Prevalence and Risk Factors of Diabetes Mellitus Among the Inhabitants of Kumasi Metropolis

In Ghana, there is an increasing prevalence of diabetes mellitus (DM) in the adult population, which stood at 3.35% by the end of 2013. About 8000 deaths were reported from diabetes in 2013. Changing dietary patterns and lifestyles are associated with the upsurge of DM and in Kumasi the prevalence is 9%. This work sought to determine DM prevalence and associated risk factors among adults in the Kumasi metropolis. The study involved 113 adults from the Oforikrom sub metro. Body Mass Index (BMI) were calculated from weight and height. Venous blood samples were collected for the determination of fasting blood glucose (FBG) using a spectrophotometer. Systolic and diastolic pressures were determined and socio-demographic data were collected using questionnaires. Mean age of participants was 41.8±1.3 years (females=44.9 and males=34.6, p<0.001), mean BMI was 27.3±0.6 kg/m (females=29.4 versus males=22.5 kg/m2, p<0.001) and mean FBG was 4.93±0.1 mmol/L (females= 4.97 versus males=4.84, p=0.55). Prevalence of hypoglycemia was 11.5%, normoglycaemia 74.3%, prediabetes 10.7% and diabetes was 3.5%. Close to 35% and 27% were obese and overweight respectively. More females were overweight or obese (82.3%) than the males (15%), p<0.001. Binary regression analysis showed gender as the only significant predictor of high FBG, with females having a 2.76 (95% CI 0.6, 12.7) increased odds of having high FBG compared to males. BMI, age, exercise, family history and diet were not significant predictors of FBG. In this population there DOI: 10.26502/acbr.50170025 Arch Clin Biomed Res 2017; 1 (4): 224‐234                                                                                                                          225 was 3.5% observed prevalence of DM, similar to national prevalence, high prevalence of overweight and obesity, associated with female gender.

blood glucose using a spectrophotometer. Body weight and height were determined, and BMIs calculated. Systolic and diastolic pressures were determined and socio-demographic data were collected using questionnaires.
Questionnaires centered on socioeconomic details, dietary management, lifestyles, health history, disease awareness and family history of diabetes mellitus.
The results obtained were analyzed using the SPSS software, version 16.0. T-tests, tests for correlation, regression analysis and crosstab analyses were used to compare the various parameters and relationships. The p-values obtained are used to test for the significance of the results.

Results
The total number of participants recruited in this study was 113 and the demographics are represented in Table 1.
Out of the 113 subjects, 79 (69.9%) were females and 34 (30.1%) are males. The mean age of the study participants was 42 (±1.28) years with a significant age difference between the males and the females ( Table 2). All participants for this study were non-smokers, 74 (65.5%) participants exercise either frequently, 1 time/week, 2-4 times/week or monthly while 38(33.6%) participants were not. Only 5 (4.4%) participants take alcohol, whether monthly or frequently while 108 (95.6%) do not take alcohol. Eleven (9.7%) participants answered no to maintaining healthy body weight, 66 (58.4%) participants answered yes to maintaining healthy body weight whilst 36 (31.9%) participants had no idea whether they were maintaining a healthy body weight or not (  From Table 2, it shows that the mean age of the female is statistically higher than that of the male, also the DBP of females is statistically higher than that of males and it shows there is a significant difference between the mean of DBP of females and males. There was no significant difference in the mean of SBP, alcohol, and exercise for both males and females. However, there mean BMI was significantly higher in females than in males (p<0.05).  Of the total study population, 4 are diabetic representing 3.5% and of these, 2 are males and 2 females. The prediabetes is 10.7% and of these 5 (41.7%) were male and 8 (58.3%) females and with the hypoglycemic group, there were 6 (46.2%) and 7 (53.8%) for males and females respectively. This accounts for 11.5% of the study population.
The rest of the population has normal blood glucose and this represented 74.3% of which females constitute 71.4% and males 28.6%. This shows that of the male population, 11.8% are hypoglycemic, 70.5% normoglycaemic, 11.8% pre-diabetic and 5.9% diabetic. The females also revealed that 2.5% diabetic, 10.1% pre-diabetic, 76% have normal blood glucose and 11.4% are hypoglycemic (   Table 4: Risk factors and FBS distribution Figure 1 shows that there is a weak direct correlation between age and BMI, Age and FBS, and BMI and FBS. These associations are weak as the correlation coefficients are less than 0.5 (Spearman's r =0.417) as seen in Figures

Discussion
The study revealed a prevalence of 3.5% for diabetes mellitus and 10.7%% of pre-diabetes. The prevalence of 3.5% It is estimated that the prevalence of diabetes mellitus is similar in women and men [8]. This study showed that the prevalence of the diseases in males and females is the same. Increasing age is associated with the prevalence of diabetes mellitus for both males and females [9]. This study shows that diabetes prevalence is the same for both genders and it is inconsistent with other studies which indicated that more women are prone to the disease than males [8,9].
The prevalence of pre-diabetes is a major concern for public health policy [1]. It is diagnosed when there is hyperglycemia which is not sufficient to be classified as diabetes. It is categorized as Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) and it is diagnosed as fasting blood glucose between 5.6 and 6.9 mmol/L [7]. The pre-diabetic condition is a risk factor for the development of diabetes and other cardiovascular diseases [10].
People with pre-diabetes are at 50% risk of developing type II diabetes mellitus within a 10 year period [11]. The high prevalence of obesity and overweight in the study participants put them at high risk of developing type II diabetes and this group forms an important target for interventions geared towards reducing the development of diabetes mellitus. Of the pre-diabetes prevalence of 10.7%, 58.3% are females and considering the high levels of obesity and overweight in the female population, it can be stated that the females are more prone to developing type II diabetes as compared to their male counterparts. This is because, obesity/overweight has been observed to be noted before a rise in diabetes and other cardiovascular diseases [12].
The increasing trend in modernization has its own benefits and demerits. From the results obtained, it is evident that a sedentary lifestyle is associated with obesity and the development of diabetes [4]. The most useful way of expressing obesity is the body mass index (BMI). The index is the body weight divided by the square of the height in meters (weight/ (height) 2 ). A BMI between 18.5 and 24.99 is considered a healthy weight and this is associated with lower risk of developing type II diabetes [13]. BMI of at least 30kg/m 2 is defined as obesity and it is implicated in the development of diabetes and increased mortality [13,14). For a BMI range of 35-50 kg/m 2 , the relative risks range from 2 to 8 for the development of type II DM and this contrasts with the low risk of people with healthy body weight [13].
There is an increasing sedentary lifestyle and obesity in most parts of Ghana especially in the urban settings [15]. In this study, the mean BMI for males and females are 22.5±0.4 and 29.4± 0.65 (p=0.00) respectively. The BMI is also dependent on the age of the participants. This was revealed with the positive correlation between age and BMI (p=0.002). This shows that the mean for females is significantly higher than that of the males. There is a high level of overweight in the study population as indicated by the prevalence of 34.5% and the prevalence of obesity is at 27.4%. This shows that more than half of the study population are abnormally heavy. The females are found to be overweight and obese than their male counterparts. This compared with similar findings reported in other studies [16].
The increased prevalence of obesity has been observed to be noted before a rise in the occurrence of diabetes, hypertension and other non-communicable diseases. The most notable risk of developing type II diabetes mellitus is obesity and the risk attributed to obesity is as a much as 75% [17,18]. This then shows that a higher percentage of the female study participants are prone to developing type II diabetes mellitus if measures are not put in place to reduce it.
A study by Perry et al. [12] revealed that BMI is not associated with FBG. Other studies, however revealed increase association of obesity and overweight with the development of diabetes mellitus [4]. This study on the contrary, showed a weak association of obesity and overweight with the Fasting blood glucose results (p=0.12).
The study revealed that 64.6% of the people are involved in some form of exercise and 35.4% had no form of exercise. Out of the group involved in physical activity, 15.1% had abnormal levels of fasting blood glucose and 12.5% of the non-physically active have abnormal blood glucose. However, physical activity has no bearing on the fasting blood 35 glucose (p=0.94) and this contrasts studies that show that engaging in some physical activity reduces the risk of developing diabetes mellitus [19]. It must be noted that developing the disease does not only depend on lack of physical activity.
In most studies relating the physical activities, roles in reducing diabetes, it was observed that the level of blood glucose reduces as people engaged in some of exercise regime [20,21]. These studies were on people with the disease already and physical activity was used as a form of intervention to reduce the risk of developing the type II diabetes mellitus. It can be seen that physical activity alone does not prevent the development of the disease, but other factors play major roles.
For the people with pre-diabetes and diabetes, engaging in some sort of physical activity would help reduce the risk of developing type II diabetes. Involving in more physical engagements would help them improve on the sensitivity of the tissues to insulin action. This is linked to the regulation of body weight, decreased adiposity, glucose tolerance and fibrinolytic and endothelial function [20].
In order to associate the effect of the various dietary patterns on fasting blood glucose, a partial correlation test was done using the various diets of the study participants. The outcome showed that there is a positive association between the various diet patterns. But the association is statistically insignificant. This is because the various pvalues obtained were greater than 0.05. A further analysis of the various diets and the fasting blood glucose was carried out. The outcome revealed that there is a weak correlation between the blood sugar and diets of the people.
However, the relation is statistically insignificant as the correlation coefficient, r, was less than the 0. 5 The current study shows the association, but it is a weak relation. It could be due to the sample population being low, therefore not much data was available. It could also be that most of the foods consumed are cereal and grain based, thereby provide enough fiber for the consumer. High fiber from cereals and grains help reduce the demand for insulin after meal and increases the sensitivity of the target cells and tissues to insulin action [23].

Conclusion
It is concluded from the study that the prevalence of diabetes stands at 3.5% and pre-diabetes is at 10.7%. The study revealed that diabetes and pre-diabetes are not associated with age, gender and BMI. The prevalence is weakly associated with lack of physical activity, diet and family history of diabetes mellitus as well. The prevalence of obesity was found to be 27.4% and overweight was at 34.3%. This indicated that over half of the population are obese and overweight.