TRENDS IN THE PREVALENCE OF TYPE 2 DIABETES AMONG ROYAL THAI ARMY PERSONNEL AND ASSOCIATED FACTORS FROM 2017 TO 2021
DOI:
https://doi.org/10.55374/jseamed.v7.160Keywords:
Diabetes, Hypertension, Body Mass Index, Prevalence, Associated factorsAbstract
Background: Diabetes is one of the essential noncommunicable diseases associated with an increased risk of atherosclerosis and cardiovascular diseases. However, limited information is available regarding type 2 diabetes (T2D) among Royal Thai Army (RTA) personnel.
Objectives: The present study aimed to determine the prevalence of T2D among RTA personnel and its associated factors.
Methods: We carried out a serial cross-sectional study from 2017 to 2021. A total of 235,491 active-duty RTA personnel aged 35–60 years were included in the study. We defined T2D as fasting plasma glucose ≥126 mg/dL or having a history of T2D diagnosed by medical personnel, or having a history of taking antihyperglycemic medication. We used a multivariable logistic regression model to estimate adjusted prevalence ratios (APR) and 95% confidence intervals (CIs) for behavioral factors associated with T2D.
Results: Age- and sex-adjusted T2D prevalence among RTA personnel was 17.9% (95% CI 17.5%- 18.2% in 2017 and then decreased to 16.5% (95% CI 16.1%–16.8%) in 2021 (p for trend < 0.001). The age-adjusted prevalence of T2D among males and females was 17.6 (95% CI 17.4%–17.8%) and 11.3 (95% CI 11.0%–11.7%), respectively. The independent behavioral factors associated with T2D included current cigarette smoking (APR 1.12; 95%CI 1.10-1.14), current alcohol use (APR 1.03; 95%CI 1.01-1.05), regular exercise (APR 0.89; 95%CI 0.87-0.90), body mass index ≥30 kg/m2 (APR 2.21; 95%CI 2.15-2.27) and hypertension comorbidity (APR 3.97; 95%CI 3.88-4.05).
Conclusion: Our study indicated that T2D is a common health issue, especially among males, higher-aged participants and RTA personnel residing in Bangkok and the northeast. Cigarette smoking, alcohol use, and sedentary behavior played an essential role in the prevalence of T2D in this population. Furthermore, obesity and HT comorbidity were related to T2D.
Metrics
References
Organization WH. Noncommunicable diseases country profiles 2018. Available from: https://apps.who.int/iris/handle/10665/274512
Sakboonyarat B, Rangsin R. Prevalence and associated factors of ischemic heart disease (IHD) among patients with diabetes mellitus: a nation-wide, cross-sectional survey. BMC Cardiovasc Disord 2018; 18:151. DOI: https://doi.org/10.1186/s12872-018-0887-0
Wittayatechakul P, Hanyos P, Rangsin R, Sakboonyarat B. Incidence and risk factors of diabetic retinopathy among patients with type 2 diabetes in a community hospital, central Thailand. J Southeast Asian Med Res 2021; 5:11–20. DOI: https://doi.org/10.55374/jseamed.v5i1.87
Euswas N, Phonnopparat N, Morasert K, Thakhampaeng P, Kaewsanit A, Mungthin M, et al. National trends in the prevalence of diabetic retinopathy among Thai patients with type 2 diabetes and its associated factors from 2014 to 2018. PLoS One 2021; 16: e0245801–e0245801. Available from: https://pubmed.ncbi.nlm.nih.gov/33481907 DOI: https://doi.org/10.1371/journal.pone.0245801
Nahmias A, Stahel P, Xiao C, Lewis GF. Glycemia and atherosclerotic cardiovascular Disease: Exploring the gap between risk marker and risk factor. Front Cardiovasc Med 2020.; 7:100. DOI: https://doi.org/10.3389/fcvm.2020.00100
Kagansky N, Levy S, Knobler H. The role of hyperglycemia in acute stroke. Arch Neurol 2001; 58: 1209-12. DOI: https://doi.org/10.1001/archneur.58.8.1209
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157: 107843. DOI: https://doi.org/10.1016/j.diabres.2019.107843
Wichai Aekplakorn. Thai National Health Examination Survey V (2014). 2014. Available from: https://kb.hsri.or.th/dspace/handle/11228/4604?locale-attribute=th
Wichai Aekplakorn. Thai National Health Examination Survey VI (2019-2020) [Internet]. 2019 [cited 2022 Jan 11]. Availablefrom: https://online.fliphtml5.com/bcbgj/znee/#p=187
Sakboonyarat B, Pima W, Chokbumrungsuk C, Pimpak T, Khunsri S, Ukritchon S, et al. National trends in the prevalence of glycemic control among patients with type 2 diabetes receiving continuous care in Thailand from 2011 to 2018. Sci Rep 2021; 11: 14260. Available from: https://pubmed.ncbi.nlm.nih.gov/34253809 DOI: https://doi.org/10.1038/s41598-021-93733-4
Lastra G, Syed S, Kurukulasuriya LR, Manrique C, Sowers JR. Type 2 diabetes mellitus and hypertension: An update. Endocrinol Metab Clin 2014; 43: 103-22. DOI: https://doi.org/10.1016/j.ecl.2013.09.005
Sakboonyarat B, Poovieng J, Jongcherdchootrakul K, Srisawat P, Hatthachote P, Mungthin M, et al. Rising trends in obesity prevalence among Royal Thai Army personnel from 2017 to 2021. Sci Re 2022; 12:1–8. DOI: https://doi.org/10.1038/s41598-022-11913-2
Sakboonyarat B, Poovieng J, Jongcherdchootrakul K, Srisawat P, Hatthachote P, Mungthin M, et al. Prevalence of hypertriglyceridemia among Royal Thai Army personnel and its related cardiometabolic risk factors from 2017 to 2021. BMC Public Health 2022; 22:1569. Available from: https://doi.org/10.1186/s12889-022-13992-2 DOI: https://doi.org/10.1186/s12889-022-13992-2
National Center for Health Statistics. Adult Tobacco Use Information: Glossary- Tobacco [Internet]. 2017 [cited 2022 Jul 19]. Available from: https://www.cdc.gov/nchs/nhis/tobacco/tobacco_glossary.htm
National Center for Health Statistics. Adult Alcohol Use Information: Glossary - Alcohol [Internet]. 2018 [cited 2022 Jul 19]. Available from: https://www.cdc.gov/nchs/nhis/alcohol/alcohol_glossary.htm
Hatthachote P, Rangsin R, Mungthin M, Sakboonyarat B. Trends in the prevalence of obesity among young Thai men and associated factors: from 2009 to 2016. Mil Med Res 2019; 6:13. Available from: https://pubmed.ncbi.nlm.nih.gov/31036084 DOI: https://doi.org/10.1186/s40779-019-0201-1
Thai Hypertension Society. 2019 Thai Guidelines on The Treatment of Hypertension. 1st ed. Chiangmai; 2019. p. 3-5 Available from: https://repository.li.mahidol.ac.th/entities/publication/cce4f5e9-d79e-4319-9933-0558bfb08599
2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021. Diabetes Care 2021; 44: S14-S31. DOI: https://doi.org/10.2337/dc21-S001
Inoue S, Zimmet P, Caterson I, Chunming C, Ikeda Y, Khalid AK, et al. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia Pty Ltd. 2000; Available from: https://apps.who.int/iris/handle/10665/206936
Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of diabetes and relationship with socioeconomic status in the Thai population: National health examination survey, 2004–2014. J Diabetes Res 2018; 2018: 1654530. Available from: https://doi.org/10.1155/2018/1654530 DOI: https://doi.org/10.1155/2018/1654530
Lee PG, Halter JB. The pathophysiology of hyperglycemia in older adults: Clinical considerations. Diabetes Care 2017; 40: 444-52. DOI: https://doi.org/10.2337/dc16-1732
Chang AM, Halter JB. Aging and insulin secretion. Am J Physiol Endocrinol 2003; 284: E7-E12. DOI: https://doi.org/10.1152/ajpendo.00366.2002
Improving care and promoting health in populations: Standards of medical care in diabetes—2022. Diabetes Care 2022; 45: S8- S16. DOI: https://doi.org/10.2337/dc22-S001
Stuckey HL, Adelman AM, Gabbay RA. Improving care by delivering the chronic care model for diabetes. Diabetes Manage 2011; 1: 37-53. DOI: https://doi.org/10.2217/dmt.10.9
Clair C, Bitton A, Meigs JB, Rigotti NA. Relationships of cotinine and self-reported cigarette smoking with hemoglobin A1c in the U.S. Diabetes Care 2011;34: 2250-55. DOI: https://doi.org/10.2337/dc11-0710
Sargeant LA, Khaw KT, Bingham S, Day NE, Luben RN, Oakes S, et al. Cigarette smoking and glycemia: The EPIC-Norfolk study. Int J Epidemiol 2001; 30: 547-54. DOI: https://doi.org/10.1093/ije/30.3.547
Jee SH, Foong AW, Hur NW, Samet JM. Smoking and risk for diabetes incidence and mortality in Korean men and women. Diabetes Care 2010; 33: 2567-72. DOI: https://doi.org/10.2337/dc10-0261
Seifu Y, Tsegaw D, Haji Y, Ejeso A. Prevalence and associated factors of diabetes mellitus among adult population in Hawassa Zuria Woreda, Sidama Region, Ethiopia. Diabetes Metab Syndr Obes 2020; 13: 4571. DOI: https://doi.org/10.2147/DMSO.S275230
Maddatu J, Anderson-Baucum E, EvansMolina C. Smoking and the risk of type 2 diabetes. Transl Res 2017; 184: 101-7. DOI: https://doi.org/10.1016/j.trsl.2017.02.004
Peer N, Kengne AP. Tobacco cessation in low- and middle-income countries: some challenges and opportunities. Addiction 2018; 113: 1390-1. DOI: https://doi.org/10.1111/add.14214
Kao WHL, Puddey IB, Boland LL, Watson RL, Brancati FL. Alcohol consumption and the risk of type 2 diabetes mellitus: Atherosclerosis Risk in Communities Study. Am J Epidemiol 2001; 154: 748-57. DOI: https://doi.org/10.1093/aje/154.8.748
Holst C, Becker U, Jørgensen ME, Grønbæk M, Tolstrup JS. Alcohol drinking patterns and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population. Diabetologia 2017; 60: 1941-50. DOI: https://doi.org/10.1007/s00125-017-4359-3
Kim SJ, Kim DJ. Alcoholism and diabetes mellitus. Diabetes Metab J 2012; 36: 108-15. DOI: https://doi.org/10.4093/dmj.2012.36.2.108
Lin Y, Sun Z. Current views on type 2 diabetes. J Endocrinol 2010; 204: 1. DOI: https://doi.org/10.1677/JOE-09-0260
Organization WH. Regional technical consultation with member states on the working document for development of the action plan (2022–2030) to effectively implement the global strategy to reduce the harmful use of alcohol as a public health priority: virtual meeting, 25–26 March 2021: meeting report. World Health Organization. Regional Office for Europe; 2021. Available from: https://apps.who.int/iris/handle/10665/341837
Fernandez WG, Hartman R, Olshaker J. Brief interventions to reduce harmful alcohol use among military personnel: Lessons learned from the civilian experience. Mil Med. 2006; 171: 538-43. DOI: https://doi.org/10.7205/MILMED.171.6.538
Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol 2018; 34: 575-84. DOI: https://doi.org/10.1016/j.cjca.2017.12.005
Su Y, Liu XM, Sun YM, Wang YY, Luan Y, Wu Y. Endothelial Dysfunction in Impaired Fasting Glycemia, Impaired Glucose Tolerance, and Type 2 Diabetes Mellitus. Am J Card 2008; 102: 497-8. DOI: https://doi.org/10.1016/j.amjcard.2008.03.087
Bays HE, Chapman RH, Grandy S. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: Comparison of data from two national surveys. Int J Clin Pract 2007; 61: 737-47. DOI: https://doi.org/10.1111/j.1742-1241.2007.01336.x
Zhao Q, Laukkanen JA, Li Q, Li G. Body mass index is associated with type 2 diabetes mellitus in Chinese elderly. Clin Interv Aging 2017; 12:745-52. DOI: https://doi.org/10.2147/CIA.S130014
Li Y, Jiang Y, Lin J, Wang D, Wang C, Wang F. Prevalence and associated factors of diabetes mellitus among individuals aged 18 years and above in Xiaoshan District, China, 2018: A community-based cross-sectional study. BMJ Open 2022; 12: e049754. DOI: https://doi.org/10.1136/bmjopen-2021-049754
Gupta S, Bansal S. Does a rise in BMI cause an increased risk of diabetes?: Evidence from India. PLoS One 2020; 15: e0229716. DOI: https://doi.org/10.1371/journal.pone.0229716
Institute of Medicine. Weight Management: State of the Science and Opportunities for Military Programs. In: Weight Management: State of the Science and Opportunities for Military Programs. 2004. Available from: https://pubmed.ncbi.nlm.nih.gov/25057674/
Ko IG, Choi PB. Regular exercise modulates obesity factors and body composition in sturdy men. J Exerc Rehabil 2013; 9: 256. DOI: https://doi.org/10.12965/jer.130008
Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and diabetes study. Diabetes Care 1997; 20: 256. DOI: https://doi.org/10.2337/diacare.20.4.537
Irvine C, Taylor NF. Progressive resistance exercise improves glycaemic control in people with type 2 diabetes mellitus: a systematic review. Aust J Physiother 2009; 55: 237-46. DOI: https://doi.org/10.1016/S0004-9514(09)70003-0
Nutong R, Mungthin M, Hatthachote P, Ukritchon S, Imjaijit W, Tengtrakulcharoen P, et al. Personal risk factors associated with heat-related illness among new conscripts undergoing basic training in Thailand. PLoS One 2018; 13: e0203428–e0203428. Available from: https://pubmed.ncbi.nlm.nih.gov/30180213 DOI: https://doi.org/10.1371/journal.pone.0203428
Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Triggering of acute myocardial infarction by heavy physical exertion -- protection against triggering by regular exertion. N Engl J Med 1993; 329: 1677-83. DOI: https://doi.org/10.1056/NEJM199312023292301
Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. J Am Med Assoc 2018; 320: 2020-8. DOI: https://doi.org/10.1001/jama.2018.14854
Soitong P, Jangjaicharoen S, Kaewsanit A, Mali P, Viriyakhaikul Y, Boonnumma S, et al. Association of neck circumference and hypertension among adults in a rural community Thailand: A cross-sectional study. PLoS One 2021; 16: e0256260–e0256260. Available from: https://pubmed.ncbi.nlm.nih.gov/34415934 DOI: https://doi.org/10.1371/journal.pone.0256260
Tsimihodimos V, Gonzalez-Villalpando C, Meigs JB, Ferrannini E. Hypertension and Diabetes Mellitus Coprediction and Time Trajectories. Hypertension 2018; 71: 422-8. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.117.10546
Todorova B, Kubaszek A, Pihlajamäki J, Lindström J, Eriksson J, Valle TT, et al. The G-250A promoter polymorphism of the hepatic lipase gene predicts the conversion from impaired glucose tolerance to type 2 diabetes mellitus: The Finnish diabetes prevention study. J Clin Endocr 2004; 89: 2019-23. DOI: https://doi.org/10.1210/jc.2003-031325
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D. DASH-Sodium Collaborative Research Group. effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med 2001; 344: 3-10. DOI: https://doi.org/10.1056/NEJM200101043440101
Ruggenenti P, Perna A, Ganeva M, EneIordache B, Remuzzi G. Impact of blood pressure control and angiotensin-converting enzyme inhibitor therapy on new-onset microalbuminuria in type 2 diabetes: A post hoc analysis of the BENEDICT trial. J Am Soc Nephrol 2006; 17: 3472-81. DOI: https://doi.org/10.1681/ASN.2006060560
Furberg CD, Wright JT, Davis BR, Cutler JA, Alderman M, Black H, et al. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Am Med Assoc 2002; 288: 2981-97. DOI: https://doi.org/10.1001/jama.288.23.2981
Downloads
Published
How to Cite
Issue
Section
License
The Journal of Southeast Asian Medical Research will hold the copyright to all published articles. The publisher's production department handles copyright forms once a manuscript is accepted and scheduled for publication.
