MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENSE MILITARY MEDICAL UNIVERSITY NGUYEN THI ANH RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS OF TYPE DIABETES AND EFFECTIVENESS OF SOME PREVENTIVE INTERVENTION MEASURES IN HUNG YEN PROVINCE (2013-2015) Major: No: Epidemiology 72 01 17 SUMMARY OF DOCTORAL DISSERTATION HA NOI-2019 THE RESEARCH WAS COMPLETED AT MILITARY MEDICAL UNIVERSITY Instructor: Dinh Professor Dao Professor Hong Duong, Xuan Vinh, Ph.D., Ph.D., Associate Associate Reviewer 1: Professor Truong Viet Dung Reviewer 2: Assoc Professor Nguyen Thi Phi Nga Reviewer 3: Professor Pham Ngoc Dinh The dissertation was protected at the school-level council At … (day) … (month) … ,2019 The dissertation can be found in: Vietnam National Library Vietnam Military Medical University Library LIST OF PUBLISHED RESEARCH RELATED TO THE AUTHOR’S DISSERTATION Nguyen Thi Anh, Dao Xuan Vinh, Dinh Hong Duong interventions (2018) on nutrition Effect and of media motility of patients with type diabetes in Khoai Chau district, Hung Yen province in 2014-2015 Vietnam Journal of Preventive Medicine, Vol 28(2), p.131-138 Nguyen Thi Anh, Dao Xuan Vinh, Dinh Hong Duong (2018) Prevalence and factors associated with type Diabetes among Hung Yen population aged 25-70 in 2014 Journal of Military Pharmaco-medicine, vol 43(%), p 162169 4 FOREWORDS The World Health Organization (WHO) Global Report 2016 on Diabetes states that about 1.5 million deaths in 2012 are due to type diabetes In 2014, the world recorded that type diabetes increased to 422 million cases, equivalent to 8.5% of the population According to the WHO, the incidence of type diabetes in 2014 is 7.1% in Africa, 8.3% in America, 13.7% in the Middle East, 7.3% in Europe, 8.6% in South Asia, 8.4% in the Western Pacific and the global rate is 8.5% In Vietnam, the research results of the National Institute of Endocrinology in 2011 reported that there are over million Vietnamese people with type diabetes, accounting for 6% of the population, the urban community is more prone to the disease than in rural areas, people with sedentary lifestyles, and those who abuse high-risk ready-to-eat foods stand a higher risk The study also found that 80% of people with the disease did not change their lifestyle and 60% had poor glycemic control According to the statistics of Hung Yen Preventive Medicine Center, in 2010, there were 15,344 patients with type diabetes who went to the provincial general hospital and most had eyes and nerve complications, kidney damage The cause is due to late examination and detection, or by accidental treatment of other diseases and then found to be infected So we the following: Describe some epidemiological characteristics and some related factors with pre-diabetes and type diabetes in 25-70 year-old people in Hung Yen province (2013-2014) effect Evaluation on of nutrition, communication intervention exercise lifestyle and of prediabetes in Khoai Chau district, Hung Yen province (2014-2015) New contributions of the dissertation: The study found that the incidence of type diabetes in Hung Yen was 4.7%; pre-diabetes was 25.4% Five (05) factors are considered to be associated with pre-diabetes: angina, being above 49 years old, having sibling with diabetes, unknown risk, not eating peanuts Three (03) factors were associated with diabetes mellitus in subjects with Hypertensive substance (BP measurement), 49 years of age or older, with siblings with diabetes mellitus The evaluated study used efficacy media with interventions multidisciplinary but control evaluation criteria as guided by the Ministry of Health The results indicate that a set of criteria can be used to assess the control of type diabetes and diabetes in the community Dissertation structure A total of 133 pages including: 2-page issue set; Chapter 1: Overview of 34 pages; Chapter 2: Object and Methodology 25 pages; Chapter 3: Research Results 43; Chapter 4: Discuss 26 pages; Conclusion 01 page, 01 page proposal The thesis has: 41 tables, figure and 19 charts, 102 references Chapter 1: OVERVIEW 1.1 Type diabetes and related factors 1.1.1 Status of type diabetes mellitus 1.1.1.1 The diabetes status in the world According to the report by WHO in 2016, diabetes mellitus has increased steadily in recent decades Type diabetes is a global health and economic crisis that threatens the health and wellbeing of all countries, especially in developed countries In the global report on type diabetes in 2016, there are 422 million people worldwide with type diabetes Thus, the rate of people having type diabetes increased to 8.5% in 2014, which was just 4.7% in 2008 About 2% of deaths among 1.5 million people in 2012 As stated by WHO, about 43% of deaths before the age of 70 were related to high blood glucose levels, equivalent to 1.6 million deaths High blood glucose mortality is associated with age and the age having risk factors ranging from 50-79 years 1.1.1.2 Situation of type diabetes in Vietnam In Vietnam, type diabetes is also tending to increase with time and level of economic development, urbanization speed as well as profound changes in lifestyle, especially people in big cities such as Hanoi, Ho Chi Minh city Motorcycles, automobiles and mechanics have almost replaced walking, bicycles and other manual work An imbalance in energy intake and energy consumption is a risk factor for obesity, hypertension, hyperlipidaemia and diabetes In 2001, new epidemiological studies of diabetes were conducted in four cities: Hanoi, Hai Phong, Da Nang and Ho Chi Minh City The results showed that the incidence of diabetes in the four major cities of Hanoi, Ho Chi Minh City, Hai Phong and Da Nang in subjects aged 30-64 years is 4.9%, disorders of blood glucose tolerance is 5.9% , the rate of impaired fasting blood glucose is 2.8%, the rate of people with risk factors for diabetes is 38.5%, it is worrying that over 44% of people with undiagnosed diabetes be guided treatment According to research by Phan Huong Duong in 2015 in Hai Phong, the incidence of diabetes is 5.2%, pre-diabetes is 26.8% Prevalence of diabetes, prediabetes in the 30-39 age group was 4.2% and 21.7%; age group of 40-49 years old is 4.4 and 23.5%; age group 50-59 years old is 6.0% and 30.5% respectively According to the results of the 2016 study in Kon Tum Province, the prevalence of diabetes in people aged 45-69 years was 16.6%, in which diabetes was 3.5% and diabetes was 13.3% As reported by the study results in 2017 in Hung Yen province, the proportion of households with diabetes in the study was 8.6%, with a cross-sectional descriptive study of 1221 households People over age 60 with diabetes are 11.7% According to Nguyen Thy 10 Khue and other authors, diabetes is a growing problem in Vietnam and is linked to obesity, changes in dietary patterns and other cultural transformations More research is needed to better understand this health issue and provide targeted interventions 1.1.2 Risk factors for type diabetes 1.1.2.1 Less effective risk factors for intervention - Age - A family history of type diabetes (genetic factors) - Ethnicity, race - Factor of fetal development 1.1.2.2 Effective risk factors for intervention - Habitat changes - Maternity factor - History of glucose tolerance - Hypertension - Overweight, obesity - Lipid metabolism disorders and lipoprotein - Some chemicals, pharmaceutical substances - Stress 1.1.2.3 Risk factors for type diabetes in the community In many domestic and international studies, many factors have been identified as a risk factor for type diabetes in the community: family history of diabetes (for example, parents, siblings with diabetes), overweight (BMI ≥ 25), sedentary lifestyle, race, 10 24 15 16 17 18 19 20 21 Do not know a Just eat oil/ an Eat animal sk Do not eat fish Do not eat be Do not eat eg Eat less fruits Table 3.17 analyzes multivariate factors in the lumped model was selected from Tables 3.11 to 3.15, including three runs of the model from 20 factors down to six factors; and six factors retracted to five factors considered to be associated with diabetes mellitus in those with angina pectoris, who are older than 49, who have siblings with diabetes Do not know the risk of diabetes (with blood sugar test) and not eat beans with OR> and p and p 49 24 25 RL/Menopause * Siblings Diabetes Unaware of the risk of age Unaware of the risk of of obesity Eat more than meals/day Eat to satisfaction Don’t eat fish Don’t eat egg Eat less fruits *adjusment 3.2 Effect of media interventions on nutrition and motility of patients with type diabetes in Khoai Chau district Table 3.24 Change the frequency of consuming some foods high in carbohydrate before and after intervention ≤ 3-4 times/week Food Rice/ sticky rice Noodle/ Ramen Cellopha 25 Before/afte r Effect rate % Before/afte r Effect rate % Before/afte >4 times/week InterContr ventio ol n 218/2 109/1 20 10 Contr ol Inter vention 1/110 2/220 100.0 -0.9 -0.9 89/92 100.0 193/19 21/18 27/28 -3.4 100/1 0.5 218/21 14.3 1/2 -3.7 2/3 26 ne noodle Bread Sweet potato Taro Cake, candy… Sugar Diet sugar Bean Vegetabl e 26 r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % Before/afte r Effect rate % 08 -8.0 104/1 06 0.5 210/21 -1.9 109/1 06 -1.0 216/21 2.8 106/1 0.9 214/20 0.9 103/1 05 -1.9 100.0 -50.0 6/4 10/8 33.3 20.0 1/4 300.0 4/6 4/5 6/11 2.3 203/21 -25.0 -83.3 7/5 17/8 28.6 52.9 94/98 -4.4 193/19 16/12 27/27 -4.3 109/1 07 0.0 216/21 25.0 0.0 4/5 1.8 74/67 0.5 147/14 1/3 200.0 73/79 9.5 4.1 36/43 19.4 % 3/8 15/13 107/1 02 -8.2% 205/2 07 -166.7 13.3 4.7 -1.0 -50.0 -25.0 27 Sweet fruit Before/afte r Effect rate % 75/75 141/14 35/35 79/72 0.0 -5.0 0.0 8.9 Evaluation on CSHQ, some diets have a clear change in the frequency of eating sweet potatoes, vermicelli, diet sugars, and vegetables Reduced to eat noodles and taro, bread and bile Table 3.25 Change the frequency of consuming some lipid-rich foods before and after the intervention ≤ 3-4 > times/week times/week Food InterContr Contr Interventio ol ol vention n Before/a 174/1 18/2 fter 92/86 72 46/48 Fat Cook oil Butter Chees e Peanu t/ Sesa 27 Effect rate% 6.5 1.1 Before/a fter CSHQ% Before/a fter 30/33 -10.0 108/1 06 52/64 -23.1 216/2 13 1.9 1.4 178/1 80 -1.1 Effect rate% Before/a fter Effect 91/86 5.5 -33.3 80/7 3.8 -4.3 2/4 100 19/2 -26.3 4/7 168/156 7.1 -75.0 42/40 4.8 28 me Egg Anima l offal Lean meat Fat meat Fisheri es Seafo od Bacon rate% Before/a fter 98/99 201/2 00 12/1 19/20 -1.0 103/1 07 0.5 215/2 15 8.3 -5.3 Before/a fter 7/3 5/5 Effect rate% -3.9 0.0 0.0 Before/a fter 36/50 96/92 57.1 74/6 Effect rate% -38.9 74/91 4.2 174/1 74 18.9 36/1 -3.2 Before/a fter -23.0 98/10 0.0 191/1 94 47.2 0.0 12/9 23/26 -3.1 105/1 10 -1.6 220/2 20 25.0 -13.0 0/0 Before/a fter -4.8 108/0 0.0 218/2 18 5/0 100 2/2 2/4 Effect rate% 0.0 0.9 0.0 -100.0 Effect rate% Effect rate% Before/a fter Effect rate% Before/a fter Effect rate% 124/128 46/46 - Evaluation on CSHQ, some diets have a clear change in the frequency of eating fat meat, smoked 28 29 meat, internal organs Increase the frequency of eating peanut, lean meat Table 3.31 Control blood glucose levels evaluation Interventio Control (n Time n (n = = 110) 220) T0 7.9 ± 1.8 7.5 ± 1.7 months 5.7 ± 1.4 5.5 ± 0.9 months 5.5 ± 1.1 5.4 ± 0.7 months 5.9 ± 0.7 5.8 ± 0.5 f Mann-Withney test; at the time of p-values 0.02f 0.69f 0.83f 0.3f Prior to intervention, the mean blood glucose concentration in the control and intervention groups was statistically significantly different at p 0.05 Table 3.32 Control of HbA1c levels at the time of evaluation Interventi Control (n HbA1c on (n = p-values = 110) 220) T0 6.1± 0.6 6.2 ± 1.0 0.48f months 5.8 ± 1.4 5.7 ± 1.3 0.85f months 5.7 ± 1.1 5.7 ± 1.2 0.22f months 5.7 ± 1.4 5.6 ± 1.3 0.85f 29 30 f Mann-Withney test; Table 3.32 and Figure 3.10 show that: before and after intervention, the mean HbA 1c level of the control and intervention groups was statistically different with p> 0.05 However, in general, the control group was significantly larger than the intervention group Chapter 4: DISCUSSION 4.1 The prevalence of pre-diabetes and diabetes in Hung Yen A survey of 4,495 Hung Yen residents over 25 years old found that prevalence of diabetes was 4.7% and pre-diabetes rate was 25.4% The lower incidence of the survey in Cao Bang Phuong in Tra Vinh province in 2011 was 9.6%, and also lower than that of the CDC in 2015, estimated at 30.3 million People of all ages or 9.4% of the US population - will have diabetes by 2015 According to Hoang Duc Hanh et al (2014), 2402 people aged 30-69 years living in Hanoi in 2014 to determine the prevalence of type diabetes and prediabetes The results shows that: The prevalence of diabetes is 7.9% (urban: 9.2%, suburban: 7.3%) The incidence of diabetes increases with age, highest in the age group of 60-69 (12.4%); The incidence of diabetes in males is higher than that of females (8.6% and 7.5%) The prevalence of pre-diabetes is 27.4%; (27.7% in urban areas, 27.0% in urban areas, 30.3% in 30 31 men, 24.3% in men) The incidence of diabetes in the community was not detected up to 61.8% (urban 50.0%, suburban 74.5%) The prevalence of type diabetes and pre-diabetes among 30-69 year olds in Hanoi is higher than the national rate In our study, pre-diabetes and diabetes were lower than in the study This may be due to the fact that our subjects are aged 25 years or older and the target population is rural, thus resulting in lower morbidity Our results show that the incidence of diabetes in women was 4.5%, lower than for men 5.1% (Table 3.9) According to Hoang Duc Hanh, Chu Thi Thu Ha et al (2012), the prevalence of type diabetes was 7.9% in men aged 30-69 years (male 8.6% and female 7.5%) Our research is in line with the above study because there is a lower incidence of diabetes in women than in men, the lower incidence may be due to our younger age group Especially for women over the age of 25, there will be many changes in the endocrine and when large age, the limitation of movement is a favorable factor for developing diabetes As in Do Thai Hoa's (2013) study in Thanh Hoa, the incidence of diabetes was 5.3% and no gender difference was observed In the study by Nguyen Van Lanh (2014) on subjects 45 years and older, the proportion of women with diabetes was higher than men (7.2% vs 4.7%) 31 32 4.2 Some factors related to diabetes mellitus can interfere After a single factor evaluation, we performed a multivariate logistic regression analysis to identify a number of risk factors that had a real impact on the prevalence of diabetes, the results of which were obtained by five factors It is thought to be related to diabetes mellitus in those with a history of angina (through question), who is 49 years or older, with a sibling with diabetes, who is unaware of the risk (blood glucose test) and not eat beans with OR> and p and p and p and p