1 Int. J. Biomol. Biomed.

International Journal of Biomolecules and Biomedicine (IJBB)

ISSN: 2221-1063 (Print), 2222-503X (Online)
http://www.innspub.net
Vol. 17, No. 3, p. 1-6, 2023

RESEARCH PAPER OPEN ACCESS

Prevalence, factors and complication of Diabetes in an

underdeveloped Region of Khyber Pukhtun Khawa: A cross-
sectional study

Fazal Shan*1, Sajid Ali2, Imad Ud Din3, Majid Ullah2, Hamza Ali2, Hammad Rashid2,
Hassan Khan2, Rafi Ullah2, Arbaz Khan2, Muhammad Khalid Khan2, Imad Khan4

1
Department of Molecular Biology and Genetics, Khyber Medical University, Peshawar, Pakistan
2
Department of Medical Lab-Technology Institute of Health Sciences, Khyber Medical University,
Dir lower, Pakistan
3
Department of Health, Institute of Health Sciences, Khyber Medical University, Dir lower, Pakistan
4
Department of Microbiology, Khyber Medical University, Peshawar, Pakistan

Key words: Associated risk factors, Prevalence, Hyperglycemia, Diabetes

Article Published: 03 December 2023

Abstract

This cross-sectional study aimed to investigate the prevalence and associated factors of diabetes in an
underdeveloped region. The study was conducted over a four-month period, involving 409 participants from a
specific region in Pakistan. Data on demographic characteristics, clinical variables, and risk factors were collected
using questionnaires and laboratory tests. Statistical analysis was performed to determine prevalence rates and
assess associations between variables. The study revealed a high prevalence of diabetes, with 22.49% of the
participants diagnosed as hyperglycemic. The prevalence of diabetes was found to be higher in males compared
to females. Risk factors such as obesity, hypertension, and positive family history were significantly associated
with diabetes. Various diabetes-related complications, including retinopathy, gestational diabetes mellitus,
periodontal disease, diabetic nephropathy, and heart disease, were identified among the participants. This study
highlights the alarming burden of diabetes in the studied underdeveloped region. The higher prevalence of
diabetes in males, the association with risk factors, and the presence of diabetes-related complications
underscore the need for urgent public health awareness campaigns. Early diagnosis, treatment, and preventive
measures are crucial to mitigate the increasing prevalence of diabetes. Further research and interventions are
required to effectively manage and reduce the burden of diabetes in underdeveloped regions.
*Corresponding Author: Fazal Shan [email protected]

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Introduction diabetes among residents living in underdeveloped

Diabetes is a metabolic disorder characterized by regions and to promote increased awareness of this
elevated blood glucose levels, known as condition within the local communities.
hyperglycemia. It arises from abnormalities in insulin
secretion, action, or both, leading to disruptions in Materials and methods
carbohydrate, fat, and protein metabolism. The Study design, duration and setting
condition is progressive and heterogeneous, A cross-sectional study was carried out over duration
displaying diverse manifestations and complex of four months, from Jan to May 2023. The study was
pathogenesis (Association, 2010). The signs and conducted at THQ Hospital Samarbagha, located in
symptoms of diabetes include polydipsia (excessive the Dir-lower region of the Khyber Pakhtunkhwa
thirst), unintended weight loss, polyphagia (increased province in Pakistan.
appetite), and hyperglycemia (elevated blood glucose
levels) (Ramachandran, 2014). Diabetes classifies into Sample size, Sample selection criteria
four categories, type I diabetes, type II diabetes, The sample size for the study, determined by using
gestational diabetes, and diabetes that has a specific the world health organization (WHO) calculator, was
etiology which may be genetic or secondary to drugs, (n= 409). In present study included all individuals
pancreatic factors, or other illnesses (Forouhi and aged 24 and above who had been diagnosed with
Wareham, 2019). It is a widespread global problem, diabetes, as well as volunteers who willingly
currently impacting around 415 million individuals,
participated. Females with pregnancies and
with projections suggesting it may affect up to 642
individuals who were not residents of Tehsil
million more people worldwide by the year 2040
Samarbagha were excluded from the study.
(Herman, 2017). A cross-sectional study of 3.47
million young individuals found that the prevalence
Data collection process
of type 1 diabetes among those aged 19 or younger
Demographic information was obtained from patients
increased significantly from 1.48 to 2.15 cases per
using a questionnaire as part of the data collection
1000 youths. Additionally, the prevalence of type 2
process. Diabetic patients were screened for random
diabetes among individuals increased from 0.34 to
plasma glucose levels (measured in mg/dl) using a
0.67 cases per 1000 individuals. Around 90 to 95% of
erba spectrophotometer Chem 7 bio chemistry
individuals are diagnosed with type 2 diabetes (Divers
analyzer within one hour of blood collection, blood
et al., 2020, Badawi et al., 2010, Whiting et al., 2011).
samples were drawn into sterilized disposable
In 2019, it is estimated that approximately 9.3% of
vacationer tubes containing sodium fluoride tube.
the global population, which amounts to around 463
million people, had diabetes (Saeedi et al., 2019).
After collecting the blood samples, they were

In the last ten years, diabetes prevalence has risen centrifuged and transported for further analysis. The

more rapidly in both developed and developing blood glucose levels were measured using the glucose
countries (WHO, 2016). Diabetes is associated with oxidase peroxidase method. Individuals were
changes in alteration in small vessels, larger vessels, categorized as having type II diabetes mellitus if their
and metabolic functions (Abbott et al., 2002). It can random blood glucose levels were equal to or higher
lead to various health complications, such as vision than 200mg/dl. Those with blood glucose levels
impairment (Diabetic Retinopathy), gestational between 140-199mg/dl (7.8-11.0mmol/L) were
diabetes mellitus, gum diseases (Periodontal classified as having pre-diabetes mellitus. Similarly,
Disease), kidney failure (Diabetic Nephropathy), hypertension was diagnosed in individuals whose
stroke, nerve disorders (Diabetic Neuropathy), and blood pressure (BP) readings were 140/90 or higher.
heart diseases (Kaul et al., 2013). The primary aim of Obesity was confirmed in persons with a Body Mass
this study was to determine the occurrence of Index (BMI) greater than 30kg/mm².

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Data analysis Table 3. The distribution of samples based on age

The data obtained from the study were analyzed using groups.
appropriate statistical methods. Descriptive statistics Age Number of Samples Percentage
such as means, standard deviations, frequencies, and 24-30 years 30 7.33%
31-40 years 86 21.02%
percentages were calculated to summarize the 41-50 years 113 27.62%
demographic characteristics and clinical variables of 51-60 years 70 17.11%
61-70 years 68 16.62%
the participants. Statistical Package for the Social 71 years above 42 10.26%
Sciences (SPSSv21) software was used to perform the
data analysis. Out of the 92 hyperglycemic samples, 53 samples
(57.60%) were from male participants and exhibited

Results hyperglycemia. On the other hand, 39 samples

A total of 409 samples were collected for the study. (42.40%) were from female participants with
hyperglycemia. This indicates a higher prevalence of
Among these samples, 92 individuals (22.49%) were
hyperglycemia in males compared to females.
identified as hyperglycemic, indicating higher-than-
normal blood glucose levels. The remaining 317
Table 4. Gender based prevalence of hyperglycemia.
samples (77.50%) were categorized as normal,
Gender Number of Samples Percentage
representing individuals with blood glucose levels
Male 53 57.60%
within the expected range as shown in table no 1. Female 39 42.40%
Total 92 100%

Table 1. Prevalence of hyperglycemic patients.

The study examined the risk factors associated with
Factors Number of Samples Percentage
hyperglycemia among a total of 409 participants. The
Hyperglycemic 92 22.49%
Normal 317 77.50% findings revealed that 52 individuals (12%) who had
Total 409 100% hyperglycemia were also affected by Hypertension,
obesity and Familial history. Moreover, 123
Out of the total 409 samples collected, 279 samples
participants (30.10%) were diagnosed with
(68.21%) were from male participants, while 130
hypertension without any reported obesity.
samples (31.78%) were from female participants as
Additionally, a significant number of 153 individuals
shown in table no 2.
(37.4%) had a positive familial history of
hyperglycemia. Furthermore, 81 participants (20%)
Table 2. Distribution of samples based on gender.
were identified as obese. These results highlight the
Parameters Number of Samples Percentage association between hyperglycemia and risk factors
Male 279 68.21%
Female 130 31.78% such as hypertension, obesity and familial history of
Total 409 100% the disease within the studied population.

The highest numbers of samples (113 samples,

Among the total of 92 diabetic individuals, various
27.62%) were collected from individuals aged 41 to 50
diseases associated with diabetes were identified.
years. The second-highest numbers of samples (86 Specifically, 15 individuals (16.3%) had diabetic
samples, 21.02%) were from individuals aged 31 to 40 retinopathy, 23 individuals (25%) had gestational
years. The distribution of samples across other age diabetes mellitus, 14 individuals (15.2%) had
groups is as follows: 70 samples (17.11%) from periodontal disease, 15 individuals (16.3%) had
individuals aged 51 to 60 years, 68 samples (16.62%) diabetic nephropathy, and 25 individuals (27.2%) had
from those aged 61 to 70 years, 42 samples (10.26%) heart disease. These findings highlight the presence of
from participants aged 71 years and above, and 30 multiple coexisting health conditions that are
samples (7.3%) from individuals aged 24 to 30 years. commonly associated with diabetes as shown Fig. 1.

Shan et al.
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Table 5. Risk Factor associated with hyperglycemia. early detection and treatment of communicable
Hypertension diseases are of utmost importance, particularly in
/obesity/ Familial
Hypertension Obesity underprivileged regions of Pakistan.
Familial history
history
No. of No. of No. of No. of
% % % % The present study investigated the prevalence of
samples samples samples samples
52 12 123 30.10 153 37.4 81 20.00 diabetes and associated factors among individuals
residing in underdeveloped regions. The present
study found that hyperglycemic individuals were
predominantly in the 41-50 age group (27.62%). In
contrast, a US study reported a higher prevalence
(41.4%) in the 26-39 age group (Stanifer et al., 2016),
while a study from Uganda showed a high prevalence
(53.6%) in the 18-39 age group (Chiwanga et al.,
2016). These variations highlight differences in the
age distribution of hyperglycemic patients across
studies, emphasizing the importance of considering
age demographics when comparing findings. The
Fig. 1. Distribution of various diseases associated
gender distribution showed a higher proportion of
with diabetes.
male participants (57.60%) compared to females
(42.40%). Higher prevalence of diabetes was
Discussion
observed among males. This finding contrasts with
Based on our study findings, it was observed that
several studies conducted in different countries
22.49% of the participants had hyperglycemia. This
worldwide, where the prevalence of diabetes was
prevalence rate is comparable to the reported rate of
reported to be higher among females than males
21.7% in the United States (US) (Stanifer et al.,
(Basit et al., 2018). In Punjab, Sindh, and Balochistan
2016).In a study conducted by Chiwanga et al in
provinces of Pakistan, a higher number of female
Uganda, it was found that the prevalence of diabetes
patients were observed compared to male individuals
was reported to be 10.1% (Chiwanga et al., 2016).
with diabetes. However, in the Khyber Pakhtunkhwa
According to the diabetes survey conducted in
province of Pakistan, the prevalence of diabetes was
Pakistan by Basit et al. in 2018, the prevalence of
higher among male patients (54.1%) compared to
diabetes in the entire country was reported to be
female patients (45.9%), which aligns with the
26.3%. The study found that individuals above the age
findings of the present study (Basit et al., 2018).
of 43, those with hypertension, and obese individuals
were at a higher risk of developing diabetes compared The prevalence of hypertension among diabetic
to those who were considered healthy (Basit et al., patients was found to be 30.10% in our study. This
2018). In the samarbagh region, the study revealed aligns closely with the reported prevalence of 31% in a
that a significant number of patients were unaware of study conducted in the United States by Stanifer et al.
their clinical diabetes condition. The variation in (Stanifer et al., 2016). Similarly, another study
prevalence rates can be attributed to the level of reported a similar prevalence of hypertension among
knowledge and awareness about diabetes within the diabetic individuals in Uganda, with a rate of
community. Factors such as dietary patterns, lack of 29.5%(Chiwanga et al., 2016). These findings are
adherence to treatment, and inadequate preventive consistent with the present study, indicating a higher
measures may contribute to the high prevalence occurrence of hypertension in individuals with
observed. It is crucial to prioritize public health diabetes (Basit et al., 2018). Obesity among diabetic
awareness campaigns in order to address the burden patients was observed 20.0% in current study. This
of diabetes in our regions effectively. Additionally, percentage differs significantly from the reported rate

Shan et al.
5 Int. J. Biomol. Biomed.

of 58.0% in the study conducted by US study males, the association of diabetes with risk factors such
conducted in 2016 (Stanifer et al., 2016). Similarly, as obesity, hypertension, and positive family history,
43.2% a prevalence of for obesity found among and the presence of diabetes-related complications.
diabetic patients in Uganda (Chiwanga et al., 2016). These results emphasize the urgent need for public
These results highlight variations in obesity health awareness campaigns to address diabetes in the
prevalence among diabetic individuals across region and promote early diagnosis, treatment, and
different studies. In our study, 37.4% of the patients preventive measures. Further research is warranted to
had a positive family history of diabetes. This explore interventions and strategies to effectively
percentage differs from the reported rate of 19.5% in manage and reduce the burden of diabetes in
the study. These findings suggest variations in the underdeveloped regions.
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