The prevalence of diabetes mellitus and associated risk factors in the female population of Kavre in rural Nepal
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Background: Non-communicable diseases, including diabetes, are the major causes of premature illness and deaths worldwide. The increasing number of people who develop diabetes is due to several modern societal factors, such as increased life expectancy, population growth, urbanization, obesity and lack of physical activity. South Asians, in general, are known to have an increased predisposition for type 2 diabetes (T2D) and tend to be younger and less obese at the time of diagnosis. Nepal has had a rapid increase in the prevalence of diabetes over the last 20 years, especially in urban areas. The prevalence of obesity, which is considered a key risk factor for T2D, is also increasing in Nepal. Data from several studies from rural Nepal demonstrate great discrepancy in the prevalence rates of diabetes and pre-diabetes, and considering the rate of urbanization and life style changes in these areas, accurate and updated prevalence rates are needed. Objective: This study aimed to investigate the prevalence of diabetes, pre-diabetes, obesity and some cardiovascular risk factors, among the female population in rural districts of the Kavre region in Nepal. Method: The study was primarily conducted in the outreach centers of Dhulikhel Hospital, Kathmandu University Hospital. We used a cross-sectional study design. Inclusion criteria were married women above the age of 15. Pregnant women were excluded. Weight, height, waist circumference and blood pressure were measured, questionnaires were filled in and blood samples were collected. Diabetes was categorized by the HbA1c-criteria of the American Diabetes Association (ADA) whereas overweight and obesity was categorized by the criteria of the International Diabetes Federation (IDF)and the World Health Organization (WHO). Statistical analyses of the data were done in SPSS version 20.0. Results: Altogether 590 women between the ages of 17 and 86 were included in the study. The mean age of the participants was 43.3 years. The prevalence of diabetes and pre-diabetes in the study population was 14.9 % and 38.0 %, respectively. Mean HbA1c was 5.8 %. Most of the women (95.6%) with HbA1c levels indicating diabetes were undiagnosed, and 83.2 % had never heard about diabetes. The prevalence of diabetes increased with age. Mean body mass index (BMI) was 22.6 kg/m². 42.2 % of women were found to be overweight, whereas 22.2 % were obese. 24.9 % were found to have central obesity with a waist circumference (WC) > 80 cm. There was no significant association between the BMI and the prevalence of diabetes, or between the WC and the prevalence of diabetes. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 112.3 and 73.6 mmHg. The prevalence of systolic and diastolic hypertension was 7.5 % and 2.4 %, respectively, increasing with age. SBP and DBP were significantly higher in diabetic and pre-diabetic women. We did not find any association between SBP and BMI. 26.1 % of the participants reported smoking regularly. No association was found between smoking and the prevalence of diabetes or between smoking and hypertension. Conclusion The prevalence of diabetes and pre-diabetes in rural Nepal was higher than expected. Currently, Nepal has little capacity for the initiation of preventive actions, but dedicates most of their resourcesto curing disease. Hopefully, disclosure on this information may contribute to more focus on early diagnosis and treatment of non-communicable diseases, thereby reducing the risk for long-term complications and early deaths.