Prevalence of Pre-diabetes and Diabetes mellitus among the Northern Railway Employees: A retrospective study.

 

Mr. Shatrughan Pareek

Nursing Brother, N.R. Divisional Hospital, Delhi

 

ABSTRACT:

Background: Non-communicable diseases are major public health threat for all community around the world. Diabetes mellitus (DM) is a non-communicable disease. DM is increased drastically in last 20 years at global level. DM is related with the life style changes. It is a metabolic disorder characterized by the increased blood sugar level due to deficiency of Insulin. The side effects of diabetes mellitus include chronic damage to vital organs.  India is becoming the diabetes hub of the world.

Aims: To assess the prevalence of Pre-diabetes and Diabetes mellitus among the northern railway employees. To assess the association among Pre-diabetes, diabetes and selected variable factors.

Settings and Design: Research approach adopted for the study was Survey. The study has been done from January 2016 to July 2017 at Northern Railway divisional hospital, Delhi. Total of 1238 Railway employees were selected for the study by random sampling. Data collection was done from periodic medical examination (PME) books.

Results: The study revealed that the prevalence of Pre-diabetes and DM were 12.05% and 08.45% respectively. Age group (45-60 years) has the most cases of DM. There was no significant association between DM (χ² = 3.453^NS) with selected factors.

Conclusions- Diabetes mellitus is a growing epidemic. The burden of Diabetes mellitus is increasing in India. Railway employees are more prone to Pre-diabetes compare to diabetes mellitus. Age is an independent factor. Pre-diabetes and Diabetes cases were more common in 46-60 years age group. The study indicates need for various awareness and screening programs to control the disease.

 

 

 

INTRODUCTION:

Non- communicable diseases (NCDs) are major public health concern for the world (1).  NCDs are long term diseases, are not passed from individual to individual (2).

 

Diabetes mellitus (DM) is a chronic disease that occur either ineffective use of Insulin by the body or insufficient production of insulin by pancreas. Increased blood sugar level is a common effect of diabetes mellitus. DM is divided into 3 categories, DM type-1 (IDDM), DM type-2 (NIDDM) and Gestational diabetes mellitus. DM type-1 and DM type-2 can lead to complications in many vital organs of the body. Cardiomyopathy, Neuropathy, Nephropathy, Retinopathy and lower limb amputation are the possible complications of continuous high blood sugar level. During pregnancy, uncontrolled blood sugar levels increase the risk of still birth and other fatal complications (3,4).

 

BACKGROUND OF THE STUDY:

DM is increasing drastically at global level. In 2014, nearly 422 million adults were living with DM but by 2040 it will be around 642 million. In 2015, around 1.6 million people will lose their life due to DM (5). China, India and USA are among top 3 nations with high numbers of DM type-2 patients. Diabetes prevalence has been increasing more quickly in lower and middle income nations (6).  DM is developing at early age among the individuals in south Asia; thus high risks of morbidity and mortality during peak years of their productive life (7). The incidence rate of diabetes and Pre-diabetes is higher among Asian Indians (8).

 

Indians has increase insulin resistance, which make them prone to DM type-2. Diabetes mellitus is increasing drastically in Indians, so in few years India will be “Diabetes capital of the World” (9). In India, more than 69 million people are affected with DM and in 2040; this figure will cross 140 million (10). The prevalence of DM has significantly increase in last 40 years; while in early 1970 prevalence rate in urban and rural was 2.3% and 1.5 %  respectively. DM prevalence was high in men compare to female (11). Nearly 25% of Indians are unaware of diabetes mellitus (12). The marked increase in diabetes cases is also affecting the economy of the developing countries. Diabetes has major role in morbidity and mortality so researcher selects this topic to assess the prevalence of altered level of blood sugar among railway employees.

 

PROBLEM STATEMENT:

A retrospective study to assess the prevalence of Pre-diabetes and Diabetes among Northern Railway employees at selected hospital of Delhi.

 

OBJECTIVES:

1.      To assess the prevalence of Pre-diabetes and Diabetes mellitus among the northern railway employees.

2.      To assess the association among Pre-diabetes, diabetes and selected variable factors.

 

Research hypotheses:

H1- There will be a significant association among Pre-diabetes, diabetes and age group of Northern railway employees at 0.05 level of significance.

 

Inclusion criteria:

1.      Both male and female railway employees.

2.      Age of the employee between 18-60 years.

 

Assumption:

The study assumes that…

1.      Most of the railway employees are prone to altered blood sugar levels and these levels may be different among individuals.

2.      Altered blood sugar level is associated with age.

 

Research methodology:

Research Approach:

Survey approach was thought to be most suitable method for the study.

 

Research Design: Descriptive Survey design:

To assesses the prevalence of Pre-diabetes and diabetes.

 

Variables:

A.- Independent variable-  Blood sugar level

B.-Dependent variable- Pre-diabetes and diabetes

C.- Extraneous variable – Age and sex

 

Setting of the study-

Northern railway division hospital, Delhi.

 

Population:

In the present study population were railway employees attending OPD for periodic medical examination at Northern railway division hospital, Delhi.

 

Sampling technique-

Random sampling was used.

 

Sample size-

1238 Railway employees

 

 

 

Data tools and techniques:

S. No.	TOOL	PURPOSE	TECHNIQUE
1.	Semi structured interview schedule:  Demographic profile	To collect background data of the employee	Pencil and paper
2.	WHO scale for blood sugar level	For assessment of  blood sugar level	Pencil and paper

 

MATERIAL AND METHODS:

Present study was conducted at OPD, Northern Railway division hospital, Delhi during January 2016 to July 2017. A total of 1238 Railway employees were selected for the present study. Sampling was performed among railway employees attending OPD for periodic medical examination at Northern railway division hospital, Delhi. Random sampling was used and samples were selected, who working in Indian Railway. Both male and female were included in the study.  Railway employee, who had Diabetes type-1 and receiving steroid therapy, were excluded from the study. Data collection was done from Periodic medical examination books.  Data was collected by using demographic profile and WHO scale for blood sugar level. WHO scale for blood sugar level was used to measure Pre-diabetes and Diabetes. Fasting blood sugar (FBS) level more than 126 mg/dl was considered as Diabetes mellitus and FBS level between 110-125 mg/dl was considered to be Pre-diabetes (13,14 ).

 

Ethical consideration:

Ethical clearance was obtained from the Institute Ethics Committee. The study participants were railway employees attending OPD.  The obtained findings were used for the research purpose only.

 

Findings of the study:

Section -1: frequency and percentage distribution of demographic characteristics 

 

Table -1: frequency and percentage distribution of demographic characteristics.  N=1238

 

Table -2  Altered level of Blood sugar level as per WHO blood sugar scale                                                             N=1238

S.No.	Category	No. of employees	Percentage
1.	Pre-diabetes	149	12.05%
2.	Diabetes	105	08.49%

 

 

Table -3:- Chi-square value shows association between Pre-diabetes and age group of Railway employees. N=1238

NS= Non Significant ( Table value χ² =7.823 at 0.05 level of significance)

 

Table -4:- Chi-square value shows association between Diabetes and age group of Railway employees.  N=1238

NS= Non Significant ( Table value χ² =7.823 at 0.05 level of significance)

 

RESULT:

Result in present study; total 1238 employees were selected for the study. Distribution age and sex of the Railway employees was done in table -1. It shows that almost all participants were male. Majority of them were in the age group of 26-35 years. According to table -2, 149 (12.05%) employees out of 1238 have Pre-diabetes and only 105(8.49%) employees had diabetes. In table 3&4, majority of Pre-diabetes and diabetes were in the age group of 45-60 years. There was no significant association among pre-diabetes, diabetes and age groups.

 

DISCUSSION:

Non -communicable diseases are increasing with a great pace at global level. Diabetes mellitus is among the major concern for the world. Pre-diabetes and diabetes are increasing more rapidly in developing countries. Prevalence of DM is higher in lower and middle- income countries compare to high-income nations. Rapid urbanization, life style changes, obesity and higher resistance to insulin make Indians prone to DM (10,14). Ravikumar P. et al (2011) reported that prevalence of pre-diabetes was 13.2% in urban societies; the present study also revealed that prevalence of Pre-diabetes among Northern railway employees was 12.05% (15). The prevalence of pre-diabetes was comparatively higher, which was supported by other studies in India (9,11). Tripathy JP et al (2017) a large community based study was conducted in India showed that prevalence of DM was 8.3% which was nearly equal to present study (16). The present study reported that prevalence of DM was 8.49% which was also noted in other studies (18,19). As per table no. 3 & 4, the Chi-square value of pre-diabetes and diabetes were 4.132 & 3.453 respectively. Association of age group with altered blood sugar levels was not statistically significance. No study was available to compare the present findings. DM type-2 is preventable disease so the early detection and appropriate management will be helpful in reduction of diabetes. It may be helpful in decreasing the burden of NCDs in India.  Higher prevalence of altered blood sugar level also affects the nation’s economy.

 

IMPLICATION OF THE STUDY:

The study will be helpful for clinician, Nurses, Dietitian and other health care providers, in detection and management of altered blood sugar level.

 

ACKNOWLEDGEMENT:

I am thankful to my faculties, my family member and my friends for their patience and support in completing my research study.

 

CONTRIBUTOR’S STATEMENT PAGE:

Shatrughan Pareek, participated in protocol development, execution of study and provided analytical framework to the study, and contributed in writing the manuscript.

 

Mr. Shatrughan pareek would act as the overall guarantor and the corresponding author of the manuscript.

 

CONFLICT OF INTEREST:-  

There was no conflict of interest.

 

SOURCE OF FUNDING:-

self funded.

 

CONCLUSION:

Present study was conducted with aim to assess the prevalence of Pre-diabetes and diabetes among Railway employees. Pre- diabetes and Diabetes assessment was done by using WHO scale for blood sugar level. According to the scale about 12.05% employees had Pre-Diabetes and 8.49% were suffering from Diabetes. There was no significant association between altered blood sugar level and age. Pre-diabetes and diabetes were more common in 46-60 years age group. Altered blood sugar level may lead to various diseases so diabetes control and management programmes are needed for its prevention. Awareness and health education regarding Diabetes management can be helpful in decline the prevalence rate of DM.

 

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4.       Global report on Diabetes. World Health Organization. Geneva.2016.

5.       International Diabetes Federation (IDF). IDF diabetes atlas. 7^th edition. Brussels. Belgium;2015

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10.     The growing danger of Non-communicable diseases acting now to reverse course. The World Bank human development network. Washington.2011.

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12.     Kumar A. India towards diabetes control: key issues. Australian Medical journal. 2013;6: 524-531

13.     American Diabetes association. Standards of Medical care in Diabetes-2016. Diabetes care. 2016; 39(1): S13-22

14.     Directorate General Health Services Ministry of Health and Family Welfare. National Programme for prevention and control of Cancer, Diabetes, Cardiovascular Diseases & Stroke Operational Guidelines (2013–17). New Delhi. 2013.

15.     Ravikumar P, Bhansali A, Ravikiran M, Bhansali S, Walia R, Shanmugasundar G, et al. Prevalence and risk factors of diabetes in a community-based study in North India: the Chandigarh Urban Diabetes Study. Diabetology and Metabolic syndrome. 2011; 37(3):216–21.

16.     Tripathy JP, J. S. Thakur, Gursimer Jeet, Sohan Chawla, Sanjay Jain, Arnab Pal et al. Prevalence and risk factors of diabetes in a large community based study in North India: results from a STEPS survey in Punjab, India. Diabetology and Metabolic syndrome. 2017:9:8 DOI 10.1186/s13098-017-0207-3

17.     Little M, Humphries S, Patel K, Dodd W, Dewey C. Factors associated with glucose tolerance, pre-diabetes, and type 2 diabetes in a rural community of south India: a cross-sectional study. Diabetology and Metabolic Syndrome.2016; 8:21.

18.     Shankar Radhakrishnan, Manivanan Ekambaram. Prevalence of diabetes and hypertension among a tribal population in Tamil Nadu. Archives of Medicine and Health Sciences. 2015; 3(1) 66-71

 

 

 

 

 

Received on 13.09.2017          Modified on 19.10.2017

Accepted on 19.11.2017          © A&V Publications all right reserved