Risk factors for self-reported diabetes among Bhutanese adults: A nationally representative survey data analysis.

Kinley Wangdi,Tshering Jamtsho

doi:10.1371/journal.pone.0206034

Kinley Wangdi, Tshering Jamtsho

Open Access

https://doi.org/10.1371/journal.pone.0206034

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Abstract

BackgroundBhutan, a small land-locked country in the eastern Himalayas has been undergoing an epidemiological and nutritional transition in the last two decades. The objective of this paper was to determine the prevalence and explore the risk factors of self-reported diabetes among Bhutanese adults.MethodsWe conducted a secondary data analysis among adults 18 years and older Bhutanese using the data from the National Health Survey 2012 (NHS, 2012) of Bhutan. The self-reported information on risk factors was obtained using standard protocols of the WHO STEPwise approach to Surveillance. The outcome of interest was self-reported diabetes on medication. Adjusted and unadjusted logistic regression analyses were performed to identify the risk factor of diabetes.ResultsA total of 31,066 participants aged 18 years and older were included for the analysis. The prevalence of self-reported hypertension was 1.8% (491). Risk factors for diabetes were: age groups: 35–44 years adjusted odds ratio (AOR) = 2.82 (95% CI, 1.07, 7.41), 45–54 years AOR = 6.02 (95% CI, 2.29, 15.83), 55–64 year AOR = 15.7 (95% CI 5.93, 41.55) and >65 years AOR = 19.60 (95% CI, 6.93, 55.71); high school and diploma/certificate education AOR = 2.57, (95% CI 1.62, 4.07) and AOR = 3.92 (95% CI 1.70, 9.07); and urban dwellers AOR = 2.37, (95% 1.58, 3.57); hypertension AOR = 3.3, (95% CI 2.47, 4.41); and fruit servings of 1–3 per week AOR = 1.63 (95% CI 1.15, 2.31).ConclusionThe number of Bhutanese adults with diabetes and co-morbidities associated with it is likely to increase with the ageing of the population, nutrition transition, and high rural-urban migration in the near future. This calls for an urgent need to implement strategies to prevent diabetes in the Bhutanese population targeting risk factors including healthy lifestyle with increased physical activities and reduced smoking. At the same time treating other chronic morbidities including hypertension.

Highlights

Diabetes Mellitus (DM) is a major public health problem globally with an estimated 422 million adults living with DM in 2014 [1]
Risk factors for diabetes were: age groups: 35–44 years adjusted odds ratio (AOR) = 2.82, 45–54 years AOR = 6.02, 55–64 year AOR = 15.7 and >65 years AOR = 19.60; high school and diploma/certificate education AOR = 2.57, and AOR = 3.92; and urban dwellers AOR = 2.37, (95% 1.58, 3.57); hypertension AOR = 3.3,; and fruit servings of 1–3 per week AOR = 1.63
The number of Bhutanese adults with diabetes and co-morbidities associated with it is likely to increase with the ageing of the population, nutrition transition, and high rural-urban

Summary

Introduction

Diabetes Mellitus (DM) is a major public health problem globally with an estimated 422 million adults living with DM in 2014 [1]. The aetiology of diabetes is multifactorial and includes modifiable and non-modifiable risk factors. The non-modifiable risk factors include genetics and age [9], while modifiable risk factors are obesity [10], sedentary lifestyle [11], an unhealthy diet that contains a high level of sugar [12,13,14] and saturated fats [15], and smoking [16,17,18,19]. The modifiable risk factors are associated with rising living standards, rural-urban migration, and lifestyle changes [20, 21]. Diabetes is a health challenge fuelled by rapidly ageing populations and lifestyle risk factors, in particular, smoking and obesity [3, 22, 23].

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