 2 diabetes if both parents have it. A study done in
India stated that hypertension, overweight, obesity,
smoking, tobacco use, alcohol consumption, and exercise
pattern are main risk factors of diabetes mellitus
(Venugopal & Iyer, 2010). According to Hu et al. (2017),
risk factors of diabetes are older age, lower educational
level, being married/live together, higher BMI, larger waist
circumference, having an unhealthy diet and having more
comorbidities. A study done in Pakistan stated that there is
a high positive relationship between diabetes mellitus and
lack of exercise, diabetic family history, poor dietary
pattern, unhealthy food supply, and television viewing
(Shaikh et al., 2013). Many risk factors contribute to the
pathogenesis of diabetes, including sedentary behaviour,
diet, smoking and alcohol consumption (Bi et al., 2012).
In order to reduce the prevalence of diabetes
mellitus, at first we should know about the risk factors of
it. There are only few amount of analyses carried out in Sri
Lanka on that topic. So this study is carried out to find the
risk factors of Diabetes Mellitus in Sri Lanka.
II. METHODOLOGY
A Cross-sectional study was conducted in
Kirillawala – West Grama Niladhari (GN) Division in
Mahara Divisional Secretary’s (DS) Division in Gampaha
District, Sri Lanka. In this study, multistage cluster
sampling method was used. A study done in Sri Lanka also
used the multistage cluster sampling method (Katulanda et
al., 2012). Gampaha District was selected because it is one
of the top 3 diabetes prevailing districts in Sri Lanka. As
well as it is the second highest population district. Not only
that Gampaha district is consisting with people from all
over Sri Lanka.
It represents all kinds of ethnicity groups,
religious groups, income groups and employment status.
From that randomly, Mahara PS Division was selected.
And out of 92 GN Divisions, Kirillawala – West GN was
selected randomly.
Individuals with age of ≥18 years were included
in the study, because the prevalence of Diabetes Mellitus
in children is very low. According to the Medical
Statistical Unit (2015), the incidence of Diabetes Mellitus
under age 16 was 1.1%. So it is meaningless to add people
who are under 16 years to the survey. And another reason
for selecting adults who are aged older than 18 is because
the sampling frame can only make with adults. The
sampling frame for this research was the election registry.
The Kirillawala – West GN Division has a
population of 2491 people. It has 1793 people who are
older than 18 years. So the population size of this study
was 1793. Also, the study has used the "population
proportion sample size" formula to choose the sample size
(Israel, 2013). The sample size derived was 100 units.
Questionnaire was used as schedules to collect
data from the participants. Illiterate participants were
explained regarding the study and essential details were
collected from them. The parameters studied were
demographic features, and socioeconomic status. Body
mass index of each participant was calculated and was
categorized into underweight, normal, overweight and
obese.
Moreover, the data has been analyzed by SPSS
Version 21 Software and Ms. Excel 2010 Software.
Statistical tools such as descriptive statistics, chi-square
test, were used to analyze the collected data.
III. RESULTS
Among all the participants, 49% people who are
not suffering from diabetes mellitus and 51% people who
are suffering from diabetes mellitus were included in the
study. Table 1 depicts the socio demographic
characteristics of the sample.
The study revealed that in the diabetic
community, out 51 participants, 61% were female and the
rest 39% were male. On the contrary, in the non-diabetic
community, among 49 participants, 53% were male and
the rest 47% female. In the diabetic community, the
majority (49%) of the participants were in the age group
41-55 years. Factors like religion, occupation, monthly
income was not directly affected to the prevalence of
diabetes mellitus. But overwhelming majority of the
participants with negative family history did not suffer
with diabetes mellitus, while those were positive with
diabetes family history suffered from the disease.
EPRA International Journal of Multidisciplinary Research (IJMR) | ISSN (Online): 2455 -3662 | SJIF Impact Factor: 4.924
www.eprajournals.com Volume: 4 | Issue: 9 | September 2018
116
Table 1: Demographic Characteristics
Diabetic
Non-diabetic
N
%
N
%
Gender
Male
20
39
26
53
Female
31
61
23
47
Age
18-25
1
1.9
5
10.2
26-40
7
13.8
19
38.8
41-55
25
49.1
16
32.7
56-70
9
17.6
7
14.2
70<
9
17.6
2
4.1
Religion
Buddhist
40
78.4
41
83.7
Hindu
5
9.8
1
2
Christian
2
3.9
3
6.1
Islam
4
7.8
4
8.2
Occupation
Unemployed
16
31.4
11
22.4
Student
1
2
1
2
Businessman
4
7.8
3
6.1
Housewife
17
33.3
10
20.4
Clerk
1
2
0
0
Labourer
1
2
3
6.1
Mason
4
7.8
3
6.1
Other
7
13.7
18
36.7
Monthly Income
(Rs.)
Below 20,000
8
15.7
3
6.1
20,000 - 40,000
16
31.4
16
32.7
40,000 - 60,000
17
33.3
15
30.6
60,000 - 80,000
7
13.7
4
8.2
80,000 - 100,000
1
2
5
10.2
Above 100,000
2
3.9
6
12.2
Weight (kg)
40-60
18
35.3
25
51
60-80
27
52.9
22
44.9
80-100
6
11.8
2
4.1
Height (cm)
130-150
5
9.8
5
10.2
150-170
39
76.5
35
71.4
170-190
7
13.7
9
18.4
Smoking
Never
29
56.90
37
75.50
Former
4
7.80
6
12.20
Current
15
29.40
2
4.10
Occasional
3
5.90
4
8.20
Alcoholism
Never
27
52.90
35
71.40
Former
3
5.90
4
8.20
Current
17
33.30
3
6.10
Occasional
4
7.80
7
14.30
Source : Survey (2017)
There was a significant association between the
smoking and diabetes mellitus χ2 (3) = 11.418, p = .010.
As well as, there was a significant association between the
consumption of alcoholism and diabetes mellitus χ2 (3) =
11.758, p = .008
Among the diabetic community, the majority
(51%) was in overweight, followed by 29.40% normal
weight and 7.80% were underweight. On the other side, in
the non-diabetic community, the majority (81.60%) was in
average weight while both underweight and overweight
was 8.20%. There was a significant association between
diabetic community and BMI χ2 (3) = 31.041, p = .000.
There was no any significant association between
diabetic community and intake of bread, fish, egg, fruit
juice, and milk. But there was a significant association
between diabetic community and fast food intake χ2 (1) =
4.137, p = .042. There was a significant association
between diabetic community and cake intake χ2 (1) =
9.159, p = .002. There was a significant association
between diabetic community and toffee intake χ2 (1) =
13.431, p = .000. There was a significant association
between diabetic community and sugary food intake χ2 (1)
= 25.130, p = .000.
A principal component analysis (PCA) was
conducted with varimax rotation. The Kaiser Meyer Olkin
(KMO) measure tested the sampling adequacy for the
analysis, KMO = .710. Bartlett’s test of sphericity χ² (45) =
530.751, p =0.000, indicated that correlations between
items were sufficiently large for PCA. To sum up, the
analyses revealed three primary scales in our study that
may relate to risk factors for diabetes mellitus. By
considering the variables, factors were given a name.
Factor one is the consumption of food; factor two is the
consumption of drug and factor three is the physical
relationship.
IV. DISCUSSION
It has been observed though this research that,
females have a highest prevailing rate of diabetes mellitus
than males. A study done in Sri Lanka, by
Ambepitiyawaduge et al. (2012) also found that prevalence
of diabetes mellitus in the female is higher. But it was not
statistically significant. But a study done in Pakistan
revealed that there’s no difference in prevalence of
diabetes mellitus with the gender (Shaikh et al., 2013). A
study done by Ambepitiyawaduge et al. (2012) showed
that highest diabetes current age group is between 55 to 59
years. In this study, the highest prevailing age group is
between 41 to 55 years. It seems to be that the onset of
diabetes mellitus occurs early as stated by International
Diabetes Federation (2015).
When compared to the previous researchers,
Katulanda et al. (2012) found that Sri Lankan Tamils
suffer from diabetes mellitus (58.8%) rather than Muslims
(28.9%) or Sinhalese (15.8%). That result is different to
EPRA International Journal of Multidisciplinary Research (IJMR) | ISSN (Online): 2455 -3662 | SJIF Impact Factor: 4.924
www.eprajournals.com Volume: 4 | Issue: 9 | September 2018
117
the results of this study. It may be due to the fact that this
precise research was conducted in defined GN Division
while the study of Katulanda et al. (2012) was carried out
countrywide with a larger sample.
From this study we could conclude that BMI is
truly a high factor that affects diabetes mellitus. Majority
of the obsessed participants were suffered with diabetes
mellitus. A study done in Sri Lanka by Pinidiyapathirage et
al. (2012), showed that there is a definite relationship
between BMI and prevalence of diabetes mellitus. Another
study was done in Sri Lanka by Katulanda et al. (2012)
proved that prevalence of diabetes mellitus was higher in
provinces where the BMI value is higher when compared
to the provinces with a lower BMI value. International
Diabetes Federation (2015) has stated that the obesity is a
major risk factor for diabetes and its prevalence. They have
further explained that obesity is becoming a major issue
especially in Low and Middle-Income Countries.
When compared to the previous researchers,
studies showed that there is a positive relationship between
diabetic family history and prevalence of diabetes mellitus
(Padaki et al., 2011; Pinidiyapathirage et al., 2012). A
study was done in Pakistan also stated that there is a high
number of the patients (73%) in their study had a positive
family history of diabetes (Shaikh et al., 2013).
From this study, it was revealed there is a positive
relationship between diabetes mellitus and drug
consumption. But a study done in Sri Lanka by
Pinidiyapathirage et al. (2012), showed that there is a
negative relationship between smoking diabetes mellitus.
Another study showed a positive relationship between
diabetes mellitus and drug consumption (Bi et al., 2012).
V. CONCLUSION
Prevalence of diabetes mellitus is increasing at a
rapid pace in Sri Lanka. Many diabetic cases remain
undiagnosed as a result of lack of screening and adequate
diagnostic facilities in the country. Besides, diagnosed
diabetic patients suffer from severe complications of the
diabetes mellitus due to unawareness of self-care, lack of
financial comfort, regular checkup and facilities for
medical supervision.
The government should take measures to aware
the public about diabetes mellitus and its impact on the
economy and the health (as a person and as a whole). As
well as government should aware the public about the
correct managing styles diabetes mellitus such as self-
monitoring and periodic checkup for the disease.
ACKNOWLEDGEMENT
The encouragement, commitment, guidance and
constructive comments of Senior Lecturer Mr. Namal
Balasooriya, University of Kelaniya, is duly
acknowledged. And I would like to express my gratitude to
everyone who participated in my survey by taking time to
answer my questionnaire.
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