|Year : 2021 | Volume
| Issue : 4 | Page : 542-545
Assessment of diabetes risk using Indian Diabetes Risk Score among medical students at a medical college in Telangana, India
Prashant Ramdas Kokiwar
Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana 500055, India
|Date of Submission||26-Jun-2021|
|Date of Decision||28-Jul-2021|
|Date of Acceptance||06-Aug-2021|
|Date of Web Publication||12-Jan-2022|
Dr. Prashant Ramdas Kokiwar
Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana 500055.
Source of Support: None, Conflict of Interest: None
Objective: The aim of this article is to assess the risk of diabetes among medical students in one medical college using IDRS (Indian Diabetes Risk Score) and to study the association between risk of diabetes and various factors. Materials and Methods: An institution-based cross-sectional study was carried out among 246 medical students at Mall Reddy Institute of Medical Sciences, Hyderabad, Telangana, India from June to July 2019. Questions pertaining to modified IDRS and measurements such as waist circumference were recorded. Results: The mean IDRS (34.15±11.57) indicated that this population was at moderate risk of diabetes. Majority (78%) were at moderate risk. IDRS was not found to be associated with blood pressure (mean systolic blood pressure for IDRS <30=117.51±6.25; for 30–50=115.72±6.65; and for >60=117.78±6.06; mean diastolic blood pressure for IDRS <30=75.55±6.15; for 30–50=75.39±6.26; for >60=73.33±6.14). Being female (mean IDRS =35.55±11.48 vs. 30.93±11.62 for males) and being overweight or obese (mean IDRS =36.84±11.56 vs. 33.07±11.54 for normal weight) were significantly associated with IDRS (P < 0.05). Conclusion: This population was at moderate risk of developing diabetes. Overweight or obese patients and females had higher IDRS and thus they were at more risk of developing diabetes in future.
Keywords: Association, diabetes, hypertension, obesity, risk factors, risk score
|How to cite this article:|
Kokiwar PR. Assessment of diabetes risk using Indian Diabetes Risk Score among medical students at a medical college in Telangana, India. J Diabetol 2021;12:542-5
| Introduction|| |
Globally, seventh leading cause of mortality is diabetes. Along with hypertension and obesity, it leads to cardiovascular diseases. All over the world, prevalence of diabetes is increasing.
The number of people with diabetes which were 108 million in 1980 had increased to 422 million in 2014. Increased expectation of life, increase in the prevalence of obesity, sedentary life style, changing dietary pattern, and population explosion are contributing to this pandemic.
Around one million people die in India from diabetes yearly and thus contribute to second largest burden of diabetes in the region. The number of people living with diabetes in 2015 was 69.2 million which is expected to rise to 123.5 million by 2040. It has been estimated that the prevalence of diabetes in urban India is 14.2% compared with 8.3% in the rural India. Type-2 diabetes is more common than type-1 diabetes. It has been pointed out that more than half of the people with diabetes remain undiagnosed even today. The factors such as more adiposity of the abdomen, more circumference of the waist, and lower body mass index (BMI) are characteristics of “Asian Indian Phenotype,” and this makes the Indians more vulnerable to diabetes and diabetes-related complications. Hence, the risk profile of Indians for diabetes is not favorable.
Given this background, it is essential that at least individuals above the age of 30 years should be screened for diabetes and also to see if they are at high risk of developing diabetes. So that the individuals with risk of developing diabetes could be identified and a high-risk strategy can be employed to prevent the occurrence of diabetes. But it is not easy to carry out the screening of such a large and diverse population in India, given the limited resources in terms of laboratory tests and man power. There is a need of a simple and fast screening tool to meet this objective. Hence, Mohan et al., have developed the modified IDRS (Indian Diabetes Risk Score) which includes factors such as age, family history of diabetes, waist circumference, and physical activity. It is a very simple and effective tool and has been validated in the Indian set up and found to be having good accuracy of predicting future risk of diabetes.
Healthcare workers including doctors are neglected for early diagnosis and prevention of many diseases. Health of this population is of utmost importance as they are supposed to keep the community healthy. Diabetes is one disease which can be prevented by early diagnosis of those at risk of developing future diabetes. Hence, IDRS can be used to screen the medical students for early diagnosis and prevention of future occurrence of diabetes among them. Identifying factors associated with high scores of IDRS will help to modify those factors (if modifiable) in this population by making them aware to modify those factors and subsequently prevent the risk of diabetes in them. Studies among medical students in India for predicting risk of diabetes are limited.
Hence, the present study was carried out to assess the risk of diabetes among the medical students in one medical college using IDRS and to study the association of IDRS with various factors.
| Materials and Methods|| |
An institution-based cross-sectional study was carried out for a period of 2 months among 246 medical students selected using a convenient sampling technique from June 2019 to July 2019 at Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad. Medical students willing to participate in the study were included, whereas students absent at the time of study and students with any illness at the time of the study were excluded.
Institutional Ethics Committee permission was not taken as this was only a questionnaire-based study, and we did not collect any identifying information. Informed written consent was taken from all the study participants. Those found high risk for diabetes as per the IDRS were given health education to modify lifestyle.
Sample size was not calculated. We contacted all medical students during the study period and those who gave consent were included using a convenient sampling technique.
Questions pertaining to modified IDRS, such as age, physical activity, and family history of diabetes in parents and measurements such as waist circumference (males ≥ 102 cm; females ≥ 88 cm) were recorded. The data were entered in the predesigned study questionnaire. Height, weight, and waist circumference were measured as per the standard guidelines laid down by the World Health Organization (WHO). A cut-off point of BMI (underweight <18.5 kg/m2; normal=18.5–24.99 kg/m2; overweight=25–29.99 kg/m2; obese >30 kg/m2) was classified as per standard guidelines. Blood pressure was measured and recorded as suggested by WHO (optimal <120 and <80 mmHg; normal 120–129 and/or 80–84 mmHg; high normal 130–139 and/or 85–89 mmHg; grade I hypertension 140–159 and/or 90–99 mmHg; grade II hypertension 160–179 and/or 100–109 mmHg; grade III hypertension ≥180 and/or >110 mmHg).
The data were entered in the Microsoft Excel worksheet. Mean and standard deviation and proportions were used to describe the variables. Pearson’s correlation coefficient was used to study the strength of linear association. Variables found to be significantly correlated were entered in the multiple linear regression model using SPSS version 16. Co-linearity was tested using tolerance and Variance Inflation Factor. Two-tailed P-value less than 0.05 was considered as statistically significant.
| Results|| |
[Table 1] shows distribution of study subjects as per anthropological characteristics (n = 246). The mean values of BMI, waist circumference, SBP, and DBP showed that they were within normal range. But mean IDRS (34.15±11.57) indicated that on an average this population was at moderate risk of developing diabetes. The mean age was 20.84±1.72 years, which indicated that majority of the population was young in the present study.
|Table 1: Distribution of study subjects as per anthropological characteristics (n = 246)|
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[Table 2] shows distribution of study subjects as per IDRS. Overall majority (78%) were at moderate risk of developing diabetes, whereas only 3.7% were at high risk of developing diabetes. About 18.3% were at low or no risk of developing diabetes. Females (69.5%) were more than males (30.5%) in the present study due to the fact that among medical students in this particular medical college, female students are more than male students.
Sex, SBP, and BMI were found to be significantly correlated with IDRS but DBP was not correlated with IDRS [Table 3].
Results of multiple linear regression analysis are presented in [Table 4].
The prediction model was: IDRS = 46.31 + 3.97*female + 0.24*BMI−0.209*SBP.
Sex, BMI, and SBP were able to explain 7.1% of variation in IDRS (r2=0.071). The IDRS increased significantly by 3.97 compared with males. With each unit increase of BMI, the IDRS increased by 0.24 which was significant. It was seen that with each unit increase of SBP, the IDRS actually decreased by 0.209 but this relation was not found to be statistically significant.
| Discussion|| |
Mean IDRS (34.15±11.57) indicated that on an average this population was at moderate risk of developing diabetes. The mean age was 20.84±1.72 years.
Overall majority (78%) were at moderate risk of developing diabetes, whereas only 3.7% were at high risk of developing diabetes. This can be attributed to the young age group in this study when compared with Acharya et al. who studied 30 years and above age group and reported that only 5.3% of the study subjects were having IDRS of less than 30. As the age group increased, i.e., 50 years and above in a study by Khan et al., this difference was further found to be potentiated to 67.2% as high risk for diabetes using IDRS. Singh et al. who carried out a study among 290 first year medical students found that only 1% was at high risk of diabetes using IDRS. Ashok et al. reported that 5% were at high risk of diabetes among first year medical students, which is really more taking into account the age groups of previous studies. Tejashwini also found that 6% of the medical students were at high risk, whereas Gopalakrishnan et al. found only 2% as high risk among medical students. Overall it can be said that as the age increases, the risk for diabetes increases as per IDRS because IDRS gives more score to elderly.
In the present study, sex, SBP, and BMI were found to be significantly correlated with IDRS, but DBP was not correlated with IDRS. On multiple linear regression, only sex and BMI were found to be significant predictors of IDRS. Acharya et al. noted that diabetes risk was significantly associated with marital status, education, BMI, and systolic blood pressure. Vardhanet al. found that fasting plasma glucose, total cholesterol, total triglycerides, low-density lipoprotein (LDL) cholesterol, and very LDL cholesterol were positively correlated with IDRS, whereas high-density lipoprotein cholesterol was negatively correlated with IDRS. They did not find any correlation between IDRS and blood pressure. Khanet al. noted that the risk of diabetes was significantly associated with BMI and HbA1c. Singh et al. found that BMI ≥23 kg/m2 was significantly associated with IDRS which is similar to the present study findings but they noted that males were more at risk of diabetes, whereas we found that females were more at risk. Gopalakrishnan et al. noted a positive association between BMI and IDRS similar to the present study findings.
Dudeja et al. reported a sensitivity of 95.12% and a specificity of 28.95% among those with scores of more than 60. They concluded that IDRS can be used to screen the people for diabetes.
| Conclusion|| |
This population was at moderate risk of developing diabetes. Risk of diabetes was found to be associated with BMI but not with blood pressure.
Public health implications: Early identification of diabetes risk among medical students by simple screening using IDRS is of paramount importance for further prevention and control of diabetes and its associated complications in this population.
As the sample size was not calculated and the convenient sampling technique was used, and the study was a single-center study, the data may not be representative of all the medical students.
Ethical approval was not taken as the study was non-invasive and the identifying information was not collected.
Financial support and sponsorship
Conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4]