Untitled Document

ORIGINAL ARTICLE

Year : 2020  |  Volume : 3 |  Issue : 1 |  Page : 18-21

DOI: https://doi.org/10.46319/RJMAHS.2020.v03i01.005

 

Study of risk factors for diabetes using Indian diabetic risk score in Tumkur
Swetha R1*, Kavya NG2, Kavya L2
1 Associate professor, 2 Interns, Department of Community Medicine, Sri Siddhartha Medical College & Research Centre, SSAHE, Agalakote, Tumakuru
*Corresponding author:
Swetha R, Associate professor of Community Medicine, Sri Siddhartha Medical College & Research Centre, SSAHE, Agalakote, Tumakuru, Karnataka, India.

E-mail: drswetha226@gmail.com
Abstract
Background: In India, more than 50% of the diabetic population remains unaware of their diabetic status. Early detection and prompt treatment are the keys to achieve sustained control and prevent complications. The IDRS is one of the simple screening tools to find high risk for diabetes in the community. Materials and methods: We had conducted a cross-sectional study of 170 individuals. The data collected included general information and IDRS questionnaire, which includes age, physical exercise, waist circumference and family history of diabetes. Results: Out of 170 individuals high risk for diabetes observed in 53(31.2%).The association between increasing BMI with high IDRS was observed and found statistically significant. We observed high blood pressure among the individuals having high IDRS and findings were statistically significant. Conclusion: In a community setting, IDRS is a feasible questionnaire to administer by a non-clinician as it involves the data collection and measurement of waist circumference. We can use a large scale community screening tool before blood glucose estimation.
Keywords: Diabetes mellitus, Risk score, Body Mass Index
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Introduction
Diabetes is a leading cause of death and disability worldwide. According to WHO diabetes will be the 7th leading cause of death by 2030.[1] In India, more than 50% of the diabetic population are not aware of their diabetic status, which added to the disease burden. The major risk factors which contribute to diabetes are unhealthy diet, physical activities, tobacco smoking and alcohol etc. The onset of diabetes can be prevented by adopting lifestyle modification measures.[2]  Due to the high burden of diabetes, a simple screening tool is needed to identify the undiagnosed who are at high risk. A simple tool for screening, Indian Diabetic Risk Score (IDRS), which is considered to be one of the strongest predictors of diabetes incidence in India.[3,4]  Early detection of high-risk individuals helps in suitable interventions like dietary changes, increased physical activity. This will help to prevent or to detain the diabetes onset in the high-risk population. The application of various screening methods will identify the asymptomatic people and modify course and complications of the disease.
                This study, therefore, conducted to assess the proportion of study participants with high IDRS and to determine the relationship between body mass index (BMI) and high blood pressure in Tumkur.
Materials and Methods
A cross-sectional study conducted among 170 individuals presented to OPD of Sri Siddhartha Medical College and Hospital, Tumkur from September 2019 to October 2019. After explaining the purpose of the study, all adult population aged 20yr and above who are apparently healthy included. Critically ill patients, unwilling to take part in the study, known case of any type of diabetes excluded. Informed consent was taken after explaining to them in their understandable language before the study. The institutional ethical committee approval obtained before conducting the study. The sample size calculated by using formula 4pq/L2, where p was 45% according to previous study and 8% of allowable error.[4] Purposive sampling method used to attain the sample size.
A semi-structured questionnaire with IDRS used for data collection. Questionnaires also included general information, family history, height, weight, waist circumference. BMI calculated using a formula and blood pressure measured using a sphygmomanometer. All the participants were requested to take rest for ten minutes before taking the readings. The participants were classified into high (score>60), moderate (score 30-50) and low risk (score<30) out of the total score 100.
Data entered in Microsoft excel sheet analysis were done using descriptive statistics and Chi-square test. P-value less than 0.05 taken as statistically significant.
Results
Out of 170 study objects, 87(51.2%)were female, and 83(48.8%)were male. Socio-demographic features wise distribution shown in table 1, more than 40% of participants were in the age group of 35-50years, followed by 20% of participants were in more than 50 years. As the age of the participant's advances, IDRS>60, which is a high risk for developing diabetes increases. We observed in our study that 53(31.2%) high-risk subjects 22(41.50%)belongs to CLASS II categories shown in table 2

 

Table 1: Distribution of study subjects according to socio-demographic features


VARIABLES

FREQUENCY OF DISTRIBUTION (n=170)

GENDER

MALE

83(48.8%)

FEMALE

87(51.2%)

AGE(IN YRS)

<35

59(34.7%)

35-50

77(45.3%)

>50

34(20%)

SOCIOECONOMIC CLASSIFICATION

CLASS I

27(15.88%)

CLASS II

58(34.11%)

CLASS III

57(34.52%)

CLASS IV

27(15.88%)

CLASS V

1(0.5%)

Table 2: Distribution of study participants according to IDRS


Indian diabetes risk score

No. of subjects (%)  

>60

53(31.2%)

30-50

104(61.2%)

<30

13(7.6%)

TOTAL

170

We observed that 53 (31.2%) were at high risk, 104 (61.2%) were at moderate risk and 13 (7.6%) study participants were at low risk of developing diabetes as shown in table 2. Out of  53(31.2%) high-risk subjects 22(41.50%)belongs to CLASS II category as shown in table 3.

Table 3. Association between socio-economic status (according to BG Prasad) and IDRS


SES

No risk

Moderate risk

High risk

Total

 

CLASS I

1(7.7%)

20(19.23%)

6(11.32%)

27(15.88%)

 

Chi square
55.22
P
<0.00001

CLASS II

4(30.77%)

32(30.77%)

22(41.50%)

58(34.11%)

CLASS III

5(38.46%)

36(34.6%)

16(30.20%)

57(33.52%)

CLASS IV

3(23.07%)

15(14.4%)

9(16.98%)

27(15.88%)

CLASS V

0(0%)

1(1%)

0(0%)

1(0.5%)

TOTAL

13(7.6%)

104(61.2%)

53(31.2%)

170 (100%)

Body mass index of the study participants and its association with IDRS shown in table 4.Normal BMI  observed in 72(42.4%), and overweight found in 97(57.06%)participants. Among overweight participants, 36 (38.3%) had a high risk of developing diabetes. The association between increasing BMI with high IDRS was observed and found to be statistically significant (p<0.0001).

Table 4. Association between BMI and IDRS among study participants.


BMI

IDRS score

TOTAL

 

<30

30-50

>60

<18.5 (underweight)

0(0%)

1(1%)

0(0%)

1(0.5%)

 

Chi square
75.99
P
<0.00001

18.5-22.99 (normal)

12(92.3%)

43(41.3%)

17(32.1%)

72(42.4%)

23-24.9(overweight)

1(7.7%)

60(57.7%)

36(67.9%)

97(57.1%)

TOTAL

13(7.2%)

104(61.2%)

53(31.2%)

170 (100%)

Among 53 participants,with high riske 13(24.5%) had high blood pressure and 40(75.5%) had their blood pressure value within normal range. The current study showed that high blood pressure was observed among the participants having IDRS more than 60 and  the findings were statistically significant(p=0.0001) as shown in table 5.

Table 5: Association between blood pressure and IDRS among the study participants


Hypertension
Status

IDRS score
<30                        30-60                     >60

TOTAL

 

Non hypertensive
<140/90

 

13(100%)

 

92(88.46%)

 

40(75.5%)

 

145(85.3%)

 

Chi square  
60.94
P  <0.00001

Hypertensive
>140/90

0(0%)

12(11.54%)

13(24.5%)

 25(14.7%)       

TOTAL

13(7.2%)

104(61.2%)

53(31.2%)

  170(100%)

Discussion
A study conducted to screen the community using IDRS in Tumkur. Total 170 participants included in the study out of which 83 were men and 87 were women. The present study showed that IDRS is a useful tool to identify high-risk individuals who can be targeted for screening for diabetes.
In the present study, 59 (34.7%) participants were 20-35 years, followed by 77(45%) in 36-50 years. In a study conducted by Mohan V et al., showed that 21.33% were of 26-35 years, 18.66% were of 36-50 years.[3] It found that 31.2%, 61.2% and 7.6% of the participants were at high, moderate and low risk respectively. In the study conducted by Madhura D et al., it was found that 27.42%,47.58% and 25% high, moderate and low risk respectively for developing diabetes.[4]In another study conducted in Gwalior 26.1% had IDRS score more than 60, where as risk score was > 60 in  57.6 % in Tamil Nadu.[5,6]   
The study showed IDRS high risk was in 61.2% and moderate risk in 7.6%. According to Anjana P et al., IDRS score used to predict the risk of developing diabetes in the general population had observed high risk among 45.5%.[7]
It found that there was a significant association between increasing BMI with IDRS with high risk. The similar findings observed in studies conducted by Madhura D et al.[4] Diabetes has several risk factors like age, waist circumference, physical inactivity and high blood pressure. The study conducted to determine the association between high blood pressure which is a risk factor for cardiovascular diseases by Mohan et al., shows that with increasing IDRS >30,30-50 AND >60, the prevalence of hypertension found to be 9.4,22.1 and 38.2 respectively.[1,3] The similar observations were found in our study 11.54%,24.5% and 14.7% respectively.
IDRS is a feasible questionnaire to administer, especially in an epidemiological setting by a non-physician since it just involves the collection of data and a single measurement of waist circumference. It could thus use as a screening tool before doing blood sugar testing in our population. This could help reduce the costs of screening for diabetes by nearly 50%.[6]
Conclusion
Our study highlights the use of Indian diabetic risk score for identifying undiagnosed high-risk participants for developing diabetes. More than half of our study participants were at high risk for developing diabetes. As this score includes two modifiable risk factor, i.e. abdominal obesity and physical activity will be helpful for lifestyle modifications to reduce the risk for diabetes and other non-communicable diseases. Regular screening programmes will help in early detection and appropriate intervention to prevent/delay the progression to diabetes and its complications.
Acknowledgements:Nil
Financial support and sponsorship:Nil
Conflict of interest:Nil
References
1. The Global Burden. IDF Diabetes Atlas. 9th edition. Available at: www.diabetesatlas.org/en/resources. Accessed on 3rd February 2020.
2. Brinda P, Santosh A. A study to Determine the Hidden Part of the Iceberg of Diabetes, using Indian Diabetes Risk Score as a Screening Tool in Rural Population of Bangalore, Karnataka, India. Int J Community Med Public Health. 2016;3(11):3076-80
3. Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects. J Assoc Physicians India. 2005;53:759-63
4. Madhura D Ashturkar MD, Kshirsagar MV, Majumdar RT, Dandekar AA. Screening for diabetes using Indian diabetic risk score in the field practice area of tertiary care hospital, Maharashtra. Int J Community Med Public Health 2019;6(7):2798-802
5. Agarwal AK, Ahirwar G, Marskole P, Bhagwat AK. A community based study to assess the validity of Indian diabetic risk score, among urban population of North Central India. Int J Community Med Public Health 2017;4(6):2101-6
6. Jayakiruthiga S, Rajkamal R,Gopalakrishnan S, Umadevi R. Assessment of diabetes risk in an adult population using Indian Diabetic Risk Score in urban area of Tamilnadu. Int J Community med public health 2018;5(4):1587-90
7. Anjana P, Bant D D. A community based cross sectional study to identify individuals at high risk for diabetes in urban slums of Hubli. Int J Community med public health 2016;3(1):212-7.


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