Introduction: Diabetes mellitus is a major public health problem that carries a high social and economic burden. Its diagnosis is unknown in half of individuals who have the disease. The diagnosis of the risk factors should be done in the beginning, since changes in lifestyle and hyperglycemic correction may delay the appearance of the disease and its complications. In this context, screening has been considered an important tool for an early detection of diabetes in asymptomatic adults. Objective: The objective is to track diabetes in people from BH, comparing genders. Patients and methods: People were interviewed with questions concerning the risk factors associated with the development of diabetes. According to the risk factors present, they were classified as non-diabetic [ND], pre-diabetic [PD] or diabetic [DM]. Statistical analyses were performed considering p ≤ 0.05 as significant. Results: 1264 individuals participated (5.5% DM, 6.5% PD, 88.0% ND). When grouped, PD and DM males were more prevalent than PD and DM females. Those in the DM group had higher blood pressure, age, glycaemia, number of past smokers, first-degree relatives with diabetes than either PD or ND. Both males and females in DM and PD groups had a higher waist circumference than did either ND males or females. ND men had a higher intake of fried food and smoked more in the past than ND women. Both ND and PD males had higher blood pressure than women from the same groups. Conclusion: Screening for diabetes is very important for an early diagnosis and to avoid future complications in patients. It’s possible to infer that women are more conscientious when it comes to taking care of themselves than men.
Diabetes mellitus is a major public health problem that carries a high social and economic burden [
The diagnosis of the risk factors should be done in the beginning, since changes in lifestyle and hyperglycemic correction may delay the appearance of the disease and its complications [
The growing prevalence of DM2 is of interest to the public health community. The Diabetes International Federation [IDF] estimated that the number of people with diabetes in the world in 2013 was 387 million, 46% of which did not have any previous diagnosis. For Brazil, the estimated contingent of 11.9 million cases may reach 19.2 million in 2035 [
Thus, the aim of this study was to screen for diabetes in individuals in the city of Belo Horizonte [BH] and to try to answer the following questions: what is the prevalence of diabetes and pre-diabetes in the city of Belo Horizonte? Is the prevalence of diabetes and pre-diabetes in men different from women? When diabetic, pre-diabetic and non-diabetic groups of people are compared, which risk factors differ in these three groups? In each group of individuals (diabetic, pre-diabetic and non-diabetic) which risk factors differ when men are compared to women?
This study was approved by the Committee of Ethics in Research at Centro Universitario de Belo Horizonte- UniBH. The study was performed following the CNS resolution number 466/12. The sample studied corresponds to those individuals who frequent (patients and caregivers) the clinical school of UniBH (various specialties) and others in various points of the city of Belo Horizonte (squares, parks) between August/2012 and December/2014. The selection of the sampling points was made arbitrarily, but covering all regions of the city. Belo Horizonte is located in the state of Minas Gerais, in the southeast region of Brazil. Were included in this study, individuals aged over 18 years old, from both genders, who agreed to sign the informed consent form [ICF]. Individuals under 18 years old, pregnant women and anyone who had not agreed to sign the ICF were excluded.
The sample size was calculated considering an estimation process for an unknown proportion (p) in a population. Considering a margin of error of 2% and an expected prevalence of 10% (according to IDF values), it is necessary to have at least 864 patients in order to estimate, with a percentage rate of confidence of 95%, the prevalence of diabetes in the city of Belo Horizonte [
The study proposal was presented to the participants who were then asked to answer a questionnaire about their lifestyle habits as well as their medical and family history of diabetes. This questionnaire was standardized for screening programs from the municipality of Belo Horizonte and was applied by previously trained examiners. On the same card, data from blood pressure, waist circumference, weight and height (to calculate the body mass index-BMI) were annotated. For each answer, a score was added. Individuals who numbered more than 9 points were then asked to undergo a capillary blood glucose measurement. The time of the last meal was asked in order to estimate the postprandial time for the execution of the test. People with a fasting glucose level >126 mg/dL or postprandial glucose level >200 mg/dL were considered diabetic. Those considered pre-diabetic were individuals with a fasting glucose level between 100 and 125 mg/dL or a postprandial glucose level between 140 and 199 mg/dL. Those considered non-diabetic were individuals with a fasting glucose level <9 mg/dL or a postprandial glucose level <139 mg/dL. These criteria followed the standards of diabetes care [
Waist circumference was measured using an inelastic tape measure at the height of the belly button. Weight and height were measured using an anthropometric scale for adults (Filizola-M31). Blood pressure was measured using an aneroid sphygmomanometer with a stethoscope (Premium). Blood glucose was measured using the ACCU-Chek Advantage (Roche Diagnostica Brasil Ltda). Only one device was used for the measurements to avoid conflicting results. These devices were calibrated periodically.
Diabetes and pre-diabetes prevalences were obtained by way of exact estimation and confidence intervals of 95% for the proportion (C.I. 95%). Statistical tests of bilateral hypothesis with a significance level of 5% (a ≤ 0.05) were performed when groups of individuals were compared. Categorical factors were evaluated using the Fisher exact test. Quantitative variables were analyzed by analyses of variance [ANOVA] or the non-parametric Kruskal-Wallis test, when necessary. The mean comparisons were performed with the Student t test. All statistical analyses were made using the EpiInfo program (http://www.cdc.gov/epiinfo). It is important to consider that, although the sample used in this study was not obtained by randomization, it may be considered representative of the population of those who are over 15 years of age in the city of Belo Horizonte. 366 people were selected for the sample, which represents the non-discrepant age from the Belo Horizonte population profile according to the 2010 IBGE Census (
1264 individuals participated in the research. 837 people were women and 427 people were men. Independently of gender, the study identified 70 diabetics (a prevalence of 5.5%-C.I. 95% = 4.4%-7.0%), and 82 pre-diabetics (a prevalence of 6.5%-C.I. 95% = 5.2%-8.0%).
Among men, the prevalence of diabetes and pre-diabetes was 6.4% (C.I. 95% = 4.3% - 9.2%) and 8.2% (C.I. 95% = 5.6% - 11.3%), respectively. Among women, the prevalence of diabetes and pre-diabetes was 5.1% (C.I. 95% = 3.8% - 6.9%) and 5.6% (C.I. 95% = 4.2% - 7.5%), respectively.
There was a significant difference between the genders in diabetic and pre-diabetic populations when they were grouped: 11% of women were diabetic or pre-diabetic, while this prevalence in men was 14% (p-value = 0.05).
The results are expressed in tables that demonstrate the comparison of the risk factors for diabetes development in the general population (
Characteristics | Group | |||
---|---|---|---|---|
ND | PD | DM | p-value | |
Physical activity practice (%) | 39 | 32 | 36 | 0.693 |
Fry intake (%) | 45 | 30 | 39 | 0.436 |
Vegetable frequently intake (%) | 82 | 56 | 83 | 0.586 |
Smokers (%) | 9 | 10 | 16 | 0.133 |
Past smokers (%) | 26 | 29 | 46 | <0.001* |
Have high blood pressure or take medicine to control it (%) | 27 | 42 | 69 | <0.001** |
Have first-degree relatives with diabetes (%) | 34 | 39 | 64 | <0.001* |
Have had an alteration of glucose levels in (%) | 12 | 25 | 61 | <0.001** |
Age (years) ( | 42 ± 17.9 | 54 ± 15.0 | 58 ± 12.9 | <0.001*** |
Body mass index (BMI), (kg/m2) ( | 26 ± 5.5 | 30 ± 5.8 | 28 ± 4.5 | <0.001** |
Systolic blood pressure, (mmHg) ( | 119 ± 16 | 127 ± 23 | 131 ± 16 | <0.001* |
Diastolic blood pressure, (mmHg) ( | 74 ± 12 | 78 ± 14 | 81 ± 12 | <0.001* |
Blood glucose, (mg/dL) ( | 105 ± 23 | 154 ± 19 | 218 ± 95 | <0.001** |
ND: non-diabetic (n = 1112); PD: pre-diabetic (n = 82); DM: diabetic (n = 70);
Characteristics | Gender | ||
---|---|---|---|
Female | Male | p-value | |
Physical activity practice (%) | 39 | 42 | 0.432 |
Fry intake (%) | 42 | 53 | 0.001 |
Vegetable frequently intake (%) | 83 | 81 | 0.616 |
Smokers (%) | 8 | 12 | 0.102 |
Past smokers (%) | 23 | 36 | <0.001 |
Have high blood pressure or take medicine to control it (%) | 29 | 21 | 0.004 |
Have first-degree relatives with diabetes (%) | 36 | 30 | 0.049 |
Have had an alteration of glucose levels in (%) | 12 | 14 | 0.198 |
Age (years) ( | 42 ± 18.0 | 41 ± 17.9 | 0.787 |
Body mass index (BMI), (kg/m2) ( | 26 ± 5.8 | 25 ± 4.8 | 0.278 |
Systolic blood pressure, (mmHg) ( | 117 ± 15.6 | 123 ± 15.3 | <0.001 |
Diastolic blood pressure, (mmHg) ( | 73 ± 11.9 | 77 ± 11.5 | <0.001 |
Waist circumference (cm) ( | 85 ± 4.6 | 96 ± 3.4 | <0.001 |
Blood glucose, (mg/dL) ( | 105 ± 25.2 | 106 ± 16.5 | 0.723 |
Sample size: ND = 1112, whereas 747 women (67%) and 365 men (33%);
Characteristics | Gender | ||
---|---|---|---|
Female | Male | p-value | |
Physical activity practice (%) | 49 | 37 | 0.369 |
Fry intake (%) | 30 | 57 | 0.023 |
Vegetable frequently intake (%) | 77 | 79 | 0.794 |
Smokers (%) | 9 | 21 | 0.188 |
Past smokers (%) | 34 | 55 | 0.103 |
Have high blood pressure or take medicine to control it (%) | 57 | 57 | 0.843 |
Have first-degree relatives with diabetes (%) | 62 | 47 | 0.253 |
Have had an alteration of glucose levels in (%) | 14 | 38 | 0.031 |
Age (years) ( | 54 ± 14.5 | 55 ± 15.7 | 0.700 |
Body mass index (BMI), (kg/m2) ( | 30 ± 6.3 | 29 ± 5.0 | 0.333 |
Systolic blood pressure, (mmHg) ( | 122 ± 23.8 | 133 ± 21.1 | 0.045 |
Diastolic blood pressure, (mmHg) ( | 75 ± 15.5 | 81 ± 12.6 | 0.071 |
Waist circumference (cm) ( | 87 ± 3.9 | 99 ± 4.1 | <0.001 |
Blood glucose, (mg/dL) ( | 153 ± 18.0 | 155 ± 21.0 | 0.576 |
Sample size: ND = 1112, whereas 747 women (67%) and 365 men (33%);
Characteristics | Gender | ||
---|---|---|---|
Female | Male | p-value | |
Physical activity practice (%) | 41 | 31 | 0.443 |
Fry intake (%) | 35 | 44 | 0.458 |
Vegetable frequently intake (%) | 88 | 74 | 0.192 |
Smokers (%) | 16 | 15 | 1.000 |
Past smokers (%) | 40 | 48 | 1.000 |
Have high blood pressure or take medicine to control it (%) | 79 | 56 | 0.061 |
Have first-degree relatives with diabetes (%) | 63 | 67 | 0.802 |
Have had an alteration of glucose levels in (%) | 51 | 77 | 0.043 |
Age (years) ( | 57 ± 15.0 | 59 ± 8.9 | 0.537 |
Body mass index (BMI), (kg/m2) ( | 28 ± 4.6 | 27 ± 4.3 | 0.533 |
Systolic blood pressure, (mmHg) ( | 130 ± 14.5 | 133 ± 18.1 | 0.401 |
Diastolic blood pressure, (mmHg) ( | 80 ± 12.5 | 82 ± 12.1 | 0.411 |
Waist circumference (cm) ( | 87 ± 3.3 | 98 ± 4.1 | <0.001 |
Blood glucose, (mg/dL) ( | 213 ± 93.4 | 225 ± 98.5 | 0.641 |
Sample size: DM = 70, whereas 43 women (61%) and 27 men (39%);
The prevalence found in this study is slightly lower than that found by the research performed by the Health Ministry of Brazil through the VIGITEL system in 2013 (Surveillance of risk and protective factors for chronic diseases through telephone interviews) (a prevalence of 6.9% in the Brazilian population) [
Physical inactivity is a major cause for triggering chronic diseases such as diabetes. Booth et al. (2012) [
With respect to eating habits, there was no significant difference (p = 0.44) between diabetic, pre-diabetic and non-diabetic groups related to the ingestion of fried food (
Another risk factor for developing diabetes is smoking [
Hypertension is a known risk factor for developing diabetes [
With respect to the questions concerning eating habits, smoking and blood pressure, it was possible to observe a significant difference when comparing women and men. Women eat better, smoke less and have better control of their blood pressure than men do. This data corroborates the literature that shows that women use public health services for routine and preventive tests more often than men [
The risk of developing diabetes in people who have relatives with diabetes compared to those who have no relationship to patients increases from 2 to 6 times [
DM2 usually develops in adults, being that age is an important contributor to the development of this disease [
One of the biggest risk factors for developing DM2 is obesity. Obese individuals are twenty times more likely to develop diabetes than individuals with normal weight [
Despite the BMI reporting the degree of overweight and obesity, this measure does not portray the distribution of fat in the body. Since the visceral fat is more metabolically active than the non-visceral, the first is most important in the development of diabetes [
As glucose is the characteristic used to separate groups of NDs, PDs and DMs, it was expected that there were significant differences between the groups (
The combined prevalence of diabetes and pre-diabetes in men is greater than that found in women. Diabetics are older, with a higher BMI, a higher waist circumference and higher blood pressure, and they smoke more in the past and have more first-degree relatives with the disease than non-diabetics. Between the genders, it is observed that women eat better, smoke less and control their blood pressure better than men. The complex interaction between risk factors for the development of diabetes demonstrates the need for the monitoring of this chronic disease by the health services community. Screening of diabetes is important for an early diagnosis and to avoid future complications to the patients.
The authors declare no conflicts of interest.
To UniBH, for financial support, and to the entire team that participated in applying the questionnaires and tabulating the data.
Braulio Roberto Gonçalves Marinho Couto,Katiussia Brito Porto,Fabiane de Freitas Sales,Deborah Campos Oliveira,Larissa da Silva Pacheco,Lídia Christina Guimarães Pereira,Talita Santos de Almeida,Geiza Francielle Rodrigues de Souza,Mariana Santos Romualdo,Jaqueline Paulino de Souza,Clara Araújo Veloso, (2016) Screening of Type 2 Diabetes in the City of Belo Horizonte: Differences between Genders. Open Journal of Endocrine and Metabolic Diseases,06,141-149. doi: 10.4236/ojemd.2016.64019