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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 31
| Issue : 5 | Page : 530-534 |
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Risk assessment for type 2 diabetes mellitus among participants in a market survey at Ebonyi State, South East Nigeria, using finnish diabetes risk score questionnaire
Chidiebere Valentine Ugwueze1, Bede I Nnolim1, Nnamdi C Anikpo1, Kenechukwu Emmanuel Onyekachi1, Cosmas Kenan Onah2, Oluomachi Esther Chukwu1, Chinweuba Michael Abonyi3, Basil Chukwuma Ezeokpo1, Onyechi M Modebe1
1 Department of Internal Medicine, Endocrine Unit, AE-FUTHA, Ebonyi, Nigeria
2 Department of Community Medicine, AE FUTHA, Ebonyi, Nigeria
3 Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| Date of Submission | 04-Jul-2022 |
| Date of Decision | 26-Aug-2022 |
| Date of Acceptance | 08-Sep-2022 |
| Date of Web Publication | 29-Nov-2022 |
Correspondence Address:
Dr. Chidiebere Valentine Ugwueze
Department of Internal Medicine, Endocrine Unit, AE-FUTHA, Ebonyi
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/NJM.NJM_79_22
Background: Type 2 diabetes mellitus is a metabolic disorder arising from insulin resistance and/or decreased insulin secretion and has continued to affect people across all economic levels in society. Due to the high prevalence of undiagnosed diabetes, it has become very imperative to emphasize screening in any given population, especially in developing countries. Aim: The aim of the study was to determine the risk factors and prevalence of diabetes mellitus among participants using the FINDRISC questionnaire. Materials and Methods: The study was a cross-sectional study which involved 200 participants but 197 had complete data. Anthropometric, blood pressure, and fasting/random blood glucose measurements were carried out. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. Results: The mean age of respondents was 41.8 ± 16.3 years. There were 104 males and 93 females. Most of the respondents were traders constituting 51.8% of the study population. The 10-year risk categorization of respondents showed that 57.9% had low risk, 17.8% with slightly elevated risk, 12.2% had moderate risk, 10.7% with high risk, and 1.5% with a very high risk of developing diabetes. The average risk score was 7.4 ± 5.4 with a range of 0.0–24.0. The mean weight, height, and body mass index were 69.6 ± 14.4 kg, 165.3 ± 8.6 cm, and 25.5 ± 5.2 kg/m2, respectively. The mean systolic and diastolic blood pressures were 126.9 ± 20.3 mmHg (range: 80–205) and 76.6 ± 12.9 mmHg (range of 50–130), respectively. Conclusion: Approximately, 25% of respondents have a moderate-to-very high risk which emphasizes the need for continuous screening of the population, especially in public gatherings.
Keywords: Diabetes risk, FINDRISC questionnaire, risk factors, screening
How to cite this article:
Ugwueze CV, Nnolim BI, Anikpo NC, Onyekachi KE, Onah CK, Chukwu OE, Abonyi CM, Ezeokpo BC, Modebe OM. Risk assessment for type 2 diabetes mellitus among participants in a market survey at Ebonyi State, South East Nigeria, using finnish diabetes risk score questionnaire. Niger J Med 2022;31:530-4 |
How to cite this URL:
Ugwueze CV, Nnolim BI, Anikpo NC, Onyekachi KE, Onah CK, Chukwu OE, Abonyi CM, Ezeokpo BC, Modebe OM. Risk assessment for type 2 diabetes mellitus among participants in a market survey at Ebonyi State, South East Nigeria, using finnish diabetes risk score questionnaire. Niger J Med [serial online] 2022 [cited 2023 Jan 31];31:530-4. Available from: http://www.njmonline.org/text.asp?2022/31/5/530/362204 |
| Introduction | |  |
Diabetes mellitus has become one of the ravaging chronic metabolic illnesses worldwide and invariably, more prevalent in the low-and middle-income countries.[1] The global prevalence of diabetes in 2019 was 9.3% which affected about 463 million persons.[2] About 700 million people will suffer from diabetes by 2045.[2] Furthermore, about one in eight persons aged between 20 and 79 years have their death attributed to diabetes and related complications.[3] The current prevalence of diabetes in Nigeria from a meta-analysis done by Uloko et al.[4] was 5.77%, with South-South Nigeria having the highest prevalence of 9.8%, and North Central the least with 3.8%.
The burden of undiagnosed diabetes is also worrisome. Asmelash and Asmelash[5] in a systematic review showed the burden of undiagnosed DM in Africa is more common in urban compared to the rural population (8.63% vs. 3.93%). The authors also demonstrated that the oral glucose tolerance test (OGTT) yielded a higher prevalence rate compared to fasting plasma glucose (8.84% vs. 4.54%). Another systematic review by Dessie et al.[6] showed that the average pooled prevalence of undiagnosed diabetes mellitus among African adults was 3.85% (95% confidence interval: 3.10–4.60). Based on geographic location, the pooled prevalence was 4.43% in East Africa, 4.72% in Western Africa, 4.27% in Northern Africa, and 1.46% in Southern Africa, respectively.[6] In view of the high prevalence of undiagnosed diabetes in Africa, the authors, therefore, opined that diabetes screening should be given proper consideration.
The debilitating acute and chronic complications of diabetes can impact negatively on the quality of life of the patients and their caregivers. It has been established that the onset of these complications emanates even before the diagnosis of overt diabetes.[7]
Sedentary lifestyles, poor engagement in physical exercise, and dietary indiscretion are some of the predisposing conditions to type 2 diabetes.[8] The market is a point of aggregation of different strata of the population thus, was chosen as a good place for diabetes screening. Moreover, the preponderance of traders in the marketplace is of importance since they are busy and hardly find time for physical exercise and clinic evaluation.
Finnish Diabetes Assessment Risk questionnaire
The Finnish Diabetes Assessment Risk questionnaire is simple and easy to administer to participants. The questionnaire can be interpreted to participants in the local dialect to ensure a better understanding of the contents. The questionnaire was developed by Lindstrom and Tuomilehto for the Finnish Diabetes Association.[9] It has been validated for identifying individuals with risk of type 2 diabetes based on a 10-year prospective population-based study [Table 1].[9] FINDRISC questionnaire has been widely used as a cost-effective screening modality in developed nations as well as in developing nations.[10],[11] | Table 1: The categorization of the diabetes risk from the Finnish Diabetes Risk Score questionnaire
Click here to view |
Alebiosu et al.[12] showed that using the FINDRISC questionnaire among 58,567 participants in a state-wide survey, 58.1% of the participants were within the <7 risk group, 26.9% had diabetes risk of 7%–11%, while 5.6% had the highest risk of >20%. Females also had a higher risk of developing diabetes. The prevalence of obesity was 19.2%, while 28.9% of subjects were overweight in their study. A similar study by Opara et al.[13] in Umudike, South East Nigeria among 165 participants showed 66.7% with low risk, 24.2% with slightly elevated risk, and 8.5% with moderately elevated risk. A study done by Nnamudi et al.[11] among 134 young adults, Nigerians aged between 15 and 35 years using the FINDRISC questionnaire showed that 1.5% have a high risk while 12% have a moderate-to-high risk of developing diabetes.
Screening for diabetes mellitus
Diabetes screening is aimed at detecting asymptomatic people with undiagnosed diabetes or detecting those with likely risk of developing diabetes.[11] Different methods have been used such as fasting venous blood glucose, fasting capillary blood glucose, and random blood glucose (World Health Organization [WHO]) estimations. Fasting capillary blood glucose has been reported to show the best equilibrium between specificity and sensitivity for the diagnosis of diabetes at 5.6 mmol.[14] The ADA criteria for diagnosis involve fasting blood glucose ≥126 mg/dl or OGTT two-h postprandial glucose or random blood glucose ≥200 mg/dl obtained on more than two occasions or on one occasion with classical clinical symptoms.[15],[16] Prediabetes includes impaired fasting glucose with FBS between 6.1 and 6.9 mmol/l and impaired glucose tolerance with OGTT two-h postprandial glucose or random blood glucose values between 7.8 and 11.0 mmol/L (two-h postprandial glucose.[17] Diabetes screening can involve screening the whole population, selected population, or can be opportunistic.[18] Opportunistic screening involves screening of people who are being attended to by health professionals for other health reasons.[18],[19]
Vos et al.[20] demonstrated better glycemic control in Type 2 DM patients detected during screening compared to those diagnosed during usual care sessions. Three cohorts were compared: 10-year screen-detected type 2 DM patients, and type 2 DM patients detected by usual care sessions of seven- and 10-year duration, respectively. The respective HbA1C was 50.1 mmol/mol, 51.8 mmol/mol, and 52.8 mmol/mol. The respective requirements for insulin were noted in 10.5%, 14.7%, and 19% in the three cohorts.[20]
| Materials and Methods | | |
The study was carried out at the International Market, Ebonyi State after proper sensitization of a screening program in the market. Participants included adults from 20 years and above who were not diagnosed to have diabetes mellitus previously. The FINDRISC questionnaires were interviewer-administered to the participants after obtaining informed consent. Measurements of fasting blood glucose and random blood glucose were taken using Accu-Check Glucometers (Roche Diagnostics, German). The weight and height of participants were also measured using a stadiometer (SECA, Steindham, Hamburg-Germany, 2013) with an attached weighing scale. The waist circumference and hip circumference were measured using a stretchable measuring tape. Ethical clearance for the study was obtained from the Ethics and Research Committee of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Ethical clearance number: AE-FUTHA/REC/VOL 3/2022/087.
The data obtained from the study were analyzed using the Statistical Package for Social Sciences (SPSS) IBM-SPSS for Windows version 23 (IBM Corp., Armonk, N. Y., USA).
| Results | | |
Data were obtained from 197 participants and analyzed. The tables and figures are shown after the reference section [Table 2], [Table 3], [Table 4], [Table 5], [Table 6] and [Figure 1]. | Table 6: Factors associated with 10 years risk for Type 2 diabetes mellitus among respondents
Click here to view |
 | Figure 1: Respondents' Type 2 diabetes mellitus 10-year risk categorization using FINDRISC questionnaire
Click here to view |
| Discussion | | |
Most of the participants (57.9%) [as shown in [Figure 1]] had a low risk of developing diabetes which is similar to other studies by Opara et al.[13] and Saleem et al.[21] who reported 66.7% and 53.50%, respectively. The individuals with a moderate and high risk of diabetes constituted 12.2% and 1.5% which are similar to 10.5% and 1.5% reported by Nnamudi et al.[11]
The proportion of participants with elevated blood glucose above the normal range from the study was 48.6% [Table 4] which was higher than the 32.80% found by Nnamudi et al.[11] Nnamudi et al.[11] studied a cross-section of young persons which may account for the lower prevalence. Those with overt diabetes mellitus accounted for 11.2% of the study subjects. This is in keeping with the finding of Ekpenyong et al.[22] who reported a prevalence of 10.51% in Uyo Metropolis. However, our finding is higher than that of Ezeani et al.[23] who reported a prevalence of 3.3% from a house-to-house survey done in Abia State, South Eastern Nigeria. The higher prevalence may be as a result of the participants in this study who were mainly traders/shop owners in a market who have a greater tendency to sedentary lifestyles and dietary indiscretion.
Daily physical exercise of 30-min duration was optimal as 54.3% of participants indicated positive responses [Table 5]. However, a study by Akarolo-Anthony and Adebamowo[24] showed that more than 80% of urban Nigerian professionals do not meet up with the WHO recommendations of physical activity. The finding from our study may be due to an increase in awareness of the importance of physical exercises in the environment. Moreover, the study by Akarolo-Anthony and Adebamowo[24] was strictly among professionals. From both bivariate and multivariate analysis in our study, daily physical exercise has statistical significance in preventing the development of diabetes mellitus (P < 0.001, respectively) [Table 6]. Those who were involved in physical exercise have approximately six times less risk of developing diabetes than those who did not involve themselves. Some authors have demonstrated that physical exercise such as walking had an appreciable reduction in the risk of diabetes mellitus by 20%–30% in women.[25] Physical exercises result in acute and chronic improvements in insulin sensitivity and may account for the significant effect reported.[26]
The intake of vegetables was suboptimal as shown by 29.4% of respondents consuming vegetables on daily basis [Table 5]. A study by Banwatt et al.[27] in Jos, North Central Nigeria, showed adequate knowledge (92.4%) of nutritional values of fruits and vegetables but a much more reduced practice of consumption of these items (69.2%). An online survey by Raaijmakers et al.,[28] which involved 1632 women in Lagos and Ibadan reported that respondents consume 2.6 portions of vegetables per day which was below recommendations. The participants who take vegetables and fruits daily had a reduced risk of developing diabetes by approximately 1.2 times. Fruits and vegetables have a high content of flavonoids and antioxidants which inhibit the process of oxidative stress that contributes to the development of diabetes.[29]
Thus, there is a need to emphasize the need for vegetable consumption on daily basis and in the right proportions. Such a recommendation has also been made by Chibike et al.[30] in their study that evaluated vegetable consumption in South Eastern Nigeria.
Among the participants in our study, 33% have been previously diagnosed to have systemic hypertension and are taking antihypertensive medications [Table 5]. This is in keeping with a nationwide survey by Odili et al.[31] with reported overall hypertension prevalence of 38.1% though the regional prevalence in South East was 52.8%. These findings depict a higher burden of hypertension among Nigerians and emphasis on awareness and subsidizing the antihypertensive medications is therefore very crucial.
The prevalence of diabetes in first-degree relatives was 14.2% [Table 5]. The finding is lower compared to the finding of 26.6% reported by Ma et al.,[32] in Chengdu though, a larger population of 535 first-degree relatives was evaluated. However, a similar finding was obtained by Xiong et al.[33] where the prevalence of one or more family degree relatives with diabetes was 18.7% and 12.8%, respectively, though the study was carried out among 8909 type 2 diabetes patients which were far greater than our study population.
| Conclusion | | |
In view of the complications of diabetes mellitus, the benefits of screening individuals with the aim of identifying those at risk cannot be overemphasized. The significant roles of physical exercise and intake of fruits and vegetables were deduced from the study and should be emphasized to individuals as effective lifestyle measures. Moreover, regular screening of individuals in different public fora should be emphasized in our public health system so as to enhance the rate of detection of people with diabetes mellitus.
Authors' contributions
Conceptualization of the topic and Manuscript writing-UCV, Data collection/Literature Search-BIN, NCA, KEO, EC, CMA, Data analysis–CKO. Review and editing-BCE, OMM.
The mean age of respondents was 41.8 ± 16.3 years. There were 104 males and 93 females
Table 6 shows that individuals aged 43 years and above are over 18 times more likely to be at risk of type 2 DM than those who are younger. Males are about 5.5 times more at risk of type 2 DM than females. People who engage in at least 30 min of physical activity per day and those who eat vegetables, fruits, or berries every day are 5.9 times and 1.2 times, respectively, as likely to be at risk of DM as their counterparts.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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