Available online freely at www.isisn.

org

Bioscience Research
Print ISSN: 1811-9506 Online ISSN: 2218-3973
Journal by Innovative Scientific Information & Services Network

RESEARCH ARTICLE BIOSCIENCE RESEARCH, 2021 18(1): 727-732. OPEN ACCESS

Serological and Epidemiological Identification of

Diabetes Disease at District Mardan Khyber
Pakhtunkhwa Pakistan
Abid Ur Rehman1, Ihteshamul Haq1, Farzeen Khan2, Naumana Rehman3, Shumaila
Bakht4, Shaheen Bibi5, Sana Khan6, Fawad Inayat6, Fazli Zahir6, Zeeshan
Shahzad1, Tanzeela5, Mehran Ali1,Aziz Ur Rehman7, Fazal Akbar8
1Department of Biotechnology and Genetics Engineering Hazara University Mansehra KP, Pakistan
2Department of Community Health Sciences Peshawar Medical College, Peshawar Kpk, Pakistan
3Department of Pathology, Khyber Medical College Peshawar Kpk, Pakistan
4Department of Human Nutrition, the University of Agriculture, Peshawar, Pakistan
5Department of Zoology Hazara University Mansehra Kpk , Pakistan
6Department of Allied Health Science Iqra National University Peshawar Kpk, Pakistan
7Rehman Medical College Hayatabad Peshawar Kpk , Pakistan
8Peshawar Institute of cardiology Peshawar, Pakistan

*Correspondence: [email protected] Received 17-01-2021, Revised: 11-03-2021, Accepted: 12-03-2021 e-

Published: 19-03-2021
The present study was organized at Mardan Medical Complex (MMC), Mardan with an aim to estimate
the burden and prevalence of diabetes disease among patients at district Mardan. Diabetes is a
common metabolic disorder which occurs due to deficiency of insulin and results in higher levels of
glucose in the blood and disturbed metabolism. A total of 3911 patients of both genders residing district
Mardan were screened at pathology laboratory of Mardan Medical Complex for the duration of six
months. HbA1c blood test was used to assess their blood glucose level. A total of 494 patients were
confirmed as positive. The recorded data shows an overall prevalence of 12.63%. However, gender
wise, it was slightly higher in males compared to the females. Prevalence was also noticed on monthly
basis. From our study, it can be concluded that this disease is mostly due to poor life styles. Awareness
among the people and healthy life styles can help eradicate it.
Keywords: Diabetes, Prevalence, HbA1c

INTRODUCTION basement membranes, impacting the delivery of

Diabetes mellitus (DM) is a metabolic disorder nutrients and hormone to the tissue, resulting in
caused by hyperglycemia due to the lack of tissue damage. The retina, renal glomerulus and
insulin. Its deficiency effects the metabolism of the nerve sheath are the mostly effected sites
proteins, carbohydrates and fats. Severe (Edwards et al. 1991). One of the major types of
metabolic decompensation also causes death and Diabetes mellitus is caused due to low level
long-term metabolic disturbance leads to production of insulin by pancreas or reduced
structural and functional changes in somatic cells, sensitivity of body cells to insulin and the ultimate
those of the vascular system being at particular result is hyperglycemia and glycosuria in the body
disposition. It destroys the vessels and the (Kaul et al. 2013). Insulin deficiency results in the
Rehman et al. Serological and Epidemiological Identification of Diabetes Disease at District Mardan

elevated blood glucose level and causes with diabetes whereas one in two persons is
structural, physiologic and hormonal changes that unaware of having the disorder. In 2014, 4.9
effect retinal capillaries making it less active million deaths were reported due to diabetes. In
(Shimizu et al.1981). Pakistan the prevalence of diabetes is 11.77%.
Prevalence of diabetes mellitus across the Unlike females (9.19%) It is slightly higher in
globe is alarming with a total of 387 million people males (11.20%). It’s prevalence in urban areas is
with prevalence rate of 8.3%. According to 14.81% compared to rural area which is 10.34%
estimates, one in each 12 individuals is diagnosed (Meo et al. 2016).

Figure 1: Symptoms of Diabetes Disease.

Health Organization 2015). Increase in prevalence
According to the International Diabetic of diabetes is associated with many factors like
Federation (IDF) survey on Diabetics, currently aging, fatty and high calorie diet and sedentary life
Pakistan ranks seventh in the list of countries with styles which contribute to obesity and then
the highest number of diabetic cases. According diabetes (Sarah et al. 2004). Due to the lack of
to 2015 report by International Diabetic Federation awareness and inadequate facilities to diagnose
(IDF), 415 million individuals have diabetes early stage diabetes mellitus in high risk groups
mellitus and this figure will rise to 642 million by leads to failure of early diagnosis. The real burden
year 2040 (IDF-Diabetes 2016). Diabetes mellitus of diabetes is because of its chronic complications
(DM) is ranked 4th among non-communicable resulting in high morbidity and mortality rate
diseases (NCDs) causing deaths, accounting for (Hakeem et al. 2010). The present study was
1.5 million worldwide deaths every year (World aimed to estimate the burden and prevalence of

Bioscience Research, 2021 volume 18(1): 727-732 728

Rehman et al. Serological and Epidemiological Identification of Diabetes Disease at District Mardan

diabetes disease among patients at district patients in population of district Mardan. The data
Mardan. was recorded for the span of six months
individually in patients of both the genders. i.e.
MATERIALS AND METHODS males and females. Informed consent was taken
from the participants included in the study.
Study site
The current study was performed at Mardan
Medical Complex (MMC) Mardan with an
objective to assess the prevalence of diabetic

Figure 2: Map of District Mardan

RESULTS AND DISCUSSION

Diagnostic assay From our results, in the figure 1 and table 1, it
The test performed to diagnose diabetes was is clear that a total of 3911 patients were under
simple blood test known as HbA1c and can be consideration for the current study. Among them,
used to detect type 1 and type 2 diabetes. It 1930 are males and 1981 are females. Out of
specifically assesses how much of blood’s them, 494 patients have been noticed as positive
hemoglobin is glycated (coated with sugar). Few through the aforementioned diagnostic test which
ml of blood was taken from each patient at the represents an overall prevalence of 12.63%
pathology lab and analyzed carefully via a special among the said patients at Mardan. Based on
HbA1c kit which shows varied ranges based on gender, we have 258 males and 236 females
sugar coated on hemoglobin. For people identified with diabetes with a prevalence rate of
without diabetes, the normal range for the 13.36% and 11.91% respectively. So, it can be
hemoglobin A1c level is between 4% and 5.6%. said that diabetic males are comparatively more
Hemoglobin A1c levels between 5.7% and 6.4% than females.
indicates chances of getting diabetes. Levels of Furthermore, it is obvious from the following
6.5% or higher represents diabetes. that the highest number of patients visited in July
while lowest in June, however, the prevalence
Data analysis was highest during August i.e. 13.82, followed by
All the data has been analyzed using MS June and lowest in April. Monthly and gender
excel and presented in the form of figure and a based suspects and diabetic patients are all
table for comparisons based on several factors. depicted in the table 1.

Bioscience Research, 2021 volume 18(1): 727-732 729

Rehman et al. Serological and Epidemiological Identification of Diabetes Disease at District Mardan

Significant variance regarding diabetes in different provinces of Pakistan, several

males and females is found across the world due populations based research studies and
to diversities in biology, culture, lifestyle, nationwide surveys have been carried out to
environment, and socio economic status (Kautzky assess the prevalence of diabetes mellitus
et al. 2016). It was found in various studies that complication. These studies include Shera et al.,
prevalence of diabetics is more in males as 1995, Basit et al. 2002, Jafar et al., 2004 and
compared to females (Meo et al 2016) as reported Shera et al. 2007 (Sultan et al. 2016).
in our study. However, other studies indicated
more prevalence in women (Anwer et al. 2017). In

Figure 3: Gender based suspects and prevalence during the given span of study

Table 1: Overall subjects and prevalence on gender and monthly basis

All All All positive All positive

Month Prevalence
patients positive males males females females
April 635 75 11.81 295 43 340 32
May 581 73 12.54 315 41 266 34
June 519 71 13.67 263 37 256 34
July 854 103 12.06 401 49 453 54
August 608 81 13.32 290 39 318 42
September 714 89 12.46 366 49 348 40
Total 3911 494 12.63 1930 258 1981 236

of diabetes mellitus in the rural town of Shikarpur,

Studies showed the average prevalence ratio Sindh, which shows an overall prevalence of
of Diabetes Mellitus in the ranges from less than 16.2% (Shera et al. 1995). Another study was
1% to greater than 50% (Shera et al 1999). Mahar conducted by Mahar et al. 2010 to find the
et al., noticed 9% prevalence of diabetes mellitus prevalence ratio of diabetes mellitus in both
which is consistent with the figures reported gender in Gaddap town, Karachi Pakistan
during Pakistan National Diabetic Survey to reported the prevalence of diabetes as 8.73%.
highlight the prevalence rate of diabetes mellitus (Mahar et al.2010). In 1999, Shera et al.
which shows a prevalence of 9.2% and 11.2% in conducted study to find out the prevalence rate of
men and women respectively (Mahar et al. 2010). Baluchistan Province in both urban and rural area
The aim was to provide better knowledge about which show 13.46% in both gender of
the pervasiveness of diabetes mellitus in the Baluchistan, Pakistan (Shera et al. 1999) study
different provinces of Pakistan. A study was show the prevalence rate of diabetes mellitus in
conducted in the Sindh to find the prevalence ratio rural region of Khyber Pakhtunkhwa are 11.1%

Bioscience Research, 2021 volume 18(1): 727-732 730

Rehman et al. Serological and Epidemiological Identification of Diabetes Disease at District Mardan

in both genders, (Shera et al. 1999) which is less Wrote the paper:
compared to our study. Our study has several Ihteshamul Haq, Mehran Ali, Aziz Ur Rehman,
strengths. To our knowledge, this is the largest Fazal Akbar
survey on diabetes in district Mardan to assess
the percent prevalence among patients at Mardan Copyrights: © 2021@ author (s).
Medical Complex, Mardan KP. It included patients This is an open access article distributed under the
overall from district as well as from urban and terms of the Creative Commons Attribution License
rural populations. In our study, first we (CC BY 4.0), which permits unrestricted use,
investigated3911 diabetes patients through distribution, and reproduction in any medium,
HbA1c method for the prevalence of diabetes provided the original author(s) and source are
patient from different areas of district Mardan KP
credited and that the original publication in this
Pakistan. Previous studies in KP Pakistan
journal is cited, in accordance with accepted
reported prevalence ratio of 6-16% in diabetes in
KP. academic practice. No use, distribution or
In this study out of 3911 diabetes patient just reproduction is permitted which does not comply
496 (12.63%) patients were positive for diabetes with these terms.
disease which is in the range of above mentioned
journal. So, this study showed that ratio of REFERENCES
prevalence of diabetes infections is even less high Anwar, F., Khan, M., Salman, M., Ahmad, S.,
than all the previous studies done in KP Pakistan Ullah, F., Khan, J., ... & Abbas, M. (2021).
for prevalence of diabetes in the respective Seroprevalence of hepatitis B virus in human
subject areas. This increasing ratio in the population of district Buner Khyber
infections of diabetes shows the poor condition in Pakhtunkhwa Pakistan. Clinical
health care facilities and also the unawareness in Epidemiology and Global Health, 10,
population in the last few years. 100688.Shera AS, Rafique G, Khwaja IA,
Ara J, Baqai S, King H. Pakistan national
CONCLUSION diabetes survey: prevalence of glucose
From the present study, it is obvious that a intolerance and associated factors in
certain percentage of population is a victim of this Shikarpur, Sindh Province. Diabet Med.
metabolic disease worldwide as well is in 1995; 12:1116-21.
Pakistan. This highest prevalence rate recorded in Anwer I, Shahzad A, Nanji K, Haider F, Ahmad
our case is due to lack of awareness among the MM. Diabetes Mellitus-Knowledge,
masses about balanced diet, healthy life styles, Management and Complications: Survey
poor health facilities, inadequate exercise and report from Faisalabad-Pakistan. Mid-East J
several others. of Fam Med. 2017;7(10):5-12.
Hakeem R, Fawwad A. Diabetes in Pakistan:
CONFLICT OF INTEREST Epidemiology, Determinants and Prevention.
The authors declared that present study was J Diabetol 2010;3:4.
performed in absence of any conflict of interest. Haq, I., Muhammad, A., Fazli Zahir, M. K., Anwar,
F., Akhtar, M. S., & Ullah, F. (2020).
ACKNOWLEGEMENT Serological and Epidemiology study of
Gratitude to my worthy professors for reviews Helicobacter pylori infection among
and improving the manuscript and thanks to the Dyspeptic patients in District Peshawar
co-authors for their contributions throughout the Pakistan. Adv. Biores, 11(3), 81-85.Sarah
process. Wild, Anders Green, Hilary King. Global
prevalence of diabetes (estimates for the
AUTHOR CONTRIBUTIONS Year 2000 and projections for 2030).
Conceived and designed the experiments: Diabetes Care 2004;27:1047–53.
Abid Ur Rehman, Farzeen Khan, Naumana Haq, I., Zahir, F., ur Rehaman, A., Ullah, N.,
Rehman. Khan, J., Qamar, N., ... & Khan, Y. (2021).
Analyzed the data: Evaluation of change in hematological
Shumaila Bakht, Shaheen Bibi, Sana Khan, parameters and epidemiological identification
Fawad Inayat. of dengue virus infection at district
Contributed materials/ analysis/ tools: Peshawar, Khyber Pakhtunkhwa,
Fazli Zahir, Zeeshan Shahzad, Tanzeela Pakistan.Kaul K, Tarr JM, Ahmad SI, Kohner

Bioscience Research, 2021 volume 18(1): 727-732 731

Rehman et al. Serological and Epidemiological Identification of Diabetes Disease at District Mardan

EM, Chibber R. Introduction to diabetes

mellitus. In: Diabetes. Springer; 2013:1-11
IDF-Diabetes Atlas 7th Edition.
[Online][cited2016May3]. Available from:
URL:http://www.diabetesatlas.org.
Kautzky-Willer A, Harreiter J, Pacini G. Sex and
gender differences in risk, pathophysiology
and complications of type 2 diabetes
mellitus. Endo Rev. 2016;37(3):278-316
Mahar PS, Awan MZ, Manzar N, Memon MS.
Prevalence of type-II diabetes mellitus and
diabetic retinopathy: the Gaddap study. J
Coll PhysiciansSurgPak.2010; 20: 528-32.
Meo SA, Zia I, Bukhari IA, Arain SA. Type 2
diabetes mellitus in Pakistan: Current
prevalence and future forecast. J Pak Med
Assoc. 2016;66(12):1637-42
Shera AS, Rafique G, Khwaja IA, Baqai S, Khan
IA, King H. Pakistan National Diabetes
Survey prevalence of glucose intolerance
and associated factors in North West at
Frontier Province (NWFP) of Pakistan. J Pak
Med Assoc 1999; 49: 206-11. Comment in:
p. 205-6.
Shera AS, Rafique G, Khwaja IA, Baqai S, Khan
IA, King H. Pakistan National Diabetes
Survey prevalence of glucose intolerance
and associated factors in North West at
Frontier Province (NWFP) of Pakistan. J Pak
Med Assoc. 1999; 49: 206-11.
Shimizu K, Kobayashi Y, Muraoka K. Mid
peripheral fundus involvement in diabetic
retinopathy. Ophthalmology. 1981, 88: 601-
612.
Ul Haq, I., Khan, M., Rehman, Z., Anwar, F.,
Ullah, H., & Ullah, N. (2018). HBV
prevalence in the volunteer blood donors in
Peshawar, Khyber Pakhtunkhwa
Pakistan. Int J Biosci, 13(5), 50-54.Edwards
CRW, Baird JD. Toft AD. Endocrine and
metabolic disease In: Davidson’s principles
and practice of medicine. Churchill
Livingston, 1991, 607-698.
World Health Organization. Non communicable
diseases. Fact sheet. Updated January
2015. [Cited on January 31, 2015]. Available
from URL: http://www.who.int/ media
centre/factsheets/fs355/en/

Bioscience Research, 2021 volume 18(1): 727-732 732