背景:未确诊的糖尿病在加纳构成了重大的公共卫生挑战。许多因素可能会影响成人未确诊糖尿病的患病率。因此,应该考虑使用考虑到这些关系的复杂网络的模型。我们的目标是评估空腹血浆水平,糖尿病的关键指标,以及相关的直接和间接相关或保护因素。
方法:这项研究采用了一项横断面调查,对1200名25-70岁的成年人进行了抽样调查,这些人认为自己是健康的,并且以前没有被诊断出患有糖尿病,来自海岸角的13个土著社区大都市,加纳。根据美国糖尿病协会(ADA)的空腹血糖标准诊断糖尿病,使用迈瑞设备(2022年8月,中国)确定血脂谱。逐步使用WHO问卷收集有关社会人口统计学和生活方式变量的数据。我们分析了外生之间的关联,调解,和内生变量使用广义结构方程模型(GSEM)。
结果:总体而言,在海岸角大都市,糖尿病前期和糖尿病的患病率分别为14.2%和3.84%,分别。在性领域,女性糖尿病前期(15.33%)和糖尿病(5.15%)的患病率高于男性(12.62%和1.24%),分别)。农村地区患病率最高,其次是城市周边地区,而城市地区的患病率最低。在GSEM结果中,我们发现体重指数(BMI),甘油三酯(TG),收缩压(SBP),γ-谷氨酰转移酶(GGT),女性是糖尿病前期和糖尿病的直接预测因素,基于空腹血糖(FPG)水平。通过腰围(WC)影响糖尿病和糖尿病前期的间接因素包括儿童超重状态,家族史,35-55岁和56-70岁,中等和高社会经济地位。高密度脂蛋白(HDL)胆固醇,童年超重,低体力活动,女性性别,中等和较高的社会经济地位,市场交易也与高BMI有关,间接影响糖尿病前期和糖尿病。总胆固醇,TG水平升高,WC,年龄,低体力活动,和农村居民通过SBP被确定为与糖尿病前期和糖尿病的间接相关因素。宗教,男性,饮酒被确定为GGT的预测因素,间接影响糖尿病前期和糖尿病。
结论:土著社区的糖尿病直接受血脂的影响,BMI,SBP,酒精水平。儿童肥胖,缺乏身体活动,性别,社会经济地位,和家族史可以间接影响糖尿病的发展。这些发现为政策制定者和卫生部门利益相关者提供了宝贵的见解,使他们能够了解与糖尿病发展相关的因素,并在加纳实施必要的公共卫生干预措施和个性化护理策略,以预防和管理。
BACKGROUND: Undiagnosed diabetes poses significant public health challenges in Ghana. Numerous factors may influence the prevalence of undiagnosed diabetes among adults, and therefore, using a model that takes into account the intricate network of these relationships should be considered. Our goal was to evaluate fasting plasma levels, a critical indicator of diabetes, and the associated direct and indirect associated or protective factors.
METHODS: This research employed a cross-sectional survey to sample 1200 adults aged 25-70 years who perceived themselves as healthy and had not been previously diagnosed with diabetes from 13 indigenous communities within the Cape Coast Metropolis, Ghana. Diabetes was diagnosed based on the American Diabetes Association (ADA) criteria for fasting plasma glucose, and lipid profiles were determined using Mindray equipment (August 2022, China). A stepwise WHO questionnaire was used to collect data on sociodemographic and lifestyle variables. We analyzed the associations among the exogenous, mediating, and endogenous variables using a generalized structural equation model (GSEM).
RESULTS: Overall, the prevalence of prediabetes and diabetes in the Cape Coast Metropolis was found to be 14.2% and 3.84%, respectively. In the sex domain, females had a higher prevalence of prediabetes (15.33%) and diabetes (5.15%) than males (12.62% and 1.24%, respectively). Rural areas had the highest prevalence, followed by peri-urban areas, whereas urban areas had the lowest prevalence. In the GSEM results, we found that body mass index (BMI), triglycerides (TG), systolic blood pressure (SBP), gamma-glutamyl transferase (GGT), and female sex were direct predictive factors for prediabetes and diabetes, based on fasting plasma glucose (FPG) levels. Indirect factors influencing diabetes and prediabetes through waist circumference (WC) included childhood overweight status, family history, age 35-55 and 56-70, and moderate and high socioeconomic status. High density lipoprotein (HDL) cholesterol, childhood overweight, low physical activity, female sex, moderate and high socioeconomic status, and market trading were also associated with high BMI, indirectly influencing prediabetes and diabetes. Total cholesterol, increased TG levels, WC, age, low physical activity, and rural dwellers were identified as indirectly associated factors with prediabetes and diabetes through SBP. Religion, male sex, and alcohol consumption were identified as predictive factors for GGT, indirectly influencing prediabetes and diabetes.
CONCLUSIONS: Diabetes in indigenous communities is directly influenced by blood lipid, BMI, SBP, and alcohol levels. Childhood obesity, physical inactivity, sex, socioeconomic status, and family history could indirectly influence diabetes development. These findings offer valuable insights for policymakers and health-sector stakeholders, enabling them to understand the factors associated with diabetes development and implement necessary public health interventions and personalized care strategies for prevention and management in Ghana.