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ORIGINAL ARTICLE
Year : 2022 | Volume
: 13
| Issue : 4 | Page : 363-367
Women and diabetes: Risk profiling of young working women using Indian Diabetes Risk Score: A study from Northern India
Monika Suri, Payal Mahajan
Department of Nutrition and Health, School of Medical and Allied Sciences, G D Goenka University, Gurugram, Haryana, India
Correspondence Address:
Ms. Monika Suri
858, Sector 46, Gurugram, Haryana 122002
India
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jod.jod_64_22
Background: Prevalence of undiagnosed diabetes is 53.1% in India as reported by the International Diabetes Federation in 10th Diabetes Atlas 2021. Diabetes is affecting people of all ages and gender. Very high prevalence of abdominal obesity and large percentage of women in Haryana with elevated body mass index (BMI) make it crucial to screen them for type 2 diabetes. Indian Diabetes Risk Score (IDRS) is a proven tool to identify the people at risk of becoming diabetic in future. Early detection and primary prevention are the most effective ways to prevent the rising numbers among women. Objective: This study was conceived to estimate the risk of type 2 diabetes in young working women (25–40 years) using the IDRS tool. Materials and Methods: A descriptive, cross-sectional observational study was followed through with 504 working females in the age bracket 25–40 years. Data were taken down using a structured questionnaire administered through personal interview procedure. Demographics and parameters listed in IDRS such as age, waist circumference, family history of diabetes, and physical activity were itemized in the questionnaire. A purposive random sampling procedure was utilized for getting the numbers. Known cases of diabetes and subjects who refused to sign informed consent were excluded from the survey. Results: About 504 working women completed the survey questionnaire. IDRS scores revealed 18%, 53%, and 29% of the subjects in high-, moderate-, and low-risk brackets, respectively. Waist circumference, sedentary lifestyle, family history, and age were found to be significantly associated with the risk level. Conclusion: The research study brings forward the need for early detection though screening of young women at risk of becoming diabetic in future and necessary steps for primary prevention for the same. It remains imperative to device a comprehensive communication strategy for responsive transitional progression from high risk to absolute healthiness among the young working women.
Keywords: BMI, Haryana, IDRS, Indian Diabetes Risk Score, type 2 diabetes, working women
Reported by the 10th edition of Diabetes Atlas More Details, diabetes is one of the rapidly spreading global health emergencies of the twenty-first century.[1] The global ranking for the year 2021, India stands at number 2 with 8.3% prevalence of diabetes and 53.1% proportion of undiagnosed diabetes.[2] Expected to remain at the same rank in future too, the current 74.2 million diabetic adult Indian population is anticipated to increase to 124.9 million by the year 2045.[2] The pre-diabetes range from 6% to 14.7% in different states; the average prevalence of pre-diabetes has been found to be 10.3% in 15 Indian states covered in the study undertaken by the ICMR-INDIAB study.[3]
Diabetes affects the men and women equally, with the prevalence of diabetes in women (10.2%) only slightly lower than that in men (10.8%).[2] As per the National Family Health Survey-5 for the year 2019–21, the data for the state of Haryana, India suggest that prevalence of diabetes among women aged 15+ years was 13.5% in urban Haryana, which is much higher than the overall prevalence of diabetes in India. About 37.5% of women (age 15–49 years) were overweight or obese (BMI > 25.0 kg/m2) and that 64.6% of women had a high-risk waist-to-hip ratio >0.85.[4]
The literature indicates that the gross effects of diabetes are adverse for the women. Miettinen et al.[5] reported that 36.9% of women with diabetes died within the first year of their myocardial infarction, in contrast to 20.2% of women without a history diabetes. Women with diabetes are significantly more likely to suffer a stroke than women without diabetes.[6] In comparison to men, women are also at an elevated threat of diabetic retinopathy blindness in the middle age.[6] It is well documented fact that overweight and obese women are at an elevated risk of developing hyperglycemia in pregnancy, which becomes a risk for pregnancy complications and adverse outcomes. The hyperglycemia in pregnancy elevates the susceptibility for future type 2 diabetes mellitus and is the most conclusive risk factor of type 2 diabetes mellitus in women. Therefore, the care of diabetes during reproductive years and pregnancy demands particular attention, as this at-risk duration programs health of progeny even in a gender-specific way. Otherwise, hyperglycemic parents give birth to diabetic young ones, thereby contributing to pandemic increase of diabetes mellitus.
The purview of global and local prevalence of undiagnosed diabetes and its comparatively adverse effects on the women sound an alarm and concern about the deteriorating health profile of the women; it remains imperative the women be screened for the risk of disease in early adulthood. The IDRS developed by Dr. V. Mohan in the year 2005[7] at Madras Diabetes Research Foundation, Chennai is a validated instrument which has been widely used in community research with great specificity and sensitivity to identify people at the risk of type 2 diabetes mellitus. The most effective way to bring a halt to the speeding diabetes prevalence is through primary prevention and early detection. This remains greatly significant as the prevention of the disorder is easier, economical, and better than management of it. This research was initiated with an intention to study the risk of type 2 diabetes mellitus among young working females (25–40 years) in the city of Gurugram, Haryana, using IDRS as a tool and to analyze the risk factors of type 2 diabetes mellitus.
Materials and MethodsThis cross-sectional observational study was carried out among 504 young working women of age 25–40 years. The study was performed from June 2021 to December 2021 in the millennium city Gurugram, Haryana, India. The sample size was determined using the formula n = 4 PQ/d2, where N is the sample size; P is the prevalence of undiagnosed diabetes among the population of India; and p was taken as 53%.[1] The calculated sample size was 492 subjects at 95% confidence interval and 80% precision. The purposive random sampling technique was employed to enroll the subjects as sample from different workplaces across the city. Data were gathered through personal interview technique. The ethical approval for the study was granted by the Institutional Ethics Committee. Written informed consent was obtained from all the subjects who enrolled for the study. Subjects with any previous known history of diabetes or any other disease, pregnant and lactating mothers, and mentally ill subjects and those who refused to sign the informed consent were excluded from the research.
Data collection instrument and data collection
To fulfill the task of gathering the data, a research questionnaire was designed which incorporated the Indian Diabetes Risk Score (IDRS) to appraise the risk of diabetes among the working women. The subjects were given a brief about the significance of the study before enrolling them into the study for gathering data. Personal interviews were conducted to assess the eligibility of the subjects for fulfilling the inclusion criteria and thereafter to fill the questionnaires. The data were gathered on sociodemographic parameters and IDRS tool which encompasses four parameters, i.e., age, waist circumference, physical activity, and family history of diabetes. Body mass index (BMI) was also measured for the subjects to estimate general obesity. Grades of BMI (WHO Classification for Asian adults) were used; a cut-off point of BMI (underweight <18.5 kg/m2, normal 18.5–22.99 kg/m2, overweight 23–24.99 kg/m2, obese >25 kg/m2) was classified as per standard guidelines.
The IDRS tool assesses the subjects on the basis of four factors: age, family history of diabetes, waist circumference, and physical activity. This study divided the age of the subjects into two categories in line with the IDRS tool: <35 and 35–49 years. Family history of diabetes was recorded with classification as “no diabetes in parents,” “one parent is diabetic,” and “both parents are diabetic.” Waist circumference was measured and recorded into categories: waist <80 cm, waist 80–89 cm, and waist ≥ 90 cm. Physical activity of the subjects was assessed by enquiring their activities as well as the intensity and duration; and subsequently data were classified into regular vigorous exercise or strenuous (manual) activities at home/work, regular moderate exercise or moderate physical activity at home/work, regular mild exercise or mild physical activity at home/work, and no exercise and/or sedentary activities at home/work categories. The observations were cleaned, coded, and scored as per the format of IDRS. The subjects were classified into risk categories as sum of the scores <30 was marked as low-risk score, sum of the scores ranging 30–50 was marked as moderate-risk score, and sum of the scores ≥ 60 was marked as high-risk score. Subjects who were found to be in high-risk category were educated about diabetes and its prevention and thereafter referred to the tertiary healthcare hospitals for biochemical diagnosis and confirmation of diabetes.
Statistical methods
The data thus obtained were cleaned and coded, categorized and typed into Microsoft Excel spreadsheets, and thereafter analyzed using SPSS 16—the Statistical Package for Social Sciences. The demographic data as well as descriptive data were represented as percentage. The significance level was appraised with 95% confidence interval where P < 0.05 was taken as statistically significant.
ResultsA total of 504 working women completed the survey questionnaire. The age-wise categorization of the subjects verified 51.3% and 48.7% of the subjects into <35 years and 35–49 years bracket, respectively. About education, 30.3% of the women subjects were graduates and 41.9% had completed master’s degree and more. The subjects were divided into socio-economic classes based on Kuppuswamy’s socio-economic scale,[8] stating 13.3% subjects in upper class-I, 39.7% subjects in upper-middle class-II, 29.5% subjects in lower-middle class-III, 17.2% subjects into upper-lower class-IV, and 0.3% subjects falling into lower class-V. [Table 1] gives details on the subjects’ observed data on IDRS. Majority of the females were found to be having waist circumference above the normal values of 80 cm. About 67% of all the subjects were either doing no physical activity or only following mild physical activity which increases the risk of becoming diabetic in future. Out of all, 29.4% of the subjects reported both parents as diabetic; 47.6% reported one parent diabetic; and 23% reported no parent diabetic/no prior family history of diabetes.
Table 1: Distribution of study population based on IDRS scores (n = 504)The data were also collated for risk profiling of the working women sub-divided into classes based on IDRS scores and the corresponding risk level. [Table 2] tabulates the detailed data about risk of type 2 diabetes based on various risk parameters.
The risk of diabetes was found to be significantly correlated to the physical activity, BMI, waist circumference, and family history of the subjects. The risk level was found to be increasing with increasing age reporting 57.9% of the subjects in the 35–49 years age group falling in different risk categories as against 42.05% of the subjects in the <35 years age group. The study finds 8.53% of the subjects falling in high-risk category, despite being less than 35 years of age. The waist circumference was recorded high among 37.09% and 45.5% in moderate- and high-waist circumference categories, with 45.4% and 25.4% of the subjects in moderate and high risk, respectively. The data report that a significant number of subjects (11.5%) were at moderate-to-high risk of diabetes despite doing vigorous physical activity to remain fit. Mild physical activity or no physical activity was reported by 29.7% of the subjects falling in the moderate-to-high risk group for diabetes. Family history of diabetes remains significant with higher number of subjects (30.95%) with prior family history falling into the high-risk category. According to the cumulative IDRS scores, 18% of the women were at high risk, 53% at moderate risk, and 29% at low risk of developing type 2 diabetes mellitus.
DiscussionThe aim and purpose of the given study undertaken was to assess the risk of type 2 diabetes mellitus in young working women in the urban area of Gurugram, Haryana, India. In the community observational research studies conducted in the past, the IDRS has been used to obtain the risk profiling of subjects in higher age and there remains a paucity of data carrying out risk assessment of young working women in the 25–40 years age bracket. This study holds added significance as the recent research indicates higher IDRS scores among young females of age <35 years.[9]
The observations secured through this study suggest 18%, 53%, and 29% of the subjects drifting into high-risk, moderate-risk, and low-risk groups, respectively. Bala et al. in their study observed and reported 38% of the subjects in the high-risk group, 40% of the subjects in the moderate-risk group, and 22% of the subjects in the low-risk group. Brahmbhatt et al.[10] in their study reported 33.8%, 57.2%, and 9% as high risk, intermediate risk, and low risk, respectively. Different other studies have documented differing fractions, i.e., 31%, 25%, and 43% of the subjects in high-risk class.[7],[11],[12] Certain studies have also documented significantly higher fraction of high-risk subjects. The differing yet significant values of individuals in high-risk class support the fact that the risk of undiagnosed diabetes remains high in India and demands prompt actions toward diagnosis and prevention of diabetes.
The present study witnesses the trend of increasing risks of diabetes with increasing age among the subjects. Multiple studies have been performed in the recent past confirming this fact.[11],[13] The present study indicates 51.3% of the women in the age group <35 years and calculates that 18% of the total sample fall into the high-risk category. Similar studies obtaining data on women suggest differential yet higher fraction of subjects falling into high risk for diabetes. Bala et al.[14] reported 38% of high-risk subjects which included 57.4% women subjects in the 30–35 years age group, whereas Sankar et al.[15] published 48.7% of high-risk subjects which included 64% of women less than 35 years. This indeed raises an alarm and need for immediate screening of risk of diabetes among women in age less than 35 years.
No exercise or physical activity is a confirmed risk factor for the development of diabetes.[16] Assessment of physical activity parameter on IDRS revealed a significantly high percentage (67%) of women not following exercise regimes, and they practice sedentary way of life. Similar results have been reported by Brahmbhatt et al.,[10] in which 50.5% of the females follow sedentary way of life; Nayak et al.[17] reported that 57.4% of the women follow sedentary way of life; Suri and Kapur[13] reported 63% of the subjects do not exercise; and Bala et al.[14] reported that 66.6% of the subjects follow sedentary way of life. Such a high fraction of women following a sedentary way of life elevates the risk of diabetes. Nevertheless, 11.5% of the subjects following vigorous exercise schedule were still found to have moderate-to-high risk of diabetes. Lack of physical activity becomes a risk factor for diabesity among working women, which is a confirmed trigger for type 2 diabetes mellitus.
The sedentary way of life is a contributing factor toward abdominal obesity, and elevated waist circumference is a principal risk factor for the occurrence of diabetes mellitus.[16] In the present study, the risk scores were received through data gathering for abdominal obesity; 37.9% of the women reported waist circumference ranging from 80 to 89 cm, whereas 45.5% reported the same to be greater than 90 cm; making it 83.4% cumulatively to the elevated waist circumference category. A similar study in Karnataka observed slightly lower numbers for the same at 53.5%.[11] Brahmbhatt et al.[10] have recorded the elevated figures for waist circumference among 84% of women. Another study performed in north India recording the data with same standards reported abdominal obesity among 75% of the women.[18] Literature reports similar findings in multiple studies. Conclusively, waist circumference figures have been recorded high in most of the studies.
The data on BMI values too were recorded and documented in the study population. This present study documents 55.95% of the subjects to be in the overweight/obese category with moderate-to-high risk for diabetes. In addition, it indicates that 11.9% of the subjects within the normal BMI range too were at moderate-to-high risk for type 2 diabetes. Similar results have been reported by a study conducted in Bangalore, in which 31% of overweight and obese subjects were into the high-risk category and 22% of the subjects with normal BMI values were in the high-risk category too.[11] This initiates a thought about necessity of screening women with high as well as normal BMI values.
In this study, 77% of the subjects confirmed a positive family history of diabetes. Contrasting results have been reported by various studies: 22.1%, 8.9%, 31.5%, and 39% of the subjects reported positive family history of diabetes.[10],[11],[12],[14] The differentiating figures may be due to lack of awareness about diagnosis of diabetes. Alternatively, for the subjects in these studies, no confirmed diagnosis might have been made by the parents for diabetes. The lowering cost of diagnosis and greater availability of glucometers might be the reason for high values confirming positive family history of diabetes in young urban working women of this study.
ConclusionIDRS is a proven tool for the risk assessment of the subjects for type 2 diabetes mellitus: a very simple, four-factor, easy to implement, non-invasive, cost-effective, quick, and result-oriented tool; IDRS has been widely used in the community research. All these factors make IDRS an ideal tool, specifically post Covid-19, since people prefer a non-invasive tool for assessments wherever possible. Being a no-cost tool, therefore, is ideal for implementation at the populace level and most importantly for India which houses a major proportion of the global population. The periodic risk assessment would enable the timely diagnosis, possible prevention, and reversal of pre-diabetes to normoglycemic status, therefore intercepting the incidence of full blown diabetes and progressive complications of it.
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Conflicts of interest
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References
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