1
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF PUBLIC HEALTH

NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY NGUYEN VAN LANH

THE SITUATION OF DIABETES, PRE-DIABETES
TO THE KHMERIN HAU GIANG PROVINCE AND AN EVALUATION
OF THE EFFICIENCY OF SOME INTERVENTIONAL METHODS
Major in: Hygiene Sociology and Health Organization
Code: 62 72 01 64 SUMMARY OF MEDICINE PhD THESIS
For further information about thesis at
1. National Library
2. National Institute of Hygiene and Epidemiology Library
3
ABBREVIATION
BMI Body Mass Index Chỉ số khối cơ thể
CDC Center of Disease Control Trung tâm kiểm soát dịch bệnh Mỹ
Cs Et al Cộng sự
ĐTĐ Diabetes

Đái tháo đường
EASD European Association for the
Study of Diabetes,
Hiệp hội nghiên cứu đái tháo đường
Châu Âu
ESC European Society of

MNT Visceral Fat Mỡ nội tạng
NPDNG Oral Glucose Tolerance Test Nghiệm pháp dung nạp glucose
NXB Publisher Nhà xuất bản
OR Odd ratio Tỷ số chênh
RR Risk ratio Tỷ số nguy cơ
TG Triglycerid

THCS Junior High School Trung học cơ sở
THPT Senior High School Trung học phổ thông
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THA Hypertension Tăng huyết áp
TT- GDSK Truyền thông – giáo dục sức khỏe
TCYTTG World Heath Organisation Tổ chức y tế thế giới
YTNC Yếu tố nguy cơ
TĐTĐ Prediabetes Tiền đái tháo đường
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INTRODUCTION

Diabetes is not a contagious disease, has an upward trend. It effects
on the health of working-age people in all over the world. In 2003, there
are 171,4 million people suffered from diabetes, it is predicted to be
double in 2030. Every day, there are about 8700 people die because of
diabetes.
The prevalence of diabetes is different from each continents and

6
- It can determine the prevalence of pre-diabetes of the Khmer in
community
- It can determine some factors related to type-2 diabetes of Khmer,
proof that the intervention of educational communication can change
behaviors and manage diabetes treatment at medical station. At the same
time, having a combination with Khmer clinic staff, mass organization
and religious authorities in the local area to organize prevention work of
diabetes in the community.
THESIS’S STRUCTURE
The thesis includes 139 pages with 41 tables, 2 diagrams, 5 graphs and 3
pictures.
Including: 2 pages of Pose problems, 33 pages of overview, 30 pages of
subjects and research methods, 36 pages of research results, 35 pages of
discussion, 2 pages of conclusion and 1 page of petition.
There are 130 references, in Vietnamese (64), in English (66).

CHAPTER 1
OVERVIEW
1.1 Overview of diabetes
1.1.1. Concepts of type-2 diabetes
According to American Diabetes Association (ADA), in 2006, “Type 2
diabetes is a metabolic disorder that is characterized by high blood
glucose in the context of insulin resistance and relative
insulin deficiency”.
According to International Diabetes Foundation (IDF), in 2010,
“Diabetes is a group of metabolic disorders of carbohydrate metabolism

Or the concentration of HbA 1c is from 5,7% - < 6,5%
- Normal. Fasting blood glucose is < 5,6 mmol/l
1.1.2.2. Classification of diabetes
According to American Diabetes Association and European
Diabetes Association
- Type 1 diabetes: the beta cells are destroyed by the immune
system and no longer secrete insulin. It can be divided into two
categories: structure with and without autoimmune. It does not depend on
cytoplasmic antibodies.
- Type 2 diabetes: It is characterized by insulin resistance, relative
insulin deficiency, and increased production of glucose by the liver,
abnormal fat transformation. Obesity caused from visceral fat or central
obesity.
- Other specific types: Diabetes due to absent beta cell function or
absent insulin action due to genetics.
- Gestational diabetes: occur while being pregnant
1.1.3. Factors related to Type 2 diabetes
In recent years, people have proved that there are many factors
related to diabetes. According to American National Institute of Health,
factors that can cause Type 2 diabetes include:
- People ≥ 45 years old, 90-95% suffers from Type 2 diabetes
- Overweight (BMI ≥ 23 for Asian people) male pattern obesity
(waist size ≥ 90 cm to male and ≥ 80 to female, high WHR)
- Blood pressure 140/90 mmHg or higher
- Have a family prehistory of diabetes
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- Woman had a prehistory of gestational diabetes or gave big child

method as follows:
Change our diet: it is recommended to change our habit to reduce the
disorder of blood lipids including the decrease of fat, cholesterol, the
increase of protein with low fat, fiber.
To reinforce physical activities: doing exercise regularly can
prevent Type 2 diabetes because exercising help reducing the resistance
of insulin. It is also easy to transform glucose to reduce plasma glucose.
A scientific Exercising can fresh our mind, reduce stress and avoid
9
insulin resistance. An increase of physical activities can reduce the risk of
obesity and eliminate some factors caused diabetes. It is encouraged to
lessen drinking hard and stop smoking.
CHAPTER 2
SUBJECTS AND RESEARCH METHODS
2.1. Subject
The Khmer who are 45 years old and over, living in Hau Giang
Province within the study period
2.2. Location: Residents live in: Long My, Chau Thanh A District and
Vi Thuy District, Hau Giang Province.
2.3. Period: From 09/2011 to 10/2013. The first period is for
investigation and the second period is for intervention research (2 years).
2.4. Research methods
2.4.1. Cross-sectional descriptive study and community intervention
2.4.2 Cross-sectional descriptive study
- Sample size. With single random sampling formula:
N = Z²
(1-α/2)

- β: Probability of the II error. With β=0,2
- Z² (α,β) = 7,9
10
The rate of pre-diabetes , diabetes desired 10% reduction compared
to pre-intervention ( 29.82 % ) . The rate of pre-diabetes , diabetes
mellitus after intervention was 20 % . So ( p2 ) is estimated to 0,2982 % ,
due to the rate pre-diabetes , diabetes does not change or less change .
Placing into the above formula, we have the minimum sample size
is 302.
So, the sample size after 2-year taking intervention at 2
communes has the smallest n with 302 in the community of 45-year-old-
and-over Khmer. At the 2 control commune, we also choose the smallest
sample size 369 to investigate after taking intervention.
Sampling: taking random sampling at the two intervention
communes are Cai Tac and Bay Ngan of Chau Thanh A District. For that
of control group are Vi Thuy Commune and Vinh Trung Commune of Vi
Thuy District.
2.4.4 Organization of intervention
Model “Commune medical station in diabetes prevention for
Khmer”
- Interventional actions
It includes 5 activities for intervention, prevention of pre-diabetes
and diabetes as follows: (1) develop resources and network at medical
station which is under the interventional model; (2) Educating community
health through communication; (3) consulting to change behaviors; (4)
doing exercises; to monitor for early detection and to manage the work of
examining and treating at commune medical station (5).


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To manage, reduce research errors through: sampling, investigator,
gathering information, tools, machines and medical equipment,
standardizing data.
2.7. Data processing
EPI-INFO software 3.5.3, Excel 2003 and Epi 6.0 are used for
analyzing through testing χ
2
, OR, Multivariate Regression Analysis.
CHAPTER 3
RESEARCH’S RESULT
3.1. THE PREVALENCE OF PRE-DIABETES, DIABETES AND
SOME RELATED FACTORS 3.1.1 The prevalence of pre-diabetes,
diabetes to the Khmer

Table 3.2. The prevalence of pre-diabetes and diabetes to the subjects
Content

Quantity

Percentage

(%)

Do not get diabetes

772

70,2


12
3.1.3. Some factor related to Khmer who get diabetes
Table 3.10. The relationship
Demography Total

The
prevalen
ce of
diabetes
Percenta
ge %
P
Sex

Male

458

52


333

37

11,1

≥ 65

248

41

16,5

Job

Farmer

626

82

13,1

<0,05
Employee

61

1

<0,05
Primary

550

41

7,5

High
school,
ollege
145 18 12,4
Financia
l status
Fairly
–

have
enough to eat
295 32 10,8
>0,05
Poor
–

poor
threshold
805 99 12,3

between demography and diabetes
low sugar
consumption
511 37 7,2
2,0
1,30 -
3,34
0,0
1
high sugar
consumption
589 94 16,0
Fat diet

low fat
consumption
687 81 11,8
0,6
0,44 -1,08
0,1
0
high fat
consumption
413 50 12,1
Eating
after 20
o’clock

No

302

56

18,5

Drinking
alcohol/
day
No, little

510

59

11,6

0,5
0,28 -0,98
0,0
4
Yes

590 72 12,2

SmokingNo

14
Table 3.15. The relationship between health indexes
Variable Total
Number
of people
suffering
from
diabetes

%
OR
95% CI
P
Belly size

Normal

918 105 11,4
0,6
0,3-1,1
0,03
High

1,4
1,0-2,1
0,04
High

313 47 15
BMI

<23

691 51 7,4
2,3
1,5-3,6
0,01
≥23

409 80 19,6
Blood
Pressure

Normal

672 55 8,2
1,7
1,1-2,5
0,01
High
blood
pressure


eAge

0,74 0,69 – 0,78 53 <0,05
BMI

0,61
0,55
-

0,66
23 <0,05
Belly size

0,78 0,74 – 0,82 77 <0,05
Prehistory of High Blood
Pressure
0,38 0,32 – 0,43 <0,05
Out of the scaleSystolic hypertension0,65 0,61 – 0,69 120 <0,05
Diastolic hype
rtension16
Table 3.20 To compare the knowledge of Khmer after the intervention.
Content
Right
knowledge
P
CSHQ

Intervent
ional
efficienc
y
(%)
Nu
mbe
r
%

Risk
factors
Intervention
(n=302)
Before

139 46,0
0,01
72,8


After

243

80,5

Control
(n=369)
Before

140

37,9

0,01
45,9
After 204 55,3
Preventi
on
Intervention
(n=302)
Before

158 52,3
0,01
14,5 5,5

Eat more

P
CSHQ
HQC
T
(%)

Numb
er
%

Eat sweet
things
Interventio
n
(n=302)
Before

131

43,4

0,01

35,3

35,3
After
85

43,2
43,2

After

49

16,2

17

(n=302)

Control
(n=369)
Before

144

39,0

0,23

<0,0
After

156

35,0

0,02
18,0
After

106

28,7

Eating
vegetables,
fruits
Interventio
n
(n=302)
Before

131

43,4

0,01
63,4
63,4
After
214

70,9

27,7
After
197

53,4

Control
(n=369)
Before

150

49,7

<0,01

<0,0
After
218

72,2

Physical
activities
Interventio
n
(n=302)
Before

beer,
alcohol
Interventio
n
(n=302)
Before

141

46,7

<0,01
75,8

63,6
After
34

11,3

Control
(n=369)
Before

173

46,9

0,01
12,2

(%)

Waist

Intervention

(n=302)
Before

Intervention
51 16,9
0,0137,3
27
After

Intervention
32 10,6
Randomized

Controlled trial
(n=369)
Before

Intervention


8,8
8,8
After

Intervention
227

75,2

Randomized

Controlled trial
(n=369)
Before

Intervention
288

78,0

0,010,0
After


85

28,1

Randomized

Controlled trial
(n=369)
Before

Intervention
198

53,7

0,030,0
After

Intervention
218

59,1

BMI

Intervention



Intervention
145

39,3

<0,010,0

After

Intervention
187

50,7

Blood
Pressure
Intervention

(n=302)
Before

Intervention
102

33,8



28,7

19
Ratio of having high the waist before and after intervention has 27
percent of interventional effectiveness. Comparing to visceral fat high
level before and after intervention has 8,8 percent of interventional
effectiveness. Ratio of high body fat before and after intervention has
over 53,6 percent of interventional effectiveness , ratio of over 23 BMI
before and after intervention has over 20,9 percent of interventional
effectiveness. Ratio of hypertension before and after intervention has 9,8
percent of interventional effectiveness.
3.2.4 Situation of medical examine and medical treatment of diabetes
at communal medical station
Table 3.26 Comparing the situation of medical examine at communal
medical station after intervention
medical examine

Medical
examine
of
diabetes
medical
examine of
other
disease
total

9870

97,6

10116
<0,0554,2
48,6
After

Intervention

780

5,7

12970
94,3

13750
Rando
mized

Contro
lled

98,1

10767
Ratio of patients examined medically before and after intervention
has 48,6 percent of effectiveness
Table 3.27. Comparing ratio of diabetes detection at communal medical station
Diabetes
Having
diabetes
Normal

Total
P
CSHQ

(%)
HQ
CT
(%)

SL

%

SL

%

Intervention



780

Randomized

Controlled
trial

Before

Intervention
7

4,7

141

95,3

148

<0,0538,3
After Intervention
13

6,5


(%)
SL

%

SL

%

InterventionBefore

Intervention
27

10,9

219

89,1
246

<0,0528,4

<0
,0514,8
After

Intervention
17

8,5

184

91,5
201

Ratio of pre diabetes patients examined and detected at communal
medical station before and after intervention has interventional 13,6
percent of effectiveness
3.2.5. Assessment of interventional effectiveness in diabetes patients
Table 3.29 and Table 30. Comparing diabetes group’s health indexes
before and after intervention
Health indexes

High

Total


14,2
14,2

After Intervention
6

16,2

37

Randomized

Controlled
trial

Before

Intervention
13

32,5

400,98


44,1
10,8

After

Intervention
19

51,3

37

Randomized

Controlled
trial
Before

Intervention
24

60,0

400,03


370,0113,3
9,3
After Intervention
20

54,1

37

Randomized

Controlled
trial

Before

Intervention
15

37,5

370,0138,5
12,4

After

Intervention
16

43,2

37

Randomized

Controlled
trial

Before

Intervention
23


54,1

370,3717,8
2,5
After

Intervention
17

45,9

37

Randomized

Controlled
trial

Before


Comparing ratio of hypertension in diabetes patients before and after
intervention has 2,5 percent of interventional effectiveness 22
3.2.6. Assessment of health indexes in pre diabetes patients
Table.3.31; 3.32. Comparing health indexes in pre diabetes patients
Health indexes High Total

P
CSHQ

HQCT
(%)
SL (%)
Waist Intervention

Before
Intervention

22 37,3

59


18 30,5

59
Organ Fat Intervention

Before
Intervention

49 83,1

59

0,01

16,4
8,5
After
Intervention

41 69,4

59
Randomized
Controlled
trial

Before


10,0
After
Intervention

25 42,4

59
Randomized
Controlled
trial

Before
Intervention

31 52,5

59

0,01

3,3
After
Intervention

30 50,9

59
BMI Intervention


59

0,12

7,4

After
Intervention

50 84,7

59
Blood
Pressure
Intervention

Before
Intervention

26 44,1

59

0,01

23,3
7,2

Comparing ratio of waist in pre diabetes patients before and after
intervention has 9,2 percent of interventional effectiveness, ratio of
visceral fat level in pre diabetes patients before and after intervention has
8,5 percent of interventional effectiveness, ratio of body fat in pre
diabetes patients before and after intervention has 10,0 percent of
interventional effectiveness, ratio of BMI in pre diabetes patients before
and after intervention has 7,7 percent of interventional effectiveness, ratio
of hypertension in pre diabetes patients before and after intervention has
7,2 percent of interventional effectiveness
3.2.7 Assessment of intervention effectiveness of direct indexes
Table 3.33. Assessment of intervention effect about ratio of detected
diabetes, pre diabetes of Randomized Controlled trial group and
interventional group
Variable

High

Normal

TotalPCSHQ
(%)

HQCT
(%)

87,7

302

0,26
19,5 13,1
After

Intervention30

9,9

272

90,1

302


332

89,9

369

Pre Diabetes Intervention

Before

Intervention

59

22,3

206

77,7

265


59

17,9

270

82,1

329

0,105,5
After

Intervention

54

16,26
264

83,74
318

Comparing ratio of detected diabetes before and after intervention
has1 13,1 percent of interventional effectiveness, ratio of having pre


diabetes is 17,9%. Ratio of getting diabetes which is higher than Cao My
Phuong’s research in Tra Vinh province in 2011 is 9,6 % and higher than
some researches about the residents in southwest region
4.1.2 Some relevant factors
Socio-economic factors: ratio of male getting diabetes is 11,4 %,
ratio of female is 12,3%. 45-54 age group getting diabetes is 10,2%, over
65 age group is 16,5%. 12,7 percent of rural people has diabetes. Ratio of
getting diabetes with the lowest level in farmer group is 13,1%. Illiterate
residents getting diabetes is 18,8 percent, the ones whose secondary
education is 12,4 percent
Our research result shows that diabetes is related to age factors,
peoples, home economy, prehistoric family having diabetes, giving birth
25
over 4000 gram. This is also consistent with medical literature and
previous researches
Understanding and practicing disease prevention
Ratio of Khmer understanding correctly about diabetes symptoms,
risk factors, disease consequences, how to prevent disease is very low,
compared to previous researches. This is suitable because their academic
standard is very low and ratio of people who do not understand
Vietnamese is very high. Therefore, communication works are mainly
based on dignitaries in pagoda, propagandizing effectively high. Having
no knowledge is related to the effectiveness of diabetes prevention
Some intermediary health indexes
The person whose normal waist has 0,6 times as many diabetes
risks as the person whose high waist (p<0.05)
The person whose high visceral fat level has 3,4 times as many