Who is at high risk of DM and pre-DM?

Abstract

Introduction: Diabetes mellitus (DM) is a serious public health issue but 50.1% of DM cases remain undiagnosed. Local guidelines recommend DM screening for those aged≥45 years or individuals with traditional risk factors, such as obesity, but lifestyle factors are not considered. This study aimed to explore the association between lifestyle factors and pre-DM and DM in order to identify those at high risk more accurately. Method: Secondary analysis of Hong Kong Population Health Survey 2014/15 was conducted. 1,857 people aged 18-84, without self-reported pre-DM/DM, hypertension, cardiovascular disease, cancer, renal disease or anaemia, and completed the lifestyle survey, health examination and blood test were included. Univariable and multivariable logistic regressions examined the association between sociodemographic and lifestyle factors (smoking, physical activity, diet, alcohol consumption and sleep) and pre-DM/DM. Clustering analysis was performed to identify the people at high pre-DM/DM risk. Results: The prevalence of pre-DM/DM was 15.08% (mean age: 40.7 years). After adjustment for other demographic and lifestyle variables, the following factors were associated with a higher risk of pre-DM/DM: older age (OR=1.067 [1.055-1.080]), current smoker (OR=1.693 [1.117-2.566]), sleeping duration of <6 hours/day (OR=1.579 [1.030-2.419], ref: 6-8 hours) and less time spent in vigorous exercise (OR=0.998 [0.995-1.000]). The population was clustered into 8 groups according to the homogeneity of demographics and lifestyles. The oldest age group (mean age=56.73) had the highest risk of pre-DM/DM at 31.52%. The middle-aged group (mean age=40.5), who were mostly male, less-educated, engaged in manual labour and lacking in vigorous recreational exercise, had the second highest incidence of pre-DM/DM (29.17%), despite normal blood pressure, waist and body mass index. Conclusions: Lack of sleep and lack of vigorous exercise were associated with increased risk of pre-DM/DM and should be added to current screening guidelines. Screening should also be targeted at middle-aged males with low education levels and limited vigorous exercise, even if they are not obese.