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All countries, irrespective of their developmental stage, face an increasing burden of non-communicable diseases including diabetes mellitus. There is substantial evidence of the existence of the gap in the level of diabetes mellitus and its complications prevention and control measures in developing countries.
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This study aimed to assess the prevalence of diabetes mellitus in urban and rural dwellers in a low-income country from both younger and older population and to identify factors related. This is a community based comparative cross-sectional study conducted in a low-income country, Ethiopia.
Fasting blood glucose levels were measured by finger pricking after overnight fasting. Data entry was done by EPI-data computer program version 3. Bivariate and multivariate logistic regression tests were used to assess the associations between diabetes status of individuals and its potential predictor variables.
The study was conducted on individuals with age range of 18—97 years old. The mean fasting blood glucose level for study participants was The prevalence of diabetes mellitus was 3. Both the mean blood glucose level and the prevalence of diabetes mellitus were significantly higher for urban residents than rural.
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More than three-fourths of diabetic cases were newly diagnosed by this study. Urban dwellers, centrally obese, overweight, and hypertensive individuals have higher odds of getting diabetes mellitus. High prevalence of diabetes mellitus involving both old and young population was documented. Most diabetic cases were suddenly diagnosed during this survey. The problem is noticeably alarming, attention should be given to the control and prevention of diabetes mellitus and related complications.
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Citation: Animaw W, Seyoum Y Increasing prevalence of diabetes mellitus in a developing country and its related factors. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper and its Supporting Information file.
Competing interests: The authors have declared that no competing interests exist. Non-communicable diseases NCDs are becoming major health challenges with continually increasing burden [ 1 ]. Diabetes mellitus is one main segments of chronic non-communicable diseases [ 2 ]. All countries, irrespective of their economic developmental, epidemiological and demographical variability, are facing an increasing burden of non-communicable diseases including diabetes mellitus [ 4 ].
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Diabetes mellitus with other NCDs are responsible for an increasing burden of diseases in developing countries. It has been projected that the number of people with diabetes will increase to million by and million by from million in The majority of these numerical increments will occur in developing countries [ 7 — 9 ]. Studies around the world reported different level in the prevalence of diabetes mellitus.
In Guatemala, the prevalence of diabetes was 8. In Bangladesh, a higher prevalence of diabetes was found among females, old age, centrally obese and urban dwellers [ 12 ]. A study conducted in Korea reported that WHO reported that there were about , people having diabetes in Ethiopia in and the number is expected to escalate to 1.
A community based comparative study in Gondar found that the prevalence of diabetes mellitus among adults aged 35 years and above was 3. Consumption of calorie-dense foods, sedentary lifestyle, tobacco consumption, older age, family history of diabetes and use of antiretroviral medications were the identified risk factors for metabolic syndrome in Gondar and Addis Ababa [ 16 , 17 ].
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Another study from southern Ethiopia found that hypertension, central obesity, and overweight had a strong association with diabetes mellitus [ 17 ]. The burden of diabetes and diabetes-related mortality and disability are rising in Africa. Sedentary lifestyles coupled with growing urbanization cultures and processed diets are predicted to triple the prevalence of diabetes mellitus in the coming 25 years involving young populations too [ 18 , 19 ].
In Ethiopia, national data on prevalence and incidence of diabetes are lacking. However, patients attendances and admission rates due to diabetes mellitus are rising in hospitals. In the previous 2—3 decades, there have been observable lifestyle changes with significant population growth and urbanization which are the main risk factors repeatedly reported.
By the time diabetes-related complications become clinically manifested, it will be too late to overcome the complications; that also demands costly resources which is unaffordable in developing countries. Early detection, intervention and avoidance of risk factors have an enormous benefit which is only possible when there is evidence depicting the magnitude and risks of diabetes.
However, most studies in Ethiopia were institution-based, focusing on urban dwellers and old age individuals only. Community-based epidemiological evidence incorporating urban and rural residents, younger and older population is essential to plan and intervene relying on evidence.
This study aimed to complement this evidence gap in the study area. Hence, this study assessed the prevalence of diabetes mellitus in urban and rural dwellers and identified related factors. Community based comparative cross-sectional study was conducted among individuals aged 18 years old and above in Pregnant, mother in post-partum period 6 weeks after delivery and sick individuals during data collection period were excluded from the study.
Taking the prevalence of DM from a study conducted in Gondar [ 16 ] 5. According to the manual, a multistage sampling strategy was used to select study participants. In the last stage of sampling SS4 , one eligible participant was selected from each of the selected HHs.
Details of sampling procedures are presented in supporting file S1 File. Using adopted questionnaire data were collected by nurses after training. The questionnaire was adopted from WHO for non-communicable diseases NCDs surveillance in developing countries [ 20 ].
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In accordance with the STEPs manual, questions related to alcohol and substance use were tailored and modified with few additional questions to reflect the local context of Ethiopia. After gaining written informed consent, data were collected in accordance with the STEP-wise approach; the approach has three levels: the first level is interview to gather sociodemographic and behavioral information, the second level is simple physical measurements weight, height, waist circumference and hip circumference , and third is for the biochemical tests blood glucose test [ 20 ].
Each study participant was contacted for a minimum of two consecutive days. In the first day contact, an appointment was made for the coming morning by instructing the participants not to take any food and fluid fasting for a minimum of 8 hours until blood sample was taken in the next morning contact.
Anthropometric measurements height, waist and hip circumferences were taken without heavy outdoor clothing. Stature was measured to the nearest millimeter using standard and caliber anthropometric rod.
Weight was measured on a pre-standardized body weighing scale. The hip circumferences were measured at the maximum circumference around the hips and the waist circumferences were obtained at the level of the umbilicus at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest hip bone using a measuring tape.
Blood pressure BP was measured while participants sitting and resting for at least five minutes. Three BP measurements were taken with minutes interval between consecutive measurements and the average was taken for analysis.
In this study, as per the appointment made in the first contact day, each participant was re-visited in the second day for fasting blood glucose level measurement. Before taking the sample, we confirmed for the right participant and appropriate fasting status. If the first test was above the normal range, the test was repeated in the next day with the similar circumstance.
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Data entered into EPI data version 3. Dependent variable fasting capillary blood glucose level was dichotomized into diabetic and non-diabetic while non-diabetic incorporated individuals with normoglycemic and impaired fasting glucose IFG level sharing the definition given by WHO. Detail operational definitions for variables used in the study are attached in supplemental materials.
To explain the study population in relation to relevant variables, frequencies and summary statistics were used. Associations between the diabetic status of individuals and its potential predictor variables were assessed and presented using logistic regression tests.
P-value below of 0. In this study, a total adult participants were recruited and of them have fully participated in the study which gives As it is presented in Table 1 , half of the participants were urban dwellers.
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The median age of the participants was 33 years old ranging from 18—97 years old. Age of the participants was categorized using four percentiles. Though the categorization system is different, more than forty percent of the current study participants were below the age of thirty which is close to the national and regional age distributions [ 23 , 24 ]. Seven hundred and ninety-six In the study area male to female ratio was reported to be about 1 to 0.
Two-thirds of the participants were married which is similar to the regional percentage [ 23 ], The mean, maximum and minimum height of participants was 1. The BMI status of the participants was categorized into four categories from underweight to obese, as defined in attachment Operational definitions in S1 File.
Accordingly, Nearly half The mean fasting blood glucose level for the study participants was The mean fasting blood glucose level of urban residents was While the mean fasting blood glucose level for rural dwellers was While drawing the boxplot extreme outliers in blood glucose level were excluded.
As shown in the boxplot Fig 1 lower outliers were only from the rural residents. The upper outliers were from both residency sites. Mean fasting blood glucose level for male participants was Only 7. Of 46 identified diabetic cases only 16 More than three-fourths When fasting blood glucose levels were categorized as defined in the supplemental attachment, it was found that 46 3.
To identify factors related to diabetes mellitus, first bivariate logistic regression tests were computed and presented in Table 3. In these tests sex, occupation, vigorousness of daily activity, academic level and Khat consumption status of participants did not show a statistically significant difference and hence these variables were excluded from final regression model multiple logistic regression tests.
Though the association test did not show a statistically significant difference, only 2. Six 1.