MINISTRY OF EDUCATION AND TRAINING

MINISTRY OF DEFENSE

MILITARY MEDICAL UNIVERSITY

NGUYEN THI ANH

RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS
OF TYPE 2 DIABETES AND EFFECTIVENESS OF SOME
PREVENTIVE INTERVENTION MEASURES
IN HUNG YEN PROVINCE (2013-2015)

Major:
No:

Epidemiology
9 72 01 17

SUMMARY OF DOCTORAL DISSERTATION

HA NOI-2019
THE RESEARCH WAS COMPLETED AT


2
MILITARY MEDICAL UNIVERSITY

Instructor:
1. Dinh
Professor

3
The dissertation can be found in:

1.

Vietnam National Library.

2.

Vietnam Military Medical University Library.

LIST OF PUBLISHED RESEARCH
RELATED TO THE AUTHOR’S DISSERTATION
1.

Nguyen Thi Anh, Dao Xuan Vinh, Dinh
Hong

Duong

interventions

(2018).

on

nutrition

Effect
and

Military Pharmaco-medicine, vol 43(%), p. 162169.

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4

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5

FOREWORDS
The World Health Organization (WHO) Global
Report 2016 on Diabetes states that about 1.5 million
deaths in 2012 are due to type 2 diabetes. In 2014, the
world recorded that type 2 diabetes increased to 422
million cases, equivalent to 8.5% of the population.
According to the WHO, the incidence of type 2
diabetes in 2014 is 7.1% in Africa, 8.3% in America,
13.7% in the Middle East, 7.3% in Europe, 8.6% in
South Asia, 8.4% in the Western Pacific and the global
rate is 8.5%.
In Vietnam, the research results of the National
Institute of Endocrinology in 2011 reported that there
are over 5 million Vietnamese people with type 2
diabetes, accounting for 6% of the population, the
urban community is more prone to the disease than in
rural areas, people with sedentary lifestyles, and those
who abuse high-risk ready-to-eat foods stand a higher


communication

intervention

exercise

lifestyle

and

of

prediabetes in Khoai Chau district, Hung Yen province
(2014-2015).
New contributions of the dissertation:
The study found that the incidence of type 2
diabetes in Hung Yen was 4.7%; pre-diabetes was
25.4%.

Five

(05)

factors

are

considered



multidisciplinary

but

control

evaluation criteria as guided by the Ministry of Health.
The results indicate that a set of criteria can be used
to assess the control of type 2 diabetes and diabetes
in the community.
Dissertation structure
A total of 133 pages including: 2-page issue set;
Chapter 1: Overview of 34 pages; Chapter 2: Object
and Methodology 25 pages; Chapter 3: Research
Results 43; Chapter 4: Discuss 26 pages; Conclusion
01 page, 01 page proposal.
The thesis has: 41 tables, 1 figure and 19 charts, 102
references.

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Chapter 1: OVERVIEW
1.1. Type 2 diabetes and related factors
1.1.1. Status of type 2 diabetes mellitus
1.1.1.1. The diabetes status in the world
According to the report by WHO in 2016, diabetes

new epidemiological studies of diabetes were
conducted in four cities: Hanoi, Hai Phong, Da Nang
and Ho Chi Minh City. The results showed that the
incidence of diabetes in the four major cities of Hanoi,
Ho Chi Minh City, Hai Phong and Da Nang in subjects
aged 30-64 years is 4.9%, disorders of blood glucose
tolerance is 5.9% , the rate of impaired fasting blood
glucose is 2.8%, the rate of people with risk factors for
diabetes is 38.5%, it is worrying that over 44% of
people with undiagnosed diabetes be guided
treatment.
According to research by Phan Huong Duong in
2015 in Hai Phong, the incidence of diabetes is 5.2%,
pre-diabetes is 26.8%. Prevalence of diabetes, prediabetes in the 30-39 age group was 4.2% and 21.7%;
age group of 40-49 years old is 4.4 and 23.5%; age
group 50-59 years old is 6.0% and 30.5% respectively.
According to the results of the 2016 study in Kon Tum
Province, the prevalence of diabetes in people aged
45-69 years was 16.6%, in which diabetes was 3.5%
and diabetes was 13.3%.
As reported by the study results in 2017 in Hung
Yen province, the proportion of households with
diabetes in the study was 8.6%, with a cross-sectional
descriptive study of 1221 households. People over age
60 with diabetes are 11.7%. According to Nguyen Thy

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11

ethnicity, have been diagnosed with impaired glucose
tolerance and fasting plasma glucose tolerance, ≥
140/90 in adults, HDL-C lipid transfusion
and 39.3% in the intervention group.
1.2.2. Preventive methods for type 2 diabetes.

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Some of the method used to prevent type 2
diabetes are: weight control, physical activity
enhancement, blood glucose control, cardiovascular
factors control, psychological control, and adjustment
nutrition…
Chapter 2: OBJECTIVES AND RESEARCH
METHODS
2.1. Object, location and time of study
2.1.1. Research subjects
2.1.1.1. Cross-sectional description of the object
The subjects selected for the study are adults,
aged 25-70, who are currently living (permanently and
having permanent residence) in 9 districts and 1 city in
Hung Yen province. (In this study, we selected the age
group 25-70 because of the representative character
that was confirmed in a number of previous type 2
diabetes surveys and in the Ministry of Health's Type 2
Diabetes Control Program).
2.1.1.2. Object of intervention study
The subjects will be selected to participate in the
intervention study of adults between the ages of 25-70
currently living (permanently and having permanent

My and Hung Yen city.
2.1.3.2. Places of intervention research
Intervention researches were conducted in 3
communes in Khoai Chau district, Hung Yen province.
+ Intervention group: Dai Hung commune and Dong
Ket commune.
+ Control group: Dong Ninh commune
2.2. Research Methods
2.2.1. Research design

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The research design consisted of two successive
studies, namely cross-sectional descriptive research
design with analysis and design of communitycontrolled intervention studies. The research was
divided into two phases:
Phase 1: Analytical cross-sectional descriptive
research
Phase 1 of epidemiological studies conducted
through cross-sectional survey was conducted to
evaluate and determine the prevalence of diabetes
and pre-diabetes in subjects aged 25-70 years by
means of laboratory tests for blood glucose analogy
(rapid
test),
blood
glucose

intervention.
Evaluation: Evaluation was carried out after 9
months. Evaluate the effectiveness of the intervention
by comparing it in the same group; comparing
intervention group with control group. Patients in both
groups were all tested for cholesterol, triglyceride,
LDLc, HDLc, plasma glucose, HbA1c, blood glucose
control; weighting, anthropometric measures at the
beginning, 3 months, 6 months and 9 months (T0, T3,
T6, T9).
2.2.2. Sample size and sampling methods
2.2.2.1. Sample size of descriptive research
- Sample size: After calculation, the total sample
size of each age group was n = 4,333. In fact, we
surveyed 4,495 people.
- Method of selection: Select the research site:
Select all 9 districts and Hung Yen city of Hung Yen
province. Select communes: Based on the list of
communes in each district will select 3 communes/
districts to study by random method.
2.2.2.2. Intervention research sample size
- Sample size: The minimum sample size was
calculated as n1 = n2 = 109 for the study and control
groups. In practice, we selected 1 control commune
and 2 intervention communes and the actual number

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of primary health care programs in districts and
communes
that intervene
in positive
health
communication and nutrition. Meetings once a month
with key commune officials for local support and
assistance including representatives from health,
culture and information, women's unions, associations
Farmers, Commune People's Committee ...
Club organization:
Organizing the club for research participants in
2 intervention communes. The club were held once a
week for the first two months. Then it took place once
every two weeks on a fixed day in the month.
Participants: representatives of commune leaders,
mass organizations and research subjects. Particularly,
for the intervention group, there are additional family
members (spouse, children).
Each session is linked to a specific topic on
issues related to diabetes prevention. Preside over
these sessions are postgraduates and specialists in
diabetes, nutrition and related subjects.
Developing

Use non-parametric statistical tests with quantitative
variables that do not follow the standard distribution
rules. Using algorithms for analyzing results such as
OR, χ2, p to determine differences and correlations
between factors exposed to diabetes and glucose
tolerance.
2.2.4. Some limitations of research and how to
overcome.
There is a gender difference in the research
team. Hung Yen is a province with many industrial
zones. The labor force in these areas is mainly female
(garment workers, leather shoes ...).
- Inadequate epidemiological data (from 2014) with
large sample size, complex research index variables,
and analyzing and processing data take much time.

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2.2.5. Ethical issues in research
There is no ethical violations in the research.
Chapter 3: RESEARCH RESULTS
3.1. Epidemiological characteristics and some
factors related to type 2 diabetes mellitus in
Hung Yen province in 2014.
3.1.1. Epidemiological characteristics of type 2
diabetes in Hung Yen province in 2014
Table 3.6 Distribution of patients by blood glucose

10.0

8

0.8

966

100.0

3.14
3

Pre-

1.14

diabetes

9

Diabetes

203

4.5

Total

4.49

4.7

4.4

100

95

.0

Figure 3.1. Relationship between age group and diabetes status
Figure 3.1. shows that there was a tendency to
increase both the prevalence of diabetes and type 2
diabetes by age. The difference in the prevalence of

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21

diabetes mellitus, type 2 diabetes among age groups
was statistically significant at p
36
17.1
Tien Lu
76
6.7
17
8.1
Kim Dong
118
10.3
8
3.8
My Hao
125
11.0
35
16.6
Hung Yen city
57
5.0
11
5.2
Total
1.141 100.0
211 100.0
Table 3.7 shows that the highest prevalence of
diabetes was in Van Giang with 18%, followed by Van
Lam (14.8%), Khoai Chau (12.2%), and the lowest in
Hung Yen 5%.
The rate of type 2 diabetes was highest in Van Lam

5.
72
1
1.4 31
11
.4

Female
(n=308
4)
n
%
2.15 69.
0
7
25
75
.8
4.
139
5
3.0 68
84
.6

Total
(n=4.49
5)
n
%

Freelance
Farmer
Worker
Student
Housewife

22

Pre-diabetes
n
%

Diabetes
n
%

74

6.5

9

4.3

141
687
86
0
40


0.6
25.4

26
2
211

12.3
0.9
4.7

The above table shows that basically all other
occupations have morbidity but are generally
equivalent. However, there was a large proportion of
pre-diabetics with 60.2% and type 2 diabetes by
64.5%.
3.1.2. Several factors related to diabetes
mellitus in Hung Yen province in 2014.
3.1.2.1. Several factors related to pre-diabetes
Table 3.17. Multivariate analysis of factors affecting
the risk of pre-diabetes
No.
Index
1
2
3
4
5
6
7

17
18
19
20
21

Do not know a
Just eat oil/ an
Eat animal sk
Do not eat fish
Do not eat be
Do not eat eg
Eat less fruits
Table 3.17 analyzes multivariate factors in the
lumped model was selected from Tables 3.11 to 3.15,
including three runs of the model from 20 factors down
to six factors; and six factors retracted to five factors
considered to be associated with diabetes mellitus in
those with angina pectoris, who are older than 49, who
have siblings with diabetes. Do not know the risk of
diabetes (with blood sugar test) and do not eat beans
with OR> 1 and p
2 and p

Rice/
sticky
rice
Noodle/
Ramen
Cellopha

25

Before/afte
r
Effect rate
%
Before/afte
r
Effect rate
%
Before/afte

>4
times/week
InterContr
ventio
ol
n
218/2
109/1
20
10

0.5
218/21

14.3
1/2

-3.7
2/3