Analysis of Associated Factors Contributing to Type 2 Diabetes Mellitus in the Coastal Community of Bahari Village, Southeast Sulawesi, Indonesia: A Cross-Sectional Study

2.1. Study Design and Setting

This research was carried out using a cross-sectional design for 3 (three) months, from March to May 2023, in the Bahari Village. To detect the lifestyle of individuals living with T2DM, the sample size has been counted considering an incidence rate of 22% and p-value = 0.05. The sample size is 113 men and 157 women.

Inclusive criteria include residents aged 17 to 65 years, both men and women. Participants have the opportunity and agree to answer all questions provided in the form of a questionnaire. Exclusion criteria include the presence of severe mental and communication disorders.

2.2. Data Collection

Observations in the lifestyles of individuals living with diabetes based on T2DM control and prevention guidelines in Indonesia 2021, blood sugar levels of 200 mg/dL+ or fasting blood sugar of 126 mg/dL+ can be diagnosed as T2DM. Symptoms of type 2 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes, and fatigue [1].

Observation also included lifestyles, such as drinking sweet tea or coffee, physical activity, family history, and smoking. Data on the following variables were collected: age (17–25; 26–35; 36–45; and 46–55 or 56+ years), gender (woman or men), education level (no education, class 1–6, class 7–12, or college/university), occupation (fisheries, and others), and family history of T2DM. Body Mass Index (BMI) was calculated as body weight (kg) divided by height (m) squared. The BMI of participants was categorized based on reference ranges specific to the Indonesian population as ‘not overweight’ if (BMI < 23 kg/m²), ‘overweight’ (BMI = 23.0 - 25.0 kg/m²), or ‘obese’ (BMI = 25.0 kg/m² +). Physical activity was defined as currently meeting the criteria for never, incidental, and regular. Data on drinking sweet tea or coffee was defined as meeting the criteria mild, moderate, or heavy. Current smoking status was defined as yes or no. Data was obtained through self-writing and reporting via the aforementioned quantitative questionnaire. All participants were asked for verbal consent before the interview.

2.3. Data Analysis

Data are displayed in frequency and percentage. Chi-square was used to determine the relationship between characteristics, lifestyle, and family history to T2DM, and (OR: CI 95%) significant at p-value <0.05. Meanwhile, logistic regression was used to assess the simultaneously associated factors to T2DM. The data were analyzed by SPSS version 25.0 for Windows (SPSS Inc., Chicago, IL, the USA).

3.1. Prevalence of T2DM

The prevalence of individuals living with T2DM for men (25.8%) and women (74.2%); respondents have an average age of 56.45±5.94 and height of 160.29±4.53. The prevalence of T2DM for 36-45 years is 21.0%, 46-65 years (48.4%), and 56+ (21.0%), underweight (12.5%), normal (19.2%), overweight (38.2%), and obese (50.0%). Family history of T2DM for the father (25.8%), mother (14.5%), and father and mother (40.3%), no education (59.7%), class 1-6 (19.4%), and class 7-9 (8.1%). There was a significant association between gender, age, BMI, education level, and occupation with T2DM at p < 0.05 (Table 1). Gender, age, education, BMI, and occupation simultaneously influence (72.7%), and age partially affects T2DM.

3.2. Lifestyle of Participants

The prevalence of T2DM for drinking tea or coffee is mild (0%), moderate (6.5%), and heavy (77.5%), physical activity for never (87.1%), incidental (12.9%), and regular category (0%). There was a significant association between drinking sweet tea or coffee and physical activity with T2DM but not for smoking habits at p<0.05, (Table 2).

3.3. Family History

The prevalence of family history living with T2DM for fathers (25.8%), mothers (14.5%), and both mothers and fathers (48.3%). There is an association between mother variables with T2DM (p=0.00), and the risk factor for the father is OR: 1.42 (Cl 95%: 0.73 - 2.75), (Table 3). Fathers, mothers, and both father and mother have significantly simultaneously influenced T2DM by approximately 77%.

4.1. Prevalence of Participants Living with T2DM

Women, age, urban residence, education level, history of hypertension, diastolic blood pressure, and lipid profiles were all associated with obesity among T2DM subjects in Indonesia. The higher prevalence of T2DM in females is related to variate risk factors such as early menopause caused by hormones [9]. Estrogen can affect insulin sensitivity and blood sugar metabolism. Apart from that, it is also influenced by diet, lack of physical activity, and genetic factors [10]. Results of the study showed the prevalence of T2DM tends to increase with age and occurs relatively higher for 46+ years (69.4%), and women living with T2DM reached 74.2%. The risk of diabetes increases with age for several reasons, such as decreased body sensitivity to insulin and difficulty maintaining weight and an active lifestyle. Respondents in the no education category reached 59.7% of T2DM. Low education causes limited access to information, healthy lifestyles, healthy food, and fitness facilities. The prevalence of T2DM for underweight (12.5%), normal (19.2%), overweight (38.2%), and obese (50.0%). It tends to increase with the BMI index. A high BMI reflects excess body fat, especially in the stomach. These fats can contribute to insulin resistance. Adherence to sweet food, vegetable, and poultry dietary patterns was favorably related to body weight, higher fasting blood glucose, and total cholesterol [11]. Family history of T2DM for the father (25.8%), mother (14.5%), and father and mother (40.3%), while a risk factor for the father 1.42, contributed to 42% for T2DM. Family history was more susceptible to the negative impact of being overweight or obese on dyslipidemia [12]. Monitoring and controlling related determinants are needed to prevent complications caused by the doubled burden of T2DM [13]. This information is important because of the strong association between being overweight/obese and several risk factors for T2DM [14]. The BMI corrected to young height; obese subjects had an increased risk for developing pre-diabetes and diabetes, with a higher risk for females than males [15]. Bodyweight change was significantly associated with cardiovascular disease risk factor changes, and >5% bodyweight reduction was associated with improved glycated hemoglobin (Xu, 2023). In addition, body weight fluctuation leads to an increased risk of T2DM in adults aged >/= 60 years [16].

4.2. Lifestyle Drinking Tea/Coffee

The abundance of information and easy-to-access food via online media push dietary lifestyle change, and increasing in the incidence of T2DM in rural areas follows the trend of lifestyle in urban citizens [4]. This is also in line with the high prevalence of T2DM in respondents who consume sweet tea or coffee. The prevalence of T2DM with heavy drinking of sweet tea or coffee reached 77.5%). Indonesian people 40.7% consume fatty foods, 53.1% sweet foods, 93.5% less vegetables and fruit, and 26.1% lack physical activity [17]. This shows that, in general, Indonesian people like sweet food or drinks is relevant to the result of this study. According to a study [18], continuous glucose monitors are needed to provide high-frequency information regarding daily glucose variation and are recognized as effective for improving glycemic control [19]. It is important to note that each individual with diabetes may have a different response to food and glucose regulation. Therefore, it is important to work with a health professional or nutritionist to develop a meal plan that suits the individual's specific needs and health condition.

4.3. Lifestyle Physical Activity

This research shows that lack of physical activity is associated with a high prevalence of T2DM (87.1%). High-intensity workout is a key factor in increasing catabolism rate in middle-aged and older people [20]. Even mild and regular exercise such as walking, swimming, and bicycling contributed to glycemic control, preventing and treating overweight or obese, and T2DM [21]. Consistency in regular physical activity is also the key to getting maximum benefits in preventing diabetes and maintaining health in general.

4.4. Lifestyle Smoking

People in this area commonly use tobacco cigarettes. Respondents have a habit of smoking and living with T2DM (22.6%), but no significant associated T2DM. In addition, there is no evidence to support an association between maternal cigarette smoking during pregnancy and the risk for gestational diabetes mellitus [22]. It is important to remember that quitting smoking can have direct health benefits, including reducing the risk of diabetes and improving blood sugar control for those who already have diabetes. Steps to managing diabetes involve a healthy lifestyle, including quitting smoking, maintaining a healthy weight, exercising regularly, and adhering to a treatment plan recommended by a health professional.

4.5. Family History

There was a strong association between patients with T2DM and those who have a family history of diabetes [10]. The prevalence of T2DM related to family history, namely father (25.8%), mother (14.5%), and both father and mother (40.3%), and variable mothers significantly associated with the incidence of T2DM at p<0.05. Other studies also show family history was significantly associated with diabetes, even in those with a low genetic risk and an ideal lifestyle [23]. A family history of T2DM is an important risk factor for gestational diabetes mellitus [24]. Families living with T2DM are not only required to maintain diet, physical activity and negative habits. Still, they are also expected to provide support for loneliness through a mediating role to relieve depression and the burden of self-perception [25]. The holistic approach acknowledges the multifaceted nature of lifestyle influences on diabetes and emphasizes the importance of comprehensive health promotion and disease prevention in Bahari Village.

Cross-sectional studies used to analyze associated factors with diabetes are only used to capture data at a single point in time, making them prone to certain limitations. Future research is important to use longitudinal designs to provide a more robust understanding of the causal relationships between lifestyle and T2DM.