ABSTRACT
Background:In the current context of rising prevalence of non-communicable diseases, simple low-cost screening tools are essential for identifying individuals who have glucose dysregulationat its early stages. Therefore, we developed and validated a screening tool for dysglycemia (defined as HbA1c≥5.7%) with the potential to identify undiagnosed prediabetes and as well as diabetes mellitus.Methods:A sample of 2800 women representative ofColombo Municipal Council area was screened using fasting blood glucose for dysglycemia. All (n=272) newly diagnosed dysglycemics and a further 345 normoglycemics were recruited following confirmation of glycemic status by HbA1c, to enable ROC analysis. Apretested questionnaire and the International physical activity questionnaire validated for Sri Lanka were used to generate variables for the risk score.Results:A risk score for dysglycemia with a sensitivity of 87% and specificity of 87% and AUC of 0.941 was developed with two common symptoms of dysglycaemia, history of recent increase in frequency of passing urine and recent reduction in vision, one common food related practice, inability to resist sugary food and one indicator of sedentary behavior, TV viewing time and a single anthropometric measurement, waist circumference.Conclusions: A tool to identify prediabetesis currently unavailable and this new tool fills this gap. Further, the tool is designed to include women with previously undiagnosed diabetes mellitus. Inclusion of lifestyle parameters having a known association with dysglycemia increased the strength of the tool. Early identification will ensure targeting of interventions at the point of maximum effect.
ABSTRACT
Introduction: Fundamental to the success of preventive measures in diabetes mellitus, is disease-related knowledge, attitudes, and practices (KAP). We aimed to assess KAP regarding type 2 diabetes mellitus (T2DM), nutrition and lifestyle in a community-based population of newly diagnosed dysglycemic and normoglycemic women, unaware of their glycemic status at the time of data collection. Methods: Women (2800) aged 30-45 years were screened for dysglycemia using cluster sampling from the Colombo Municipal Council area. All 272 dysglycemic detected through screening and 345 normoglycemic randomly selected from the same screened sample were enrolled. All women were unaware of their glycemic status. The sampling strategy aimed to include adequate numbers of women with altered glycemic status who were unaware of their status at the time of the study. A validated and pretested intervieweradministered questionnaire was used and analyzed using Chi-square test and student’s t-test. Results: KAP on T2DM, nutrition and a healthy lifestyle were poor, particularly knowledge on prediabetes. Some aspects of lifestyle modification were known. Women with a family history compared to those without, had better knowledge (p<0.001) and attitudes (p<0.05), but lower practice scores (p<0.05). Majority of women who found it difficult to resist foods high in fat and sugar, ate while watching television, and a higher proportion of them had a family history (p<0.001). Conclusion: Poor food-related practices observed among those with a family history, despite better knowledge and attitudes indicate a need for targeted intervention. The specific KAP related aspects identified here, can direct future intervention strategies.
ABSTRACT
As the incidence of noncommunicable diseases such as diabetes continues to rise at an alarming rate in South-East Asia, it is imperative that urgent and populationwide strategies are adopted. The most important contributors to the rise in noncommunicable disease are a rise in mean caloric intake and a decrease in physical activity. The evidence for population-based dietary approaches to counter these factors is reviewed. Several structural and cohesive interdepartmental coordination efforts are required for effective implementation of prevention strategies. Since low- and middle-income countries may lack the frameworks for effective and integrated multi-stakeholder intervention, implementation of population-based dietary and physical-activity approaches may be delayed and may be too late for effective prevention in current at-risk cohorts. Evidence-based strategies to decrease energy intake and increase physical activity are now well established and their urgent adoption by Member States of the World Health Organization South-East Asia Region is essential. In the context of Sri Lanka, for example, it is recommended that the most effective and easy-to-implement interventions would be media campaigns, restrictions on advertisement of unhealthy foods, taxation of unhealthy foods, subsidies for production of healthy foods, and laws on nutrition labelling that introduce colour coding of packaged foods.