595860 research-article2015
APHXXX10.1177/1010539515595860Asia-Pacific Journal of Public HealthNguyen et al
Review
Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Vietnam: A Systematic Review
Asia-Pacific Journal of Public Health 1–13 © 2015 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539515595860 aph.sagepub.com
Chung T. Nguyen, MPH1,2, Ngoc Minh Pham, PhD3,4, Andy H. Lee, PhD1, and Colin W. Binns, PhD1
Abstract This systematic review examined trends in the prevalence of type 2 diabetes mellitus (T2DM) and identified its risk factors among adults in Vietnam. PubMed, Web of Science, Wiley Online Library, and Scopus databases were searched to identify relevant literature. The search yielded 10 studies, including 2 national surveys and 8 regional investigations. National prevalence estimates of T2DM were 2.7% in 2002 and 5.4% in 2012. The estimates for the northern region were 1.4% in 1994 and 3.7% in 2012 and those for the southern region were 3.8% in 2004, 7.0% in 2008, and 12.4% in 2010. The major determinants of T2DM included older age, urban residence, high levels of body and abdominal fat, physical inactivity, sedentary lifestyle, genetic factors, and hypertension. The prevalence rate by gender was variable in both national and regional studies. There was insufficient information available on some potentially important risk factors such as smoking, dietary intake, income, and educational level. Our review signifies a rapidly growing prevalence of T2DM in Vietnam and suggests that extra effort is required to prevent and control this disease. Keywords diabetes, prevalence, risk factors, hyperglycemia, Vietnam
Introduction Once type 2 diabetes mellitus (T2DM) was considered as only a disease of affluent countries, but now, it has become a public health priority for developing countries. The prevalence rate of T2DM in Asia has increased rapidly in the past decade, characterized by young age of onset and low body mass index (BMI).1 It was estimated that there were 387 million persons suffering from this disease worldwide in 2014, of whom 213 million reside in Asia (75 million in South East Asia and 138 million in the Western Pacific region); about 3.6 million patients die annually from diabetes-related causes in this region.2
1Curtin
University, Perth, WA, Australia Institute of Hygiene and Epidemiology, Vietnam 3Stanford University, Stanford, CA, USA 4Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam 2National
Corresponding Author: Chung T. Nguyen, Department of Epidemiology, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Habatrung District, Hanoi 043, Vietnam. Email: [email protected]
Downloaded from aph.sagepub.com at Stockholm University Library on August 12, 2015
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Asia-Pacific Journal of Public Health
The etiology of T2DM is characterized by the interaction of environmental and genetic factors. Although the association between T2DM and genetic factors is strong,3 other risk factors, including diet and lifestyle, play an important role in the occurrene of T2DM.1 Unhealthy diets,4 physical inactivity,5 passive and active smoking,6,7 and excessive alcohol intake8 have all been commonly shown to be modifiable risk factors for T2DM. Along with rapid economic growth and urbanization, Vietnam is one of the Asian countries that has experienced dietary changes, including increasing fat and meat intakes.9 There are also concerns about increasing body size,10-12 physical inactivity,11-13 tobacco smoking,14 and alcohol overuse15 among Vietnamese adults. Increased life expectancy16 has resulted in a rapid growth in the number of older persons, and low health care expenditures17 are also contributing to a high prevalence of T2DM. These changes are all potentially contributing to the accelerating prevalence of diabetes in Vietnam. Over the past 2 decades, in this country, a number of epidemiological studies on diabetes have been undertaken both nationwide11,18,19 and at regional levels.12,20-22 Synthesis of these epidemiological data can provide a better understanding of the prevalence and trends and suggest solutions to addressing the problem. To date, no reviews have been conducted. We, therefore, performed a systematic review of epidemiological studies on T2DM in Vietnam, addressing secular prevalence trends in the disease and its risk factors.
Methods We perfomed a systematic literature search through PubMed, Web of Science, Wiley Online Library, and Scopus databases in 2 steps. First, we identified relevant publications using the key words: diabetes, diabetes mellitus, type 2 diabetes, type 2 diabetes mellitus, hyperglycemia, Vietnam without any restriction on the type, year, and language of publication. Second, we eliminated duplicated articles retrieved from the aforementioned databases. In the next stage, we checked the titles and abstracts of each identified article for eligibility based on the following selection criteria: Inclusion criteria ● Primary data, population-based epidemiological studies ● Hospital-based studies Exclusion criteria ● ● ● ●
Gestational diabetes Type 1 diabetes Latent autoimmune diabetes in adults Letters, commentaries, and editorials
We extended our search to published reports from Web sites of the World Health Organization (WHO) and International Diabetes Federation. We also searched the reference lists of selected articles and recruited relevant articles and national reports in Vietnamese, then contacted authors or coauthors to obtain full-text records. Finally, the full text of eligible articles and reports were evaluated and synthesized in this review. This systematic review was conducted according to the PRISMA guidelines.23
Results Selection Procedure Figure 1 shows the PRISMA flow diagram of the systematic search. Among the 329 publications identified and retrieved from the databases and other sources, 86 articles were found to
Downloaded from aph.sagepub.com at Stockholm University Library on August 12, 2015
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Nguyen et al
Figure 1. PRISMA flow diagram for study selection in the systematic review on trends in prevalence and risk factors for type 2 diabetes in Vietnam (1994-2012).
be associated with diabetes in Vietnam after initial screening and excluding duplicates. These articles were manually checked by title and abstact, and accordingly, 58 articles were found to be irrelevant to the inclusion criteria. Of the 18 remaining articles that met the selection criteria, we excluded 1 research letter, 1 editorial, and 6 non–full text articles. Finally, 10 original full text articles were included for this review.
Characteristics of Included Studies Three studies estimated only the prevalence of diabetes,18,19,24 2 investigated risk factors,10,25 and 5 addressed both prevalence data and risk factors.11-13,20,21 The sample sizes varied, from
Downloaded from aph.sagepub.com at Stockholm University Library on August 12, 2015
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Asia-Pacific Journal of Public Health
144 to 11 191 participants. The 8 studies that estimated prevalence all used the 1998 World Health Organization diagnostic criteria,26 except for one that used the 1985 WHO criteria.27 One study13 recruited individuals older than 15 years, and the remainder selected adults 30 years and older11,12,18-21,24 (Table 1). Risk factors and their odds ratios (ORs) with 95% confidence intervals (95% CI) for diabetes are presented in Table 2. All selected studies meet the level III of evidence that is recommended by the National Health and Medical Research Council in Australia.28
Prevalence of T2DM The prevalence of T2DM was estimated nationally and regionally to be between 1994 and 2012 (Table 1). Data derived from 2 national surveys, which used the same 1998 WHO criteria, showed that standardized prevalence rates were 2.7% in 200218 and 5.4% in 2012.19 The prevalence rates of T2DM in the northern region were 1.4% in 199420 and 3.7% in 201221; the corresponding data in the southern region were 3.8% in 2004,13 7.0% in 2008,24 and 12.4% in 2010.12
Demographic Factors The association between age and diabetes prevalence was examined in 2 studies11,13 and showed that increasing age was positively associated with higher prevalence of diabetes; the OR (95% CI) among those ≥45 years old relative to the
APHXXX10.1177/1010539515595860Asia-Pacific Journal of Public HealthNguyen et al
Review
Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Vietnam: A Systematic Review
Asia-Pacific Journal of Public Health 1–13 © 2015 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539515595860 aph.sagepub.com
Chung T. Nguyen, MPH1,2, Ngoc Minh Pham, PhD3,4, Andy H. Lee, PhD1, and Colin W. Binns, PhD1
Abstract This systematic review examined trends in the prevalence of type 2 diabetes mellitus (T2DM) and identified its risk factors among adults in Vietnam. PubMed, Web of Science, Wiley Online Library, and Scopus databases were searched to identify relevant literature. The search yielded 10 studies, including 2 national surveys and 8 regional investigations. National prevalence estimates of T2DM were 2.7% in 2002 and 5.4% in 2012. The estimates for the northern region were 1.4% in 1994 and 3.7% in 2012 and those for the southern region were 3.8% in 2004, 7.0% in 2008, and 12.4% in 2010. The major determinants of T2DM included older age, urban residence, high levels of body and abdominal fat, physical inactivity, sedentary lifestyle, genetic factors, and hypertension. The prevalence rate by gender was variable in both national and regional studies. There was insufficient information available on some potentially important risk factors such as smoking, dietary intake, income, and educational level. Our review signifies a rapidly growing prevalence of T2DM in Vietnam and suggests that extra effort is required to prevent and control this disease. Keywords diabetes, prevalence, risk factors, hyperglycemia, Vietnam
Introduction Once type 2 diabetes mellitus (T2DM) was considered as only a disease of affluent countries, but now, it has become a public health priority for developing countries. The prevalence rate of T2DM in Asia has increased rapidly in the past decade, characterized by young age of onset and low body mass index (BMI).1 It was estimated that there were 387 million persons suffering from this disease worldwide in 2014, of whom 213 million reside in Asia (75 million in South East Asia and 138 million in the Western Pacific region); about 3.6 million patients die annually from diabetes-related causes in this region.2
1Curtin
University, Perth, WA, Australia Institute of Hygiene and Epidemiology, Vietnam 3Stanford University, Stanford, CA, USA 4Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam 2National
Corresponding Author: Chung T. Nguyen, Department of Epidemiology, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Habatrung District, Hanoi 043, Vietnam. Email: [email protected]
Downloaded from aph.sagepub.com at Stockholm University Library on August 12, 2015
2
Asia-Pacific Journal of Public Health
The etiology of T2DM is characterized by the interaction of environmental and genetic factors. Although the association between T2DM and genetic factors is strong,3 other risk factors, including diet and lifestyle, play an important role in the occurrene of T2DM.1 Unhealthy diets,4 physical inactivity,5 passive and active smoking,6,7 and excessive alcohol intake8 have all been commonly shown to be modifiable risk factors for T2DM. Along with rapid economic growth and urbanization, Vietnam is one of the Asian countries that has experienced dietary changes, including increasing fat and meat intakes.9 There are also concerns about increasing body size,10-12 physical inactivity,11-13 tobacco smoking,14 and alcohol overuse15 among Vietnamese adults. Increased life expectancy16 has resulted in a rapid growth in the number of older persons, and low health care expenditures17 are also contributing to a high prevalence of T2DM. These changes are all potentially contributing to the accelerating prevalence of diabetes in Vietnam. Over the past 2 decades, in this country, a number of epidemiological studies on diabetes have been undertaken both nationwide11,18,19 and at regional levels.12,20-22 Synthesis of these epidemiological data can provide a better understanding of the prevalence and trends and suggest solutions to addressing the problem. To date, no reviews have been conducted. We, therefore, performed a systematic review of epidemiological studies on T2DM in Vietnam, addressing secular prevalence trends in the disease and its risk factors.
Methods We perfomed a systematic literature search through PubMed, Web of Science, Wiley Online Library, and Scopus databases in 2 steps. First, we identified relevant publications using the key words: diabetes, diabetes mellitus, type 2 diabetes, type 2 diabetes mellitus, hyperglycemia, Vietnam without any restriction on the type, year, and language of publication. Second, we eliminated duplicated articles retrieved from the aforementioned databases. In the next stage, we checked the titles and abstracts of each identified article for eligibility based on the following selection criteria: Inclusion criteria ● Primary data, population-based epidemiological studies ● Hospital-based studies Exclusion criteria ● ● ● ●
Gestational diabetes Type 1 diabetes Latent autoimmune diabetes in adults Letters, commentaries, and editorials
We extended our search to published reports from Web sites of the World Health Organization (WHO) and International Diabetes Federation. We also searched the reference lists of selected articles and recruited relevant articles and national reports in Vietnamese, then contacted authors or coauthors to obtain full-text records. Finally, the full text of eligible articles and reports were evaluated and synthesized in this review. This systematic review was conducted according to the PRISMA guidelines.23
Results Selection Procedure Figure 1 shows the PRISMA flow diagram of the systematic search. Among the 329 publications identified and retrieved from the databases and other sources, 86 articles were found to
Downloaded from aph.sagepub.com at Stockholm University Library on August 12, 2015
3
Nguyen et al
Figure 1. PRISMA flow diagram for study selection in the systematic review on trends in prevalence and risk factors for type 2 diabetes in Vietnam (1994-2012).
be associated with diabetes in Vietnam after initial screening and excluding duplicates. These articles were manually checked by title and abstact, and accordingly, 58 articles were found to be irrelevant to the inclusion criteria. Of the 18 remaining articles that met the selection criteria, we excluded 1 research letter, 1 editorial, and 6 non–full text articles. Finally, 10 original full text articles were included for this review.
Characteristics of Included Studies Three studies estimated only the prevalence of diabetes,18,19,24 2 investigated risk factors,10,25 and 5 addressed both prevalence data and risk factors.11-13,20,21 The sample sizes varied, from
Downloaded from aph.sagepub.com at Stockholm University Library on August 12, 2015
4
Asia-Pacific Journal of Public Health
144 to 11 191 participants. The 8 studies that estimated prevalence all used the 1998 World Health Organization diagnostic criteria,26 except for one that used the 1985 WHO criteria.27 One study13 recruited individuals older than 15 years, and the remainder selected adults 30 years and older11,12,18-21,24 (Table 1). Risk factors and their odds ratios (ORs) with 95% confidence intervals (95% CI) for diabetes are presented in Table 2. All selected studies meet the level III of evidence that is recommended by the National Health and Medical Research Council in Australia.28
Prevalence of T2DM The prevalence of T2DM was estimated nationally and regionally to be between 1994 and 2012 (Table 1). Data derived from 2 national surveys, which used the same 1998 WHO criteria, showed that standardized prevalence rates were 2.7% in 200218 and 5.4% in 2012.19 The prevalence rates of T2DM in the northern region were 1.4% in 199420 and 3.7% in 201221; the corresponding data in the southern region were 3.8% in 2004,13 7.0% in 2008,24 and 12.4% in 2010.12
Demographic Factors The association between age and diabetes prevalence was examined in 2 studies11,13 and showed that increasing age was positively associated with higher prevalence of diabetes; the OR (95% CI) among those ≥45 years old relative to the
