Microsoft Word - GJPHM-2022- DM BABYLONdocx.docx 608 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Original Research ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC, HEALTH CHARACTERISTICS AND TYPE 1, TYPE 2 DIABETIC CASES IN GOVERNORATE OF BABYLON, IRAQ Wael Sulaiman Sabea1, Suhair Mohammed Hassoun2, Ahmed Ali Hussein1 1 Community Health technician, Master of Community Health Technology, Ministry of Environment and Health. 2Assistant Professor, Community Health Department, College of Health and Medical Technology/Baghdad, Middle Technical University, Iraq *Corresponding author: wael2791992@gmail.com ABSTRACT Introduction: Health characteristics and socio-demographic of diabetic patients are important in the determination of livening patterns and factors that contributed in development of diabetes. We aim to identify on socio-demographic and health characteristics of diabetics, and find out association between them and with type of diabetes. Methods: The study of cross-sectional was carried out in Governorate of Babel /Iraq in Endocrinology and Diabetics Centre for period that starting on 3rd November /2018 and to 10th March /2019.Samples of study were collected through systematic random technique using a questionnaire form had been constructed and developed by a researcher after a comprehensive review of available literature and related books about subject. SPSS had used for data statistical analysis in the current study. Results:. (420 diabetics ) of both type 1 and type 2 had been participated in the study with response rate (96. 9%). Their ages ranged from (15-75 ) old years with a mean and standard deviation of (51.8 ± 13.5) years, (46.7%) were male and 53.4% were female. Most of diabetic patients were married and (63.3%) were livening in urban areas. Low percentage (26.9%) of diabetics were with illiterate level and type 2 diabetes was calculated for (81.2%). Hypertension was accounted for (36.4%) while obesity for (35.7%) of them. The study has been showed significant association between type of diabetes and relating their age (type 2 was more in adult group > 44 years while type 1 more in 15- 44 years old ), gender (type 2 was more in women compared to type 1), family history (diabetics with type 1 were more with history of family), body mass index (obesity was more in type 2 compared to type1), comorbidity diseases (chronic hypertension and kidney diseases were more in type 2). Conclusion: The current study had concluded that prevalence of type 2 diabetes was more compared to type 1 dibetes and with high percentage in women group and more in age group > 44 years. High percentage of diabetics with type 2 were with chronic hypertension and obesity and especially in women compared to type 1 diabetes. Keywords: Association, Diabetic patients, Socio-demographic, Health, Babylon. 609 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Introduction Diabetes mellitus is a chronic disorder characterized by the presence of hyperglycemia due to insulin secretion, defective insulin work or both. Many of disease-causing processes are involved in the development of diabetes (American Diabetes Association, 2014) . Type 1 diabetes (insulin dependent) accounts for 5%-10% of all cases of diabetes and refers to a condition of autoimmune diseases that represents a very complex metabolic disorder characterized by massive destruction of the pancreas, specifically beta cells which in turn leads to an absolute lack of insulin (Turton et al., 2018). While the second type of diabetes (non-dependent insulin) accounts for around 90% of all cases of diabetes and refers to a group of disorders that are characterized by high blood sugar that results from a combination of resistance to insulin work, insufficient secretion of insulin and excessive or inappropriate glucagon secretion (Goyal R., 2019). Diabetes is one of the main causes of morbidity, mortality and high costs to the community (Seuring et al., 2015). International Diabetes Federation has suggested that the number of adults living with diabetes around the world increases from time to another (Alemu, 2015). Prevalence of type 2 diabetes mellitus for 45 countries representing nearly 90% of the world's population; in 2018, there were more than 500 million type 2 diabetes cases around the world, and type 2 diabetes prevalence is compared between high and low-income countries (Kaiser et al., 2018). In Iraq, the prevalence of diabetes in Basrah city, Southern Iraq, had increased from 5% in 1978 to 19.7% in 2012, with a prevalence of hypoglycemia of 48.8%. This shows the outbreak of diabetes in Iraq, which is facing a diabetic epidemic like the Middle East (Mansour & Al Douri, 2015). In another study about incidence of Type 1 diabetes mellitus in Basra, results of study have showed that the mean annual incidence rate of T1DM was 7.4 per 100,000 among people 0–40-year-old. Incidence rate has been increasing over the past three years (from 2012 to 2016), this is explained by the changes in T1DM epidemiology in Iraq (Almahfoodh et al., 2017). Demographic and health factors like age, family history, genetic factors, bad meals, stress, others had been considered as contributing factors in development of type 1 diabetes mellitus (Antonela et al., 2017).The increase in the prevalence of metabolic diseases (such as type 2 diabetes mellitus ) in old age may be directly related to age or the process of ageing itself or indirectly through other risk factors associated with age of T2DM (Suastika et al,. 2012) . Individuals at the middle socio-economic level that are living in urban areas with low sport activity and do not consume large amounts of fruit are the most susceptible to the incidence of type 2 diabetes (Gudjinu & Sarfo, 2017). Hence , the researcher in this study had aimed to identify the socio- demographic and health characteristics of diabetics and find out association between them and types of diabetes in Governorate of Babylon, Iraq 610 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Methods A descriptive study design (cross-sectional) had been carried out for a period from 3rd November 2018 to 10th March 2019. This study had taken place in Endocrinology and Diabetics Center in (Medical Marjan City), Babel Governorate/Iraq. It isi located 100 Km south of Baghdad city. The researcher collected diabetic responses through direct interviews and informed diabetics about the purposes of research and aims. Period of interview for the patient from 20-30 minutes. The sample size was collected (420) diabetics through systematic random sampling method from both genders and different ages. Sample size had calculated according to specific Daniel sample size formula for the continuous (infinite) community; which was explained as the following formula: n = 𝒛 𝟐 𝒑(𝟏&𝒑) 𝒅𝟐 ,n = expected sample units number;Z: statistic value for a level of confidence (for the level of confidence of 95%;which is conventional, Z .value = 1.96), P: expected proportion or prevalence; d:is level of the desired of absolute precision. (d is considered as 0.05 to produce precision of good and smaller error of estimate). (Thompson, 2012).This is meaning that z = 1.96 , diabetes prevalence in Iraq according to study in Iraq was 20% (Mansour & Al Douri, 2015) ,d = 0.05. n = [(1.96)2 *(0.20 * 0.80) / (0.05)2 = 3.8416 * 0.16 / .0025] = 245 (minimum sample size). So that the number = 420 diabetics were specific suitable for the study. The questionnaire form had constructed and revised by a researcher after an adequate review of a previous literature review and articles related to the subject of the study. It consists of 2 parts 15 items. Six items for socio-demographic characteristics which include age, sex, residency, job, marital status, and education level. Nine items for health characteristics of diabetics include diabetes type, period for the onset of diabetes, age of onset of diabetes, history family with diabetes mellitus, medications used for diabetes mellitus, body mass index (BMI), associated diseases or medical history according to a specialized doctor, history of smoking, drinking alcoholic beverages. The validity of the questionnaire was determined through a panel of 13 experts that have experience of more than 3 years in their specialties. The expert's responses were assessed based on their agreement or disagreement on the relevancy of items. Expert's suggestions were taken into consideration; modifications are utilized and the final copy of the constructed instrument is completed to be an appropriate tool for conducting the study. Evaluation results by experts indicated that the questionnaires were clear, adequate, relevant, and valid. Statistical Analysis of data by using Statistical Package of Social Sciences (SPSS) version 25, examples: frequency, mean, percentage, Pearson chi-square test. Where at least one cell of table had an expected count less than 5 for 2x2 tables; Yate's corrected Chi-square instead of Pearson chi-square test had used to get adequate results. Ethical consideration Administrative approval from College of Health and Medical technology/Middle technical University/Bagdad; furthermore, Endocrinology and Diabetes Diseases Center /Babylon Health Directorate had approved and gave final permission for author to conduct the study and collect data from diabetics after verbal consent. 611 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Results: The results of this study had been based on the analysis of 420 diabetics; 224 (53.4%) were female but 196 (46.7%) were male (female: male ratio was 1.14:1). Diabetic ages ranged from (15-75) years with a mean of 51.8 years old and a standard deviation of (±) 13.5 years old. More than half (50.5%) were in the age group of 55-75 years and the lowest percentage (11%) were in the age group < 35 years. Regarding the residence; most of the cases (63.6%) were from urban areas. Respecting an occupation; high percentage (39.3%) were housewife. Regarding the marital status and educational level; majority (83.1 %) were married and (26.9%) were illiterate as noted in table no. (1). Table (1):Socio-demographic characteristics of diabetics Socio- demographic & health characteristics No. % Total No. of diabetics 420 100.0 Age (years) < 35 years 46 11 35--44 64 15.2 45--54 98 23.3 55--75 212 50.5 Mean±SD (Range) 51.8±13.5 (15-75) Gender Female 224 53.3 Male 196 46.7 Residence Urban 267 63.6 Rural 153 36.4 Occupation Employee 46 11.0 Student 20 4.8 Earner 52 12.4 Housewife 165 39.3 Retired 76 18.1 Free work 61 14.5 Marital status Single 25 6.0 Married 349 83.1 Separated 1 0.2 Divorced 23 5.5 Widow 22 5.2 Educational level Illiterate 113 26.9 Read & Write 47 11.2 Primary 79 18.8 Intermediate 66 15.7 Secondary 49 11.7 Institute 37 8.8 College and Higher 29 6.9 612 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Table (2) had showed that high percentage (81.2%) were in type 2 diabetics group. Regarding the age of onset of diabetes mellitus was ranged from (8-65) years with mean of (39.6) years and a standard deviation of (±) 13.4 years. High percentage (53.3%) were with history of family for DM and (46.7 %) without family history, most of them (80.5%) with using oral hypoglycemic drugs. Regarding the comorbidity diseases were ordered as following percentages; chronic hypertension (36.4%), rheumatoid arthritis (19.5%), respiratory diseases (9.5%), kidney diseases (5.7%), thyroid gland diseases (4.3%) respectively. Regarding the body mass index; the higher percentage (35.7%) was with obesity. While regarding the smoking; the higher percentage (74.8%) were non-smokers and duration of smoking was ranged from (2-50) years old with mean of (17.0) years and standard deviation (±) 10.8 years. The high percentage (96.4%) of patients were not drinking alcoholic beverages and duration of alcoholic was ranged from (1-15) years old with mean of (6.3) years and standard deviation (±) 10.8 years. While the higher percentage (63.3%) of patients were not drinking soft drinks. Table (2):. Health -characteristics of diabetics : Health characteristics No. % Total No. of diabetics 420 100 Type of diabetes Type 1 diabetes mellitus (DMT1) 341 81.2 Type 2 diabetes mellitus (DMT2) 79 18.8 Age for onset of DMT1 Mean±SD (Range) 20.5±8.4 (8-55) Age for onset of DMT2 Mean±SD (Range) 44±8.2 (15-65) Family member with DM Yes 224 53.3 No 196 46.7 Medications used for DM Oral hypoglycemic drugs 338 80.5 Insulin 82 19.5 Suffered from any of the diseases according to specialized doctor or medical history No. % Chronic hypertension 153 36.4 Rheumatoid arthritis 82 19.5 Respiratory diseases 40 9.5 Kidney diseases 24 5.7 Thyroid gland diseases 18 4.3 BMI (Kg/m2) Thin (<18.5) 29 6.9 Normal (18.5-24.9) 123 29.3 Overweight (25-29.9) 118 28.1 Obese (=>30) 150 35.7 Smoking (years period) Yes 107 25.5 No 313 74.5 Duration of smoking (years) Mean±SD (Range) 17.0±10.8 (2-50) Drinking alcoholic beverages Yes 15 3.6 No 405 96.4 613 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Table (3) showed that there was a significant association (p.value ≤ 0.05) between types of diabetes and their age {type 2 was more in adult group > 44 years while type 1 more in (15- 44 years) }, gender {type 2 was more in women compared to type 1}, family history {diabetics with type 1 were more with history of family },BMI {obesity was more in type 2 compared to type1}, comorbidity diseases {chronic hypertension and kidney diseases were more in type 2} . And in another side, although thyroid gland diseases were more in type 1, and arthritis, respiratory diseases were more in type 2 but there wasn't significant. Table (3): The association between type of diabetes and some selected demographic & health characteristics. Socio-demographic and health Variables Type of diabetes mellitus Type 1 % Type 2 % Total % Total No. 79 100 341 100 420 100 Age < 35 y. 43 54.4 3 0.9 46 11 35---- 44 27 34.2 37 10.9 64 15.2 45--- 54 4 5.1 94 27.6 98 23.3 55--- 75 y. 5 6.3 207 60.7 212 50.5 Chi-square test χ2 = 242.333 df=3 p. value = 0.0001 * Gender Male 51 64.6 154 42.5 196 42.5 Female 28 35.4 196 57.5 224 53.3 Chi-square test χ2 = 12.513 df=1 p. value = 0.0001 * Family history Yes 54 68.4 170 49.9 224 53.3 No 25 31.6 171 50.1 196 46.7 Chi-square test χ2 = 8.821 df=1 p. value = 0.003 * BMI < 18.5 (Thin) 25 31.6 4 1.2 29 6.9 18.5 – 24.9 31 39.2 93 27.3 124 29.5 25-29.5 13 16.5 104 30.5 117 27.9 >=30 10 12.7 140 41.1 150 35.7 Chi-square test χ2 = 108.393 df=3 p. value = 0.0001* Chronic hypertension Yes 6 7.6 147 43.1 153 36.4 No 73 92.4 194 56.9 267 63.6 Chi-square test χ2 = 34.931 df=1 p. value = 0.0001 * Kidney diseases Yes 0 0 24 7 24 5.7 No 79 100 317 93 396 94.3 Yate's corrected Chi- square Y = 4.663 df=1 p. value = 0.031 * Thyroid gland diseases Yes 4 5.1 14 4.1 18 4.3 No 75 94.9 327 95.9 402 95.7 Yate's corrected Chi- square Y= 0.005 df=1 p. value = 0.944 Arthritis Yes 12 15.2 70 20.5 82 19.5 No 67 84.8 271 79.5 338 80.5 614 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo Discussion The current study had illustrated that 50.5% of diabetics were in the age group of 55-75 years with a mean age of 52 years. This finding was agreement by the study in Lebanon that showed the role of ageing in the development of diabetes type 2 (Karaoui et al., 2018), and also similar according to report of American Diabetes Association, which had found that diabetes is an increasing burden on public health and the ageing of the world's population is a major contributor to the epidemic of diabetes (Kalyani et al., 2017). More than half of diabetics were female, this showed that the prevalence of DM among females more than males, may because nature of life style for women this study is similar to studies in Iraqi that had been explained that the majority of diabetes were female (Al-Tukmagi & Moussa, 2014; Ebrahim et al., 2014), but compared to another study in Lebanon by had been illustrated that ratio the male/ female was 1.38, (Karaoui et al., 2018).This disagreement may be because of the nature of the study place or different lifestyles between the two countries. Regarding the residence; most of the cases are from the urban area; the findings are similar to the study in Baghdad, Iraq (Abbas et al,. 2016) and also another study in Palestine that showed that most of the diabetics were from the urban population (Ishtaya et al., 2018). Regarding an occupation; a high percentage of diabetics were housewives, the possible reason may be related to educational level or may the opportunity to get a job for a woman is few in Iraqi society. This outcome was also supported by other studies in Iraqi (Al- Rubaye, 2011; Mansour et al., 2018). Regarding marital status; most the diabetics were married, this was interpreted as the effect of the early marriage; similarly reported by other studies (Ebrahim et al., 2014; Al-Tukmagi & Moussa, 2014). Relating the educational level; the high percentage of diabetics were illiterate, this might reflect the educational background of Iraqi population especially with poor economic level and impact of many wars that happened in the past periods; where many students left school in first stage of the study to work. This result is similar to what had been reported by study in Basra, Iraqi that had noted that high percentage of diabetics were with poor level of education ( Mansour et al., 2018), but this the result was disagreement by the study of in Basra , Iraqi ; where had found that the high percentage of diabetics were in secondary & high education (Ebrahim et al., 2014). This difference might be because of nature of the study place and method of sample selection. In relation to smoking, most of diabetics (74.5%) were non-smokers and duration of smoking ranged from 2-50 years. The possible explanation of the result is that the majority of diabetics were female and more compliance to social habits in Iraq about avoiding the smoking; the finding was the nearest to the Chi-square test χ2 = 1.163 df=1 p. value = 0.281 Respiratory system diseases Yes 6 7.6 34 10 40 9.5 No 73 92.4 306 90 379 90.5 Chi-square test χ2 = 0.517 df=1 p. value = 0.420 *Significant association between proportions using Pearson Yates correction and Chi-square tests ≤ 0.05 level. 615 GLOBAL JOURNAL OF PUBLIC HEALTH MEDICINE 2022, VOL 4, ISSUE 1 gggggglo study in Babylon, Iraq (Alsaadawi, 2016) and in Southeastern Nigeria (Nwaokoro et al., 2014). The present study showed that the majority of diabetics (96.4%) were not drinking alcoholic beverages; this might be related to religious attitude and reject these alcoholic beverages by Iraqi society. To the best of our knowledge; there is no previous similar study, but in comparison to survey results in Iraq, it had been illustrated that 96.8% of people do not drink alcoholic beverages (Al-Hemiery et al., 2017), unlike the study done in America that had indicated that the majority of diabetics in America were drinking different alcoholic beverages (Vaeth et al., 2014) . Most of diabetics were not drinking soft drinks on daily basis; this explains the good behavior and awareness towards avoiding the soft drinks; similarly the finding was supported by the study in Al-Khobar, Saudi Arabia Kingdom (Mokabel et al., 2017). Regarding the type of DM, study had been illustrated that most of diabetics were female with type 2 DM and the mean age of onset of DM was equal or more than 44 years; this had shown that bad lifestyles like lack of physical activity and obesity play a main role in the development of diabetes type 2. This outcome was similar with another study in Basra, Iraqi ( Mansour et al., 2018) and the study in Palestine which had been shown that diabetes type 2 was accounted for a high ratio compared to diabetes type 1 that was calculated for low percentage (El Sharif, 2017).Concerning with family history of diabetes; a high percentage of diabetics (53.3%) had shown that they have a family history and higher in type 1 diabetes, this illustrates family role in the development of diabetes; similarly this the finding was similar by the study in Basra ,Iraqi (Ebrahim et al., 2014) and in Lebanon (Karaoui et al., 2018). Regarding the type of therapy; majority of diabetics (80.5%) took oral hypoglycemic drugs, the reason that most of diabetics were with type 2 diabetes and most of diabetics had taken oral tablets to keep on normal glucose in the blood; this result of the study is similar to other studies in Lebanon (Karaoui et al., 2018), and also with acceptable level by the study in Tehran, Iran (Darvishpoor & Abed, 2013).The present study explained that most of adult female diabetics with type 2 have {chronic hypertension (36.4%), obesity (35.7%)}; this had interpreted that diabetes with bad life styles like unhealthy diet, bad sleeping, stress, lack of physical activity have significant main impact with long period of time in development of chronic hypertension and obesity among diabetics; this result had agreed by the study in Baghdad, Iraq (Al-Rubaye, 2011), (Colosia et al,. 2013). Conclusion: The present study had concluded that the prevalence of type 2 diabetes was more compared to type 1 and with a high percentage in the women group and more in age group morr than 44 years. A high percentage of diabetics with type 2 were with chronic hypertension and obesity and especially in women. The study has been suggested the establishment of modern well-organized educational programs supported with modern developed educational technologies for diabetics in diabetic centers and other institutions show role of socio-demographic and health factors in development of diabetes. 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