Prevalence and Incidence of Type-2 Diabetes Mellitus Among the Rural Population of Erode District of Tamil Nadu, South India

Diabetes mellitus is a group of metabolic disorders characterised by hyperglycaemia, caused by elevation of blood glucose level. A sedentary lifestyle is the most common cause of diabetes and has a wide range of long-term effects, including cardiovascular disease, kidney disease, blindness


Introduction
Diabetes is a syndrome that includes persistent hyperglycaemia, which impairs protein, fat, and carbohydrate metabolism, as well as a complete or partial lack of insulin secretion or action.Prolonged hyperglycaemia in DM is linked with short and long-term health related issues, and Prevalence and Incidence of Type-2 Diabetes Mellitus Among the Rural Population of Erode District of Tamil Nadu, South India ://jazindia.comhttps e online at: ilabl Ava -664 -malfunction of a number of organs, particularly the Kidneys, Heart, Nerves, eyes, and Blood vessels.type-2 dm and its health-related problem are a big global public Health issue suffering almost all individuals in developed and developing nations with greater diabetes-related morbidity and fatality rate.These problems lead to low QOL and decreased life span.In addition, the illness places a significant financial strain on global health resources [1,2].The International Diabetes Federation (IDF) recently performed a survey in 2020, which found that 433 million people globally had diabetes, 88 million of them from Southeast Asian.77 million of these 88 million peoples are from India.According to WHO, India is home to the majority of diabetics.According to the IDF, 8.9% of people in the population have diabetes [3,4].Over the following ten years, India's existing diabetes situation could get worse.Ages 40 to 59 make up the majority of diabetics.India is the second-most seriously impacted nation in the world, behind China, with an estimated 77 million diabetes.India accounts for one in every six (or 17%) people with dm worldwide.By 2045, the International Diabetes Federation predicts that number would increase to 134 million [5].Major public health issues are being exacerbated by the rising occurrence of dm in Tamil Nadu, particularly in the Chennai area.According to Indian medical research council, the occurrence of dm and pre-diabetes in rural Tamil Nadu raised from 4.9 % and 14.6 % in 2006 to 13.5 % and 18.25 % in 2020 Respectively [6][7][8].
Indians are typically become unwell at a young age due to raised insulin resistance, raised obesity (high waist circumference despite decrease obesity index), and a increased prevalence of poor glucose tolerance.There is a raised risk of developing dm due to epidemiological changes, economic imbalance, lack of physical exercise, bad diet, and environmental variable also contribute, to this risk [9].People who adopt urbanized lifestyles-such as dietary changes, sedentary work habits, stressas well as members of socioeconomic categories who are disproportionately poor and live in citiesare a highest risk of developing dm [10].
Patients are more likely to develop dm problems if they have a number of common risk factors, including long-term Diabetes Mellitus, high blood pressure, bad metabolic control, smoking, overweight and hyperlipidaemia.Long-term DM problems rise linearly in both men and women as DM ages and duration lengthens.Additionally, ineffective DM management brought on by noncompliance, unfavourable attitudes about the condition and its consequences, unhealthy eating, insufficient physical exercise, and subpar medical care are all associated with the emergence of DM issues [11][12][13][14][15].
Although Type-2 diabetes (T2DM) is linked to a number of problems, it can be avoided with the right care.Secondary prevention can lower morbidity and death through routine screening, early detection, and effective management of hyperglycemia and its consequences.It's important to identify the risk factors that are related to T2DM in order to manage it.Socioeconomic position, age, sex, genetic vulnerability, and other environmental factors are examples of uncontrollable risk factors.Obesity, high blood pressure, dyslipidemia, and smoking are all preventable risk factors.To stop or postpone the commencement of T2DM development and the occurrence of life-threatening consequences, it is crucial to manage these risk factors.Despite this, the vast majority of individuals with diabetes-related issues receive subpar care.Therefore, improvements in disease therapy and measurement must be improved to guarantee that guideline targets are attained [16][17][18].The WHO reports that T2DM has recently become more prevalent across all age groups and is currently being discovered in younger age groups.This emphasizes the significance of educating the public and putting screening programs in place to find diabetes early and lower morbidity and fatality.In order to determine the prevalence and occurrence of type 2 dm among the rural residents of Tamil Nadu's Erode district, a study was carried out

Materials and Methods
A prospective study was conducted for a year among rural people who sought therapy for type 2 dm at the primary care clinic.The study sample was gathered using a convenience sampling technique.There were 870 diabetic individuals included in this research.Patients who were over 18 years old, had been diagnosed with T2DM for more than a year, and were willing trial participants and were using minimum 1 oral hypoglycaemic agent and/or insulin treatment.Patients who didn't fit the https://jazindia.comle online at: b ila Ava -665 -requirements for inclusion were dismissed.Before being enrolled in this study, patients who visited the primary care clinic were approached and given verbal and, written informed consent.
The participant's demographic information, diabetes history, diagnosis, lab reports, comorbidities, complications of dm, and therapy received were all gathered using a standardized questionnaire.Ethical permission was collected prior to performing this study from Vivekananda medical care hospital, elayamabalayam, Tiruchengode.(Approval Number: SVCP/IEC/JAN/2021/15).

Results and Discussion
In this prospective study, most of the respondents were females (n= 493; 56.66%), Married (n=824; 94.71%), Un employed (n= 208; 49.06%) and Illiterate (n=238; 27.35%), Do not Smoke and take Alcohol (n=595; 68.39%), and also non-veg (n=546; 62.75%).The information is shown in Table 1.The most of the study respondents (n=755; 86.78%) received OHA treatment, 108 (12.41%) received insulin plus OHA treatment, and just 7 (0.80%) received insulin treatment alone.The detailed description of types of therapy regimen is shown in Table 5.The prospective study was aimed to analyse the prevalence and occurrence of T2DM among the rural residents of Erode district of Tamil Nadu, South India.The Sex distribution shown that, the most of the respondents were female in this location (n=494), These results are similar with other research, the maximum of the dm individuals in klang valley malaysia, (n=234) [19], turaif, Saudi (n =249) [20] and Bangladesh (n=10,901) [21] are women population.The most of the respondents in this research were greater the age of fifty, which was comparable to previous research by Khalid Aljabr et al. and Hassan Saadati et al., in which the geriatric population were most prominent (n=558; 58.2%, and n=1206; 33.3%, respectively) [22,23].These results evident that dm is more common in female over 50.This could be owing to the fact that the female population in this area is obese and has experienced stressful life events, both of which have a direct influence on how DM develops.
The most of the individuals in this research are married, graduates, and do not have any job.Similar to this, the majority of people with diabetes individuals in research by Fasil et al., (n=157, n=127, respectively) [24].andSuwannaphant et al., (n=13440, n=4677, Respectively) [25] had no schooling and job.This result is in contrast with the earlier research, the most of the individuals had minimum schooling level, (n=1110, 55.53%) and (n=51, 51%; 27; 27% respectively) [26,27].These findings unequivocally demonstrate that job, work demands, and marital status all significantly affect the risk of developing diabetes.
Social habits are one of the main factors of the occurrence of dm.However, in this research, many individuals do not have any social history such as smoking and drinking alcohol (n= 595; 68.39%) whereas, one-third of the individuals were non-vegetarian.These results are same to a previous study, the many of the dm individual didn't smoke or using alcohol but ate fatty diet (n=387, n=269) Respectively [28].This is in contrast to a previous study the most of the dm individual either smoke or take alcohol daily.(n=118 n=54 Respectively) [29].These results demonstrate that non-smokers, drinkers of alcohol, and non-vegetarian eaters had the highest prevalence of T2DM.
Additionally, the Family History of dm may have a small impact on the progress of diabetes mellitus among the rural residents as the numbers is equally Distributed among the individuals with the Family History of dm and no history.These results are in contrast to the previous research by Gopalakrishnan et al., [30].and Mayur Patel et al., [31] in which 68.8% and 67% respectively were having a family history of diabetes.Rohini Kanta Goswami et al. reported, 83% of the study respondents had no family history of dm.[32].
In this investigation, every diabetic had a history of type II dm, followed by High blood pressure.This is similar with various research conducted by Pati et al., [33] and El-Hazmi, et al., [34]. in which 84%, 62%, 77%, and 98%, Respectively, have a past medical history of dm and high blood pressure.
https://jazindia.com le online at: b ila Ava -669 -In this research, almost eighty percentage of the individuals had dm for greater than 5 years and had increased FBG, PPBG, and Glycosylated Haemoglobin, and half of them were hypertensive.However, a small number in this research had raised cholesterol level.These outcomes are similar with Pati et al., the most of the individuals were diabetics and hypertensives (84% and 62% Respectively) [33].Furthermore, in research by Jelinek et al., the most of the individuals were having dm for greater than five years (68.80%),followed by Hyperlipidaemia (n=18; 4.11%) [35].This shows that dm is a chronic metabolic syndrome that oftenly coexists with other issues such as high blood pressure and dyslipidaemia.This might be because of chronic illnesses have harmful effects on the body, like metabolic and cardiovascular problems.
A sizable number of the participants in this study suffered from micro and macrovascular issues.Study subjects with diabetes frequently had CAD, diabetic nephropathy, and diabetic neuropathy.This is same to a study by Mantro et al., diabetic neuropathy (n=41), diabetic nephropathy (n=28), and Macrovascular issues (n=11) were the most frequently noticed complications of dm [36].Chronic dm may cause many complications which includes, Diabetic neuropathy, nephropathy and retinopathy, and Macrovascular issues.These issues may have an adverse impact on the QOL of the diabetic individual and resulting in increased morbidity and fatality.
The majority of the study individuals were taking Oral anti-diabetic medications in which metformin is the frequently prescribed monotherapy.These results were similar with previous research carried out by Sharma et al., where the most of the individuals received oral hypoglycaemic agent as single drug therapy (n=230) [37].

Limitation
The diabetic person's response might not be suitable because of recollection bias.As the study population is less, it's possible that not all populations are represented by this finding

Conclusion
Diabetes is the most prevalent metabolic disorder among the rural areas, and type 2 diabetes makes up the majority of cases.Incidence of diabetes is higher among married, overweight, and femalepredominant populations.Oral anti-diabetic medications were the preferred choice of antidiabetic treatment and metformin was the commonly used single drug therapy to treat diabetes.The incorrect way of living and absence of knowledge of dm and its problems increased the occurrence and prevalence of dm among this resident.This is a critical health issue, and it could increase the morbidity and fatality rate if is not resolved right way.A well-structured health comprehensive programme must be executed in order to decrease detrimental health results and enhance QOL for the research population.

Table 2 :
An explanation of the respondents' Age range, the Duration and Family History of DM, and their history of Stressful life event (n=870)

Table 4 :
Past Medical History, Comorbidities, and Problems of DM among the study subjects (n=870)

Table 5 :
Types of treatment regimen Among the study subjects (n=870)