http://www.aurora.edu/documents/wellness/toolbox/assessment.pdf
PSQI: http://www.opapc.com/uploads/documents/PSQI.pdf
** Citation: Buysse,D.J., Reynolds,C.F., Monk,T.H., Berman,S.R., & Kupfer,D.J. (1989). The Pittsburgh Sleep
Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research, 28(2), 193-213.
Berlin: http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf
MSQ: *need patient’s family members - http://www.mayoclinic.org/documents/msq-
copyrightfinal-pdf/doc-20079462
*** Please decide on one, (from what I have found out, PSQI is more commonly used compared
to the others)
Sociodemographics
1. Age + Gender vs DM
Age Gender Type 2 Diabetes Mellitus Total
Group
No Yes
< 30 M 15 0 25
F 10 0
30 - 39 M 3 5 17
F 7 2
40 - 49 M 9 3 30
F 11 7
50 - 59 M 11 16 65
F 14 24
60 - 69 M 16 19 60
F 11 14
70 - 79 M 7 12 40
F 6 15
≥ 80 M 1 3 10
F 2 4
A study by Veghari stated that there was a positive and significant correlation between age and
blood glucose.1
GENDER
The current study shows no statistical difference in prevalence of type 2 diabetes between
male and female subjects. A study by Gale et.al in 2001 on the European population
correlates with these results.[1] However two other studies on this topic contradict these
results. A study carried out on the Indonesian population showed higher prevalence in
females compared to males.[2] Another study involving the Chinese and Japanese
population found higher prevalence in males rather than females. The variability of these
results could be due to the difference on dietary habits in these populations.
1. Gale, E.A, Gillespie, K.M. Diabetes and gender. Diabetologia. 2001;44(1): 3 - 15.
2. Mihardja, L, Soetrisno, U., et. al Prevalence and clinical profile of diabetes mellitus in
productive aged urban Indonesians. Journal of Diabetic Investigation. 2014;5(5): 507 - 512.
3. Yang, W.Y., Lu, J.M., et. al Prevalence of Diabetes among Men and Women in China.
The New England Journal of Medicine. 2010;1(362): 1090-1101.
2. Ethnic + FHDM vs DM
No Yes
Without FHDM 16 5
Chinese With FHDM 24 32 98
Without FHDM 26 16
Without FHDM 19 13
Without FHDM 1 1
1. Venkataraman, K, Kao, S.L, Thai , A.C, Salim, A, Lee, J.J.M. Ethnicity modifies the
relation between fasting plasma glucose and HbA1c in Indians, Malays and Chinese.
Diabetic Medicine. 2012;29(7): 911-917.
2. Teh, J.K.L, Tey, N.P, Ng, S.T. Ethnic and Gender Differentials in Non-Communicable
Diseases and Self-Rated Health in Malaysia. Public Library of Science. 2014;9(3).
Overall, our results showed that family history of diabetes mellitus are associated with a
higher incidence of diabetes mellitus(OR = 2.59; 95% CI = 1.53 - 4.38). The result
corresponds with the study conducted by RA Scott et. al. which showed higher incidence of
type 2 diabetes mellitus among individuals with a family history of diabetes mellitus and
that family history is a strong independent risk factor for type 2 diabetes mellitus. Annis
AM et. al. also showed that prevalence of diabetes is more than 4 times higher among
individuals with a family history . In addition, both prevalence and odds ratio significantly
increased with the no. of relatives affected with diabetes.
Overall, our results showed that family history of diabetes mellitus are associated with a
higher incidence of diabetes mellitus(OR = 2.59; 95% CI = 1.53 - 4.38). The result
corresponds with the studies conducted by RA Scott et al. and Annis AM et. al. which
showed higher incidence of type 2 diabetes mellitus among individuals with a family history
of diabetes mellitus.
1. Annis AM, Caulder MS, Cook ML, et. al. Family history, diabetes, and other
demographic and risk factors among participants of the National Health and
Nutrition Examination Survey 1999-2002. Prev Chronic Dis[serial online]. 2005
April[cited 7 July 15]. Available from:
http://www.cdc.gov/pcd/issues/2005/apr/04_0131.htm
2. Scott RA, Langenberg, Sharp SJ, et. al. The link between family history and risk of
type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors:
the EPIC-InterAct Study. Diabetologia. 2013 Jan[cited 7 July 15]; 56(1): 60-69.
Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038917/
Education vs DM
No education 4 11 15
Primary 18 36 54
Secondary 67 63 130
Tertiary 34 14 48
No Yes
DISCUSSION(LITERATURE VIEW)-vino:
Our study shows that the level of education is inversely related to the percentage of diabetic
patients.There was a higher prevalence of diabetics among the illiterate. A study by Sacerdote
and et al. that compared participants with high educational level against participants with a low
educational level of which the latter had a higher risk of T2DM.1 Added to that, the study by
Veghari and et al. showed that there was an association between illiteracy and DM. Lower level
people will lack the knowledge about self care for the prevention or treatment of DM and other
diseases.2
between socio-demographic factors and diabetes mellitus in the north of Iran: A population-
based study. International Journal of Diabetes Mellitus 2010; 2(3): .
Lower educational level is a predictor of incident type 2 diabetes in European countries: the
4. Income vs DM
Reliability Statistics
.741 14
5. DM vs Sleep Quality
Poor Good
Diabetic 95 29 124
According to our results, we discovered that poor sleep quality was associated with an
increased prevalence of Type 2 Diabetes Mellitus in the Seremban population who went to
Seremban Health Clinic and Seremban 2 Health Clinic. Subjects with a global PSQI score
of 5 demonstrated a higher association of Type 2 Diabetes Mellitus (OR 1.76, CI 95%)
compared to those with a global PSQI score of < 5.
A cross-sectional study conducted by Lou P et al. in 2008 among the Chinese population
aged 18-75, independently of potential confounders such as age, obesity, family history of
diabetes, alcohol consumption, smoking, physical activities and other health conditions
supports our result.Both poor quality of sleep and short sleep
[1] A cohort study conducted by Hayashimo et al from 1999 until 2004 which uses data
from participants in a High-risk and Population Strategy for Occupational Health
Promotion Study (HIPOP-OHP) concluded that medium and high frequencies of difficulty
initiating sleep but not sleep duration are associated with higher prevalence of diabetes. [2]
This correlates with our findings as well given that PSQI assesses each individuals sleep
latency as part of the component score which contributes to the global PSQI score.
1. Lou P, Chen P, Zhang L, et al. Relation of sleep quality and sleep duration to type 2
diabetes: a population-based cross-sectional survey. BMJ Open 2012;2:e000956.
doi:10.1136/bmjopen-2012-000956
2. Hayashino et al.. Relation between Sleep Quality and Quantity, Quality of Life, and Risk of
Developing Diabetes in Healthy Workers in Japna: the High-risk and Population Strategy
for Occupational Health Promotion (HIPOP-OHP) Study. BMC Public Health 2007; 7(129).
Shim U, Lee H, Oh J, Sung Y. Sleep Disorder and Cardiovascular Risk Factors among
Patients with Type 2 Diabetes Mellitus. The Korean Journal of Internal Medicine.
2011;26(3):277.
69% of patients had a global PSQI score ≥5, indicating that they were "poor
sleepers." (mean, 7.08; standard deviation, 3.89)The global PSQI score positively
correlated with the duration of diabetes and was also independent of other
variables such as age, gender, body mass index, HbA1c, or medications.
0 1
<1 25 0 25
1-5 10 7 17
6 - 10 20 10 30
11 - 15 25 40 65
16 - 20 27 33 60
> 20 13 27 40
6. DM vs HPT
No Yes
Diabetic 31 93 124
In our study, our results show that hypertensive subjects are 5.2 times more likely to
develop T2DM than non-hypertensive subjects.
1. Summary: In an observational studies from 36 countries around the world, Colosia A.D et al. showed
that hypertension is prevalent in 50% of diabetic subjects worldwide.
Citation: Colosia A, Khan S, Palencia R. Prevalence of hypertension and obesity in patients with type 2
diabetes mellitus in observational studies: a systematic literature review. Diabetes, Metabolic Syndrome
and Obesity: Targets and Therapy. 2013;:327.
2. Summary: In a cohort study done by Abougalambou et al. on a total of 1077 T2DM patients who
attended diabetes clinic of Universiti Sains Malaysia (USM) teaching hospital in Kelantan, the prevalence
of hypertension (BP > 130/80 or on medication for high blood pressure) was 92.7%.
Citation: Abougalambou S, Abougalambou A. A study evaluating prevalence of hypertension and risk
factors affecting on blood pressure control among type 2 diabetes patients attending teaching hospital
in Malaysia. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2013;7(2):83-86.
3. Summary: In a cross sectional study done on urban Indonesians, Mihardja et al. concluded
that hypertensive patients have 2.2‐fold (95% CI 2.0–2.4) increased risk of hyperglycemia
compared with non-hypertensive patients.
Citation: Mihardja L, Soetrisno U, Soegondo S. Prevalence and clinical profile of diabetes mellitus in
productive aged urban Indonesians. Journal of Diabetes Investigation. 2013;5(5):507-512.
7. DM vs Smoking
Diabetic 97 10 17 124
DISCUSSION(LITERATURE VIEW)-ernest: The results show that there are more non-diabetic
patients associated with smoking than diabetic patients. Among the non-smoking subjects, diabetic
patients are equal to the number of non-diabetic patients. Current smokers are mostly non-
diabetic, while lesser diabetic patients as current smokers. The p-value calculated is 0.004 (<0.05),
and therefore is significant and we reject the null hypothesis.
The overall results is in contrast to the journal by Toshimi Sairenchi et al. (1) who concluded that
smoking was independently associated with increased risk of T2DM among elderly women and men
& middle-aged men and women. Julie C Will (2) also shows the positive correlation between
diabetes and smokers. Our study however failed to show the dose-response relation between
number of cigarettes smoked per day and the risk of diabetes. Besides that, our studies have also
failed to show the duration of previous exposure of smoking duration.
1. Toshimi Sairenchi, Hiroyasu Iso, Akio Nishimura, Takako Hosoda, Fujiko Irie, Yoko Saito,
Atsushi Murakami and Hisayuki Fukutomi. Cigarette Smoking and Risk of Type 2 Diabetes
Mellitus among Middle-aged and Elderly Japanese Men and Women.American Journal of
Epidemiology 2004; Volume 160(Issue 2): . http://aje.oxfordjournals.org/content/160/2/158.long
(accessed 7th July 2015).
2. Julie C Will, Division of Nutrition and Physical Activity, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770
Buford Highway NE, Mailstop K-26, Atlanta, GA 30341–3724, USA.. Cigarette smoking and
diabetes mellitus: evidence of a positive association from a large prospective cohort
study..International Journal of Epidemiology September 5, 2000; Volume 30 (Issue 3): .
http://ije.oxfordjournals.org/content/30/3/540.full (accessed 7th July 2015).
Factors Sleep Quality Total
Poor Good
Diabetic 95 29 124
Diabetic + Hypertensive 69 24 93
(stephen)
Diabetic + Smoker(ernest) 9 1 10
Our study shows that 74.2% of subjects with both T2DM and hypertension have poorer sleep quality,
which was evaluated using PSQI. This result is similar as in previous cohort study done by Fiorentini et al.
which concluded a high prevalence of sleep quality disorders in subjects with hypertension and T2DM.
Additionally, the study also suggests poor sleep quality as a significant cause for both hypertension and
T2DM.
Citation: Fiorentini A, Valente R, Perciaccante A, Tubani L. Sleep's quality disorders in patients with
hypertension and type 2 diabetes mellitus. International Journal of Cardiology. 2007; 114(2):E50-E52.
No Yes
0 50 26 76
1 19 13 32
2 19 20 39
3 35 65 100
No Yes
0 34 22 56
1 22 13 35
2 26 19 45
3 41 79 111
Our analysis indicates that frequent night bathroom visits are almost twice more prevalent
in DM patients compared to non-DM patients (71.2% vs 36.9%; p-value = 0.004) due to
nocturia. Nocturia in DM patients can occur in association with polyuria, and the
mechanism is solute diuresis leading to increased urine production. Similar results were
seen in previous study conducted in Australia in 2000 with 74 T2DM patients.
DM Total
0 1
Income 0 75 87 162
1 17 17 34
2 11 10 21
3 7 3 10
4 7 3 10
5 6 4 10
ExerciseGrp * DM Crosstabulation
Count
DM Total
0 1
ExerciseGrp 0 81 91 172
1 42 33 75