International Journal of Biomedical and Advance Research
A STUDY OF DISTRIBUTION AND DETERMINANTS OF DIABETES
MELLITUS AMONG ARMY PERSONNEL IN BELGAUM CANTONMENT
IN INDIA
Madhusudhana M.V.1, Manjunath M.L.2*, Girish Babu M.2
1
Department of community medicine, Shimoga institute of medical sciences, Shimoga577201.
2
Dept. of Physiology, Shimoga Institute of Medical Sciences, Shimoga-577201.
E-mail of Corresponding author: manjunathmlphysio@gmail.com
Abstract
Background and Objectives: Diabetes is rapidly emerging as a major public health problem
in India; and Indiahas the maximum number of diabetics in the world. Diabetes assumes
special importance in context of Indian army, where Diabetes is one of the leading causes of
hospital admission, disability, and invalidment from service. The present study was
conducted to find out the prevalence of Diabetes Mellitus and its distribution and
determinants among Army personnel in Belgaum Cantonment. Methodology: A one year
cross sectional study with a sample size of 600 participants, carried out by a structured
interview using questionnaire, physical examination, anthropometry, and fasting blood sugar
estimation. The present study was performed after the institutional ethical clearance and the
informed and written consent from all the participants. The data obtained was analyzed for
the statistical significance using SPSS software version 10 by adopting univariate and
multivariate analysis. P<0.05 was considered the level of significance. Results: The overall
prevalence of diabetes mellitus among army personnel was 6.67 %. Out of 40 diabetics
identified, 17(42.5%) of them are newly detected cases of diabetes. Conclusion: The various
risk factors found to be significantly associated with diabetes in the present study are
increasing age, higher army rank and educational status, lack of physical exercise, increased
Body Mass Index (BMI), and increased Waist Hip Ratio (WHR). Diabetes was also
positively associated with current Hypertension status and family history of diabetes.
Keywords: Distribution, Determinants, Diabetes Mellitus, Army Personnel, Belgaum CantonmentIndia
1. Introduction
the world today. Diabetes mellitus is a
Diabetes is one of the most pervasive
major health problem in all nations, and
and worsening health problems facing
the disease afflicts a broad swath of
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Manjunath et al
310
people, young and the old. The highest
for
incidences have been reported from
retirement 7.
India, China, and the USA1. Diabetes is
Diabetes assumes special importance in
rapidly emerging as a major public
context of Indian army, where diabetes
health problem in India; As Prevalence
along with hypertension is the leading
of diabetes has increased globally, now
cause of death, disability, hospital stay
India has the maximum number of
and invalidment from service8. The
diabetics hence India has a distinction of
armed forces in our country forms one
being called, "the diabetic capital of the
of
world"2.
personnel of different caste and creed of
With very few exceptions, applicants
people from the length and breadth of
with diabetes are generally refused a
our country and they form a distinct
military career in most armed forces in
group, as majority of them are young,
the world. There has been growing
predominantly males and are subjected
concern over recent increases in the
to severe stress, strain and extremes of
prevalence of diabetes and obesity in the
climate. The implications of developing
U.S. and the impact this may have on
a chronic disorder with such far
morbidity, mortality, and health care
reaching consequences for a person
3,
4
possible
the
medical
largest
discharge
groups,
or
employing
Furthermore,
serving in an establishment where
accumulating evidence shows that this
fitness takes priority over everything
epidemic is affecting young adults in the
else is worth considering. Although the
U.S., with similar increases in type 2-
prevalence of type 2-diabetes was well
expenditure
.
5, 6
. These trends
reported in the Indian scenario, the data
may directly affect the military in terms
on Indian armed force personnel’s was
of recruitment, retention, and military
not documented. Therefore, the present
readiness. Diabetes of any type is cause
study has been undertaken to investigate
for rejection into military service, in
the prevalence of diabetes mellitus and
accordance with Department of Defense
its
directive (DoD instruction no. 6130.3,
amongst the armed force personnel in
Physical Standards for Appointment,
Belgaum Cantonment.
diabetes and obesity
distribution
and
determinants
Enlistment, and Induction, 2 May 1994).
Members of the military who develop
2. Methodology
diabetes during active duty are referred
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2.1 Study Design
were screened by estimation of fasting
The present study was a cross-sectional
blood sugar, those with borderline or
study
higher
undertaken
in
Belgaum
fasting
sugar
values
were
Cantonment India with a sample size of
subjected to glucose tolerance test for
600 and the study period covered one
confirmation. The subjects were divided
year from January to December.
in to “diabetics” or “non diabetics” on
the basis of their Blood sugar levels as
2.2 Sampling procedure
per the latest WHO guidelines9. Data
A complete list of all serving army
was analyzed using SPSS software
personnel
all
version 10, univariate and multivariate
in Belgaum
analysis was carried out to find out the
Cantonment. A sample of 600 study
various risk factors associated. p<0.05
participants was drawn from the list
was considered the level of significance.
was
collected
military units located
from
using random number tables. The
required sample was selected from
3. Results And Discussion
different categories (Officers, junior
commissioned officers (JCOs) and other
The present study shows that the overall
ranks using stratified random sampling
prevalence of diabetes mellitus among
method).
serving army personnel in Belgaum
The personnel’s belongs to the age
Cantonment is 6.67% (Figure-1). The
group of 25-55 years with and without
majority of the diabetics were in the 35-
hypertension under the categories of
49 year age group and an upward trend
officers; junior commissioned officers
of Diabetes prevalence was observed
and other ranks were included in the
with
present study. Personnel are diagnosed
prevalence was high among officers 6
for diabetes and fresh recruits were
(12.5%)
excluded from the study.
officers 25(5.34%) than the other ranks
Data was collected using pretested
9 (10.71%). Various other risk factors
Questionnaire; anthropometry included
associated with diabetes in the present
the measurement of height, weight,
study
waist circumference, hip circumference
educational status, lack of physical
and the blood pressure using validated
exercise, alcohol intake, increased Body
instruments. All the study participants
Mass Index (BMI), increased Waist Hip
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increase
and
are
in
age.
Junior
higher
Also
the
commissioned
army
rank
and
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312
Ratio (WHR), extra fat intake in the
which accounts for more than 90 per
diet and psychological stress including
cent of all diabetes cases.
long duration of field service and
The present study conducted to find out
prolonged mental stress. Diabetes was
the prevalence of diabetes mellitus and
also positively associated with current
its distribution and determinants among
Hypertension status and family history
Army personnel revealed association
of Diabetes. Also the prevalence of
between age of the study participants
diabetes
among
and the prevalence of diabetes mellitus.
normotensives
These findings compare well with the
(Figure 2). Using these risk factors
findings of Verma et al12 and Datta13
univariate
who observed an strong association of
was
hypertensives
regression
higher
than
and
multiple
analysis
was
logistic
performed.
increasing age with diabetes.
After eliminating the effect of other
Hypertension has a strong alliance with
concomitant variables the important risk
diabetes, as shown in our study; the
factors that are associated with diabetes
mean Systolic blood pressure among 40
mellitus are extra fat intake, physical
diabetics was 135.5 ± 12.94 mm of Hg,
activity, and hypertension and waist hip
while it was 124.9 ± 9.35 mm of Hg
ratio (Table 1).
among
The prevalence of diabetes is rapidly
diastolic blood pressure among 40
rising all over the globe at an alarming
diabetics was 87.5 ± 6.43 mm of Hg,
rate10. Over the past 30 yr, the status of
while it was 81.5 ± 6.39 mm of Hg
diabetes
among
has
changed
from
being
non
diabetics.
Non
diabetics.
The
Also
mean
the
considered as a mild disorder of the
prevalence of diabetes was higher
elderly to one of the major causes of
among
morbidity and mortality affecting the
normotensives. The findings of this
youth and middle aged people. It is
study are in agreement with the study of
important to note that the rise in
Bhalwar et al14.
prevalence is seen in all six inhabited
The prevalence of diabetes mellitus was
continents of the globe11. Although there
higher among participants belonging to
is an increase in the prevalence of type
higher army ranks and having higher
1diabetes also, the major driver of the
education status than the others. It
epidemic is the 217 more common form
compares well with the study report of
of diabetes, namely type-2diabetes,
Verma et al12. It is well known fact that
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hypertensives
than
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age, higher social and economic status
hypertension and waist hip ratio (WHR).
are risk factors for the development
Urgent actions need to be taken to
diabetes, in order to eliminate the effect
prevent diabetes becoming a major
of these concomitant factors
health problem in this organization.
we
subjected the data for multiple logistic
regression analysis. The important risk
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Table: 1 Unadjusted and Adjusted Odds Ratio for Development of Diabetes. N=600
personnel’s.
Unadjusted
Predictor
Odds
Ratio
Age
1.16
Army rank
Literacy
Adjusted
95% CI
P-value
Odds
Ratio
1.10-1.22
0.027
1.06
0.97-1.15
0.163
0.59
0.39-0.92
0.018
0.85
0.44-1.64
0.629
0.57
0.35-0.93
0.025
0.53
0.27-1.06
0.074
Extra fat intake(yes/no) 2.01
1.09-3.95
0.026
2.50
1.12-5.58
0.025
Mental stress(yes/no)
2.91
1.21-7.04
0.017
1.40
0.47-4.13
0.545
Alcohol intake(yes/no)
2.31
1.01-5.31
0.050
0.75
0.26-2.15
0.591
Physical
activity(min/week)
0.34
0.23-0.51
0.000
0.54
0.29-1
0.050
Family history(yes/no)
3.39
1.39-8.23
0.007
2.98
0.95-9.36
0.061
Hypertension(yes/no)
14.49
5.59-37.55
0.000
5.67
1.61-20.06
0.007
BMI
2.66
1.93-3.66
0.000
0.81
0.62-1.04
0.100
WHR
3.04
2.29-4.03
0.002
3.12
2.16-5.01
0.001
95% CI
P-value
Note: BMI=Body Mass Index, WHR=Waist Hip Ratio.
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