|BRIEF RESEARCH ARTICLE
|Year : 2013 | Volume
| Issue : 1 | Page : 24-28
Prevalence of diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, and its correlates among police personnel in Bankura district of west Bengal
Pranav Kumar1, Debabrata Mallik2, Dipta Kanti Mukhopadhyay3, Apurba Sinhababu4, Banamali Sinha Mahapatra5, Phalguni Chakrabarti6
1 Superintendent of Police, Bankura, India
2 Demonstrator, Bankura Sammilani Medical College, Bankura, India
3 Assistant Professor, Bankura Sammilani Medical College, Bankura, India
4 Professor & Head, Bankura Sammilani Medical College, Bankura, India
5 Professor, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, India
6 Demonstrator, Department of Biochemistry, Bankura Sammilani Medical College, Bankura, India
|Date of Web Publication||4-May-2013|
1483, R.N. Tagore Road, Dumdum, Kolkata - 77, West Bengal
| Abstract|| |
A cross-sectional study was conducted among police personnel (N = 1817) in Bankura District, West Bengal, India to estimate the prevalence of diabetes mellitus (DM), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and its correlates during July-November, 2011. Participants were enquired about their age, gender, physical activity, and predominant occupational activity. Diagnosis of DM, IFG, and IGT was based on a history, fasting, and 2-h post-load blood glucose estimation as per World Health Organization (WHO) criteria. Body mass index, waist circumference (WC), and blood pressure (BP) were estimated. Out of 1817 subjects, DM was found in 15%, 1.1% had IFG and 5.7% had IGT. Age >50 years, family history of diabetes, hypertension, and abdominal obesity were found to be significantly associated with DM and IGT, whereas IFG was significantly associated with the family history of diabetes and hypertension. High prevalence of diabetes and pre-diabetic condition warrants early effective intervention to keep the police force healthy and agile.
Keywords: Diabetes mellitus, Hypertension, Impaired fasting glucose, Impaired glucose tolerance, Police personnel
|How to cite this article:|
Kumar P, Mallik D, Mukhopadhyay DK, Sinhababu A, Mahapatra BS, Chakrabarti P. Prevalence of diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, and its correlates among police personnel in Bankura district of west Bengal. Indian J Public Health 2013;57:24-8
|How to cite this URL:|
Kumar P, Mallik D, Mukhopadhyay DK, Sinhababu A, Mahapatra BS, Chakrabarti P. Prevalence of diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, and its correlates among police personnel in Bankura district of west Bengal. Indian J Public Health [serial online] 2013 [cited 2014 Sep 1];57:24-8. Available from: http://www.ijph.in/text.asp?2013/57/1/24/111364
Diabetes mellitus (DM) is emerging as a major health-care challenge for India. According to the World Health Organization (WHO) estimates, India had 32 million diabetic subjects in the year 2000 and this number would increase to 80 million by the year 2030.  Prevalence of diabetes across various occupational groups and its relationship with occupational factors is a topic of recent interest. Police work is considered as inherently stressful on account of several factors such as long and unpredictable hours of work, constant exposure to traumatic situations, dealing with anti-social elements, strong disciplinary mechanism, etc.  Occupational stress can alter blood glucose levels in an undesirable manner and can affect the management of dysglycemia and its complications.  Therefore, early detection of those states also provides an opportunity for preventive actions including appropriate life-style modifications. This study was undertaken to estimate the prevalence of DM, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT), and its correlates among police personnel in Bankura District, West Bengal.
A cross-sectional community based study was conducted among all police personnel of Bankura District of West Bengal during July-November; 2011. Total 19 camps were conducted to cover all the study subjects of 78 police stations/outposts of Bankura Districts on pre-defined dates. After obtaining informed consent, study participants were interviewed to collect information about gender and age, duration of formal education, and length of service in completed years. Moderate intensity leisure time physical activity such as brisk walking and cycling for more than 30 min a day for at least 5 days in a week was taken as regular physical activity.  Predominant occupational activities were categorized as sitting and standing as reported by the participants. Body weight (to the nearest 0.5 kg) and height (to the nearest 0.5 cm) were measured following the standardized procedure with the bathroom scale and anthropometer rod. Waist circumference (WC) was measured around the midpoint between iliac crest and lower rib cage by flexible, metal, non-stretchable measuring tape, in the standing position. Body mass index (BMI) of 23-24.99 kg/m  and >25 kg/m  for both sexes were used to determine the overweight and obesity.  WC 90 cm in male and 80 cm in female were considered as cut-off point for diagnosing abdominal obesity.  Blood pressure (BP) was recorded on right arm by mercury sphygmomanometer in a sitting position after 5 min rest. An average of three readings measured at an interval of 5 min was taken. Systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) >90 mmHg was regarded as the criteria for hypertension.  Subjects on anti-hypertensive treatment were also considered as hypertensive in the present study. Blood samples with the sodium fluoride for fasting and 2-h post-load blood glucose (75 g) was collected by venipuncture and was estimated by glucose oxidase peroxidase method by XL 300 (Trans Asia) machine. Diabetes was considered if fasting plasma glucose (FPG) value was >126 mg/dL and/or 2-h post-load plasma glucose value was >200 mg/dL and/or (s)he was a known diabetic. IFG was diagnosed if FPG was 110-125 mg/dL and 2-hour. post-load glucose (2-hour. PG) was <140 mg/dL and (s)he was not a known diabetic. IGT was diagnosed if 2-h PG was 140-199 mg/dL and FPG <110 mg/dL and (s)he was not a known diabetic.  IFG and IGT were collectively considered as pre-diabetes condition.
Prevalence of DM, IFG, and IGT were expressed in percentages. Mean and 95% confidence interval (CI) was used to describe independent continuous variables. To identify the correlates, binary logistic regression was carried out with the presence or absence of diabetes, IFG and IGT as dependent variables and socio-demographic, life-style factors as independent categorical variables.
The study was approved by the Institutional Ethics Committee of the concerned institution.
A total of 1817 police personnel working in different police stations/outposts participated in the study excluding 85 absentees. The mean age of the respondents were 42.3 ± 11.27 years (range = 20-59 years) with 34.9% aged 50 years or more. Service duration of majority (70.0%) was 10 years or more and 19.0% of the study subjects were graduates/postgraduates. Family history of diabetes was present in 11.7% respondents. Nearly, 42.2% of study subjects were hypertensive. 57.6% and 25.7% had obesity and overweight as per BMI. On the basis of WC, 37.9% had abdominal obesity. Only 10.5% exercised regularly and in 71.1% participants, standing was predominant nature of occupational activities.
The prevalence of diabetes was 15% of which known diabetic was 9%. IFG and IGT were found in 1.1% and 5.7%, respectively.
[Table 1] shows that in IFG subjects mean fasting blood glucose remained towards lower cut-off with narrow CI. Same was true for post-load glucose level in IGT subjects. Respondents with IFG, IGT, and DM had higher mean SBP, DBP, and BMI compared to normoglycemic participants. Abdominal obesity was significantly higher in IGT and DM subjects compared to IFG and normoglycemic subjects.
|Table 1: Distribution of fasting and 2-h post-load glucose level and some modifi able risk factors among subjects with normoglycemia, IFG, IGT, and DM (N =1817)|
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[Table 2] reveals that participants with age of 50 years or more, hypertension, abdominal obesity, and family history of diabetes were 4.8, 1.5, 1.7, and 3.3 times more likely to have diabetes. Subjects having hypertension and family history of diabetes were found to be 2.2 times and 3.6 times more likely to have IFG. Age of 50 years or more, family history of diabetes, the presence of hypertension, and central obesity were also positively associated with IGT.
The prevalence of diabetes in India is increasing at an alarming rate. Different nation-wide studies showed high prevalence of diabetes and IGT with gross regional variations. , The so called "Asian Indian Phenotype" makes Indian more prone to diabetes. 
|Table 2: Binary regression analyses to identify associated factors of DM, IFG, and IGT (N=1817)|
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Irregular life-style and work-related stress were responsible for increased vulnerability of personnel from certain occupations to non-communicable diseases including diabetes.  Pan et al. reported that rotating night shift duty had dose response relationship with incidence of diabetes among nurses even after adjustment for BMI.  However, Nagaya et al. argued that increased prevalence of diabetes among policemen and fire-fighters was probably due to high BMI rather than occupational influences.  Two earlier studies among police personnel in India clearly showed high prevalence of diabetes and more so in Chennai. , Prevalence of diabetes in the present study was somewhat higher than that of Kolkata study, whereas the prevalence of IFG was lower.  It might be due to assessment of 2-h PG for diagnosis of diabetes and IGT as well as higher prevalence of obesity in the present study. The proportion of newly diagnosed diabetes was higher compared to Kolkata study.  Lack of awareness and lack of facilities might be the contributing factors. In a study in Belgaum cantonment in India, overall prevalence of diabetes among army personnel was 6.7%, lower than the present study. 
Mean of FPG in IFG subjects and 2-h PG in IGT subjects were slightly higher than the lower cut-off with narrow CI. It depicted the lower risk of those subjects. However, higher mean BP, BMI, and WC posed a greater risk to this population. Hence, success of preventive measures mostly depends on appropriate life-style modifications.
Age dependent increase in the prevalence of diabetes was noted in studies among police personnel in Kolkata and Chennai. , Present study, though failed to find any increasing trend with age, showed that the age group of >50 years had significantly higher prevalence of diabetes and IGT.
Family history had a significant positive association with DM, IFG, and IGT, which corroborated the finding of many previous studies among police personnel and general population. ,
More than 80% of the study subjects were overweight or obese based on BMI and around 40% had abdominal obesity. Given the stringent rules and health specification followed at the time of recruitment, this picture could establish the derailment from health after several years of service in police. The present study reported a positive association of abdominal obesity with DM and IGT. Similar finding was noted in earlier studies among police personnel and army personnel. [14,,
Education, leisure type physical activity, predominant occupational activity were not found to be associated with dysglycemia probably due to narrow differences and influences of confounding variables, not taken in the study, e.g., rank, income, etc.
This study is most probably the first study in India among police personnel outside metropolitan city to estimate the prevalence of DM, IFG and IGT and its correlates using the latest WHO criteria. The present study gave an opportunity for risk mapping of police personnel working in Bankura District in relation to diabetes and other dysglycemic states. This study could be viewed as the very first step for planning interventional strategies to halt the conversion of pre-diabetes to diabetes, restore health in diabetics and promote healthy life-styles among police personnel.
| Acknowledgments|| |
We are grateful to Dr. Manoj Chowdhury, Principal of B.S. Medical College and Singh Vineet Goyal, DIG Midnapore for permitting us to carry out this study on policeman. We are also thankful to the other police authorities for their support and whole-hearted cooperation during the course of study. We are thankful to all the PGTs and internee and all the technical staff for their kind cooperation during the period of data collection.
| References|| |
|1.||Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53. |
|2.||Selokar D, Nimbarte S, Ahana S, Gaidhane A, Wagh V. Occupational stress among police personnel of Wardha city, India. Australas Med J 2011;4:114-7. |
|3.||American Diabetes Association. Living with diabetes: Stress. Available from: http://www.diabetes.org/living-with-diabetes/complications/stress.html. [2011 Nov 13]. |
|4.||World Health Organization. Global recommendation on physical activity for health: 18-64 years old. Geneva, Switzerland: WHO; 2011. Available from: http://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64 years.pdf. Accessed on 17 th August 2011. |
|5.||Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163-70. |
|6.||Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52. Available from: http://www.hyper.ahajournals.org/content/42/6/1206. Accessed on 17 th August 2011. |
|7.||World Health Organization and International Diabetes Fedaration. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva, Switzerland: WHO; 2006. p. 1-3. |
|8.||Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM, et al. The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: Prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract 2004;66:301-7. |
|9.||Mohan V, Mathur P, Deepa R, Deepa M, Shukla DK, Menon GR, et al. Urban rural differences in prevalence of self-reported diabetes in India - The WHO-ICMR Indian NCD risk factor surveillance. Diabetes Res Clin Pract 2008;80:159-68. |
|10.||Joshi SR. Metabolic syndrome - Emerging clusters of the Indian phenotype. J Assoc Physicians India 2003;51:445-6. |
|11.||Chandramohan P, Mohan V. High prevalence of diabetes and metabolic syndrome among policemen. J Assoc Physicians India 2008;56:837-9. |
|12.||Pan A, Schernhammer ES, Sun Q, Hu FB. Rotating night shift work and risk of type 2 diabetes: Two prospective cohort studies in women. PLoS Med 2011;8:e1001141. |
|13.||Nagaya T, Yoshida H, Takahashi H, Kawai M. Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: A follow-up study in Japanese men. Am J Ind Med 2006;49:30-5. |
|14.||Kumar S, Mukherjee S, Mukhopadhyay P, Pandit K, Raychaudhuri M, Sengupta N, et al. Prevalence of diabetes and impaired fasting glucose in a selected population with special reference to influence of family history and anthropometric measurements - The Kolkata policeman study. J Assoc Physicians India 2008;56:841-4. |
|15.||Tharkar S, Kumpatla S, Muthukumaran P, Viswanathan V. High prevalence of metabolic syndrome and cardiovascular risk among police personnel compared to general population in India. J Assoc Physicians India 2008;56:845-9. |
|16.||Madhusudhana MD, Manjunath ML, Girish Babu M. A study on distribution and determinants of diabetes mellitus among army personnel in Belgaun Cantonment in India. Int J Biomed Adv Res 2011;2:1-8. Available from: http://www.ijbar.ssjournals.com. [Last accessed on 2012 Jan 23]. |
[Table 1], [Table 2]