Spatial, Demographic and Physical Risk Factors for Type 2 Diabetes Mellitus: A Retrospective Examination of Adult Screening Data for Nine Communes in Siem Reap Province, Cambodia
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Diabetes is recognised as a global public health threat due to its emergence as a leading cause of death, as well as its burden on national healthcare systems and impacts on health and economic productivity. In 2017, there were nearly 425 million diabetes cases reported worldwide, with more than 60% of cases reported in Asia. By 2035, the number of type 2 diabetes mellitus (T2DM) cases in Southeast Asia is projected to exceed 123 million, with almost 95% of these being T2DM. In Cambodia, a lower-middle-income country within Southeast Asia, diabetes is a health condition of increasing concern, with the number of T2DM cases projected to rise to more than 260,000 by 2028. Previous research on risk factors for T2DM in Cambodia has primarily focused on the effects of unhealthy lifestyles, genetic disorders, and societal risk factors for T2DM. These include the effect of an unhealthy living environment, limited diabetes awareness and access to health services, and cultural beliefs on the use of traditional medicine. Despite the absence of diabetes diagnostic and treatment centres outside Cambodia’s provincial capitals, previous studies have not examined constrained geographical access to diabetes health services as a risk factor for T2DM. This research examined physical distance from diabetes health services as a T2DM risk factor. It investigated the differences in the prevalence of T2DM in nine communes geographically situated at various distances from the province-level diabetes health services in Siem Reap province. The study employed a quantitative research methodology, through secondary data analysis of previously collected diabetes screening data, gathered by the Cambodian Diabetes Association in 2010. It analysed de-identified data from 399 voluntary diabetes screening study participants aged 26 years and older, including anthropometric measures of body mass index, weight, height, waist circumference and hip circumference as well as blood glucose and blood pressure measurements. Study results showed that although each commune had a different prevalence of T2DM, the total prevalence was 20.3% (81/399) 95%CI 16.7-24.5. Newly diagnosed T2DM cases were nearly double those who had been previously diagnosed, 13.3% (53/399) (95%CI: 10.3-17.0) and 7.0% (28/399) (95%CI: 4.9-10.0), respectively. This study found that distance to the Siem Reap provincial capital was a significant predictor for T2DM (p-value = .006). Age and hypertension were also identified as T2DM risk factors of T2DM (p-value = .005 and p-value = .028, respectively). In conclusion, this study found increasing age, distance from diabetes health services in Siem Reap provincial capital, and hypertension were risk factors of T2DM. These findings suggest that the distance between the place of residence and province-level diabetes health services may be a risk factor for T2DM. As diabetes healthcare providers are limited in Cambodia’s rural areas, these research findings have the potential to inform future planning to improve diabetes control and prevention by enhancing geographical access to diabetes health services.