Diabetes has become one of the leading causes of death worldwide. It is one of the four priority Non-Communicable diseases (NCDs) targeted by world leaders. According to World Health Organization (WHO) around 1.6 million people worldwide died due to diabetes in 2016. It is estimated that 425 million people are living with diabetes all over the world [1]. There has been a significant increase in the prevalence of diabetes over the last few years, particularly in India. The WHO has mentioned India as “The diabetic capital of the world” as it has got the highest number of diabetics [2]. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels. More than 95% of people with diabetes have type 2 diabetes. This type of diabetes is largely the result of excess body weight and physical inactivity. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation [3]. Type 2 diabetes is a significant cause of premature mortality and morbidity related to cardiovascular disease (CVD), blindness, kidney and nerve disease, and amputation [4]. Although regular physical activity (PA) may prevent or delay diabetes and its complications, most people with type 2 diabetes are not active [5].  

In this article, the broader term “physical activity” (defined as “bodily movement produced by the contraction of skeletal muscle that substantially increases energy expenditure”). The intention is to know that any physical movement can have a positive effect on physical fitness, morbidity and mortality among diabetics. The American Diabetes Association (ADA) recommends the use of any of the following four criteria for diagnosing diabetes: 1) glycated hemoglobin (A1C) value of 6.5% or higher, 2) fasting plasma glucose ≥126 mg/dl (7.0 mmol/l), 3) 2-h plasma glucose ≥200 mg/dl (11.1 mmol/l) during an oral glucose tolerance test using 75 g of glucose, and/or 4) classic symptoms of hyperglycemia (e.g., polyuria, polydipsia, and unexplained weight loss) or hyperglycemic crisis with a random plasma glucose of 200 mg/dl (11.1 mmol/l) or higher. In the absence of unequivocal hyperglycemia, the first three criteria should be confirmed by repeat testing [6].

Prediabetes is diagnosed with an A1C of 5.7–6.4%, fasting plasma glucose of 100–125 mg/dl (5.6–6.9 mmol/l; i.e., impaired fasting glucose [IFG]), or 2-h post load glucose of 140–199 mg/dl (7.8–11.0 mmol/l; i.e., impaired glucose tolerance [IGT]. As the prevalence of diabetes continues to rise worldwide, it becomes increasingly important to identify high-risk populations and to implement strategies to delay or prevent diabetes onset. Women diagnosed with GDM are at substantially increased risk of developing type 2 diabetes; therefore, PA may be considered a tool to prevent both GDM and possibly type 2 diabetes at a later date [7]. Individuals with type 2 diabetes should engage in a minimum of 150 min/week of exercise undertaken at moderate intensity or greater. Aerobic activity should be performed in bouts of at least 10 min and be spread throughout the week. Around 150 min/week of moderate-intensity exercise is associated with reduced morbidity and mortality in observational studies in all populations [8].

Study Population

Newly diagnosed diabetic patients in the Out-Patient Department and the in-Patient Department of Medicine at a tertiary care hospital in Himachal Pradesh. To ensure maximum recruitment of patients in the study, patients from weekly diabetic clinic also included in the study.

Study Period

2021-2022. The study was carried out for a period of one year from the day of start of the study.

Study Design

This was an open cohort study design

Inclusion Criteria

All newly diagnosed patients of Diabetes, irrespective of presence or absence of any co morbidity, in the out-patient department and in-patient department of the Department of Medicine including the patients from weekly diabetic clinic and who were willing to participate were included in the study.

Exclusion Criteria

Patients not willing to give consent were excluded. Patients who were earlier on diabetes treatment but presently not taking any anti-hyperglycemic medications for any time period were also included in the study.

Study Tools

A pretested semi structured interview Questionnaire were used for data collection on various co-relates for Diabetes and socio-demographic characteristics of the study population.

Methodology

The study included newly diagnosed diabetic patients with or without co-morbidities from a hospital in Himachal Pradesh. It was an open cohort study conducted over one year, with participants followed up for a period of six months. Recruitment finished after six months, with the last patient enrolled at the study’s end.

Table 1 shows the socio-demographic and baseline characteristics of study participants. It was observed that out of total 62 patients, there were 39 males and 23 females with male to female ratio of 1.6:1. Maximum number of patients were in age group of 41-60 years 32 (52.6%) followed by 15 (24.1%) patients in age group of 61-80 years. There were only 2 (3.2%) patients of age more than 80 years.

Table 1:  Socio-Demographic Details of Participants (N=62)

There were 26 (41.9%) tobacco users in our study. History of alcohol consumption was present in 21 participants and 35 participants were physically active as per WHO-GPAQ (Table 2).

Table 2: Risk Factors Associated with Diabetes

Table 3 above shows the age and sex wise distribution of study participants. Total 62 participants were enrolled for the purpose of the study. Mean age of male and female patients was51.9 and 54.2 years respectively. Out of total 20.9% (13/62) patients in the 20-40 years age group, 16.1% (10/62) were males and 4.8% (3/62) were females. In the age group 41-60 years, out of total 50% (31/62) patients, 27.4% (17/62) were males and remaining 24% (15/62) were females. Similarly, in the age group 61-80 years, out of total 25% (16/62) patients, 16.1% (10/62) were males and 8% (5/62) were females. Therefore, there was male preponderance in each age group.

Table 3: Distribution of Patients According to Age and Sex

Table 4 above shows association between physical activity and control of blood glucose after 6 months of follow up. Out of all participants majority 56.4% (35/62) were physically activity whereas 43.5% (27/62) of the participants were not doing any kind of physical activity. Among physically active participants 82.8% (29/35) had blood glucose under control and 17.1% (6/35) had uncontrolled blood glucose. Participants with no physical activity majority 85.1% (23/62) had uncontrolled blood glucose and 14.8% (4/62) had controlled blood glucose. This difference in association between physical activity and blood glucose control was found to be statistically significant (p = <0.01) (Figure 1).

Table 4: Association Between Physical Activity and Control of Blood Glucose

Figure 1: Association between Physical Activity and Control of Blood Glucose

The present study discusses the socio-demographic and baseline characteristics of study participants in a hospital based open cohort study of newly diagnosed diabetic patients. The manuscript presents the data on gender distribution, risk factors and physical activity.

The results showed that out of total 62 patients, 64.5% were males and 35.5% were females, with male to female ratio of 1.6:1. The majority of patients belonged to the age group of 41-60 years (52.6%), followed by 24.1% in the age group of 61-80 years. Only 3.2% of patients were above 80 years of age. Criteria used to check physical activity among patients was WHO-GPAQ. The GPAQ covers several components of physical activity, such as intensity, duration, and frequency, and it assesses three domains in which physical activity is performed (occupational physical activity, transport-related physical activity, and physical activity during discretionary or leisure time). 56.4% (35/62) of the patients were physically active, whereas rest of 43.5% (27/62) were physically inactive. Out of total physically active patients 82.8% (29/35) had their blood glucose controlled, on other hand majority of the patients 85.1% (23/27) had uncontrolled blood glucose level who were not physically active. This difference in control of blood glucose level and physical activity was found to be statistically significant.

The findings of this study are consistent with previous research. Similar age distribution patterns have been reported in other studies conducted in different regions. The higher prevalence of diabetes among males, as observed in this study, aligns with the findings from various other population based studies. The association between control of blood glucose and physical activity has been documented in previous researches.

In conclusion, the study highlights importance of considering factors such as gender, age, tobacco and alcohol use, socio economic status and physical activity in management of diabetes. The results contribute to the existing knowledge in the field and can guide future interventions and public health strategies for better diabetes care.

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7. Dyck, R.F. et al. “Preventing non-insulin-dependent diabetes mellitus among aboriginal people: is exercise the answer? Description of a pilot project using exercise to prevent gestational diabetes.” International Journal of Circumpolar Health, vol. 57, 1998, pp. 375–378.

8. Physical Activity Guidelines Advisory Committee. “Physical activity guidelines advisory committee report.” U.S. Department of Health and Human Services, 2008, pp. 683.