Prevalence of Type 2 Diabetes among Patients Visiting Nepal Police Hospital in Kathmandu: A Descriptive Cross-sectional Study

ABSTRACT Introduction: The growing prevalence of diabetes mellitus (DM) is a critical threat for global health, including in Nepal, especially in Kathmandu District, where diabetic patients are increasing in hospitals catastrophically. This study tends to assess the prevalence rate of type 2 diabetes among admitted patients visiting a hospital in Kathmandu. Methods: An electronic chart review was done to assess the prevalence of type 2 diabetes in Nepal Police hospital, Kathmandu, Nepal. Ethical approval was taken from the Nepal Health Research Council. Considering eligibility criteria, 8631 cases from 4 May 2018 to 31 August 2020 were observed. The calculated sample size was 500. However, all diabetic cases, i.e., 576, were processed and analyzed using Python and later visualized using MS Excel. Results: The overall prevalence rate of type 2 diabetes was 6.67%. The prevalence rate was seen higher among males (7.5%). Similarly, a high prevalence rate was seen among 64-73 years, i.e., 15.10%. Conclusions: The findings showed a high prevalence rate of type 2 diabetes. Older age groups are at high risk. Urgent public health interventions including lifestyle modification measures are required to reduce the extra burden of type 2 diabetes.


INTRODUCTION
The burden of diabetes continues to pose a significant problem in both low and high-income countries. In 2019, the global prevalence of diabetes was projected at 9.3 percent (463 million people), increasing to 10.2 percent (578 million) by 2030 and 10.9 percent (700 million) by 2045. 1 It is estimated that the biggest rise would take place in regions where economies are transiting from low-to middle-income status. Of the two types of diabetes, type 2 accounts for nearly 90% -95% of all diagnosed diabetes cases. 2 Nepal is undergoing an epidemiological transition phase experiencing a double burden, from a higher prevalence of communicable diseases to noncommunicable diseases. 3  Taking high non-response rate, i.e., 30%, the total sample size was 500.
Exclusion criteria: ICU admitted cases, pediatric population, missing values of data; redundant data, diabetic associated with other endocrinal pathology were excluded.

Data Pre-Processing:
The initial cluttered data was cleaned with the process of data mining techniques as follows: 1. Removal of unwanted observations, which included, falls under exclusion criteria.
2. Handling the inconsistent data by converting them into a common format or consistent format by using python script. The ages that had other characters rather than numbers were removed using regular expressions from the python script.

Data Analysis and Visualization:
1. The cleaned data were then grouped under the features of age and gender.
2. The ratio of the overall Diabetes Mellitus (Type 2 Diabetes) observations to the overall observations of the clinical records was calculated. The prevalence of the overall observations was the percentage of the ratio calculated. 3. The same analysis was done based on age groups and genders whose outcomes were individual prevalence of the age groups and the genders. 4. The above was visualized in a bar graph and a line graph using MS Excel.

RESULTS
The total prevalence rate of type 2 diabetes in Nepal Police Hospital was 576 (6.67%).

Figure 1. Prevalence Rate based on gender
The highest prevalence rate was seen among 64-73 years, i.e., 15.10%. The finding of this study were consistent to studies conducted by Baral (5.29%), 5 Dhimal (8.5%), 6 Ono K (9.5%). 7 In contrast the prevalence was lower than previous studies from Nepal; Mehta (10.9%) 8 , Bishal (11.7%), 9 Shrestha (19%), 10 Singh (14.7%), 11 Dhungana(10.5%). 12 Likewise, the prevalence for diabetes was higher than in the earlier nationwide STEPS survey, which was 3.6%. 13 The pooled prevalence from a systematic review study of Nepal showed a higher prevalence of diabetes (8.5%) but low awareness (52.7%) among diabetes patients. 14 A meta-analysis done by Gyawali  Age is one of the most prominent risk factors for type 2 diabetes, and the disease prevalence in older groups is quite high. 15 There is the highest risk of developing type 2 diabetes in middle-aged and older adults. A study reported the age-wise prevalence of diabetes in the Asian population. Among Chinese and Japanese subjects, the prevalence of diabetes grew with age and peaked at 70-89 years of age, but among Indian subjects peaked at 60-69 years of age, followed by a decline at 70 years of age. 16 This is similar to our study that showed a peak point at 64-73 years of age.
It has been found that cases of diabetes are increasingly registered in hospitals of Nepal. In 2010, diabetes accounted for almost 10 percent of admissions to the medical ward at TU Teaching Hospital, Kathmandu, which is higher than our study. 17

CONCLUSIONS
The study revealed a high prevalence rate of type 2 diabetes among admitted patients of Nepal Police hospital. The result also showed a higher prevalence among the older age group and male gender. Since if diagnosed and treated early, diabetes mellitus is a preventable condition. Therefore, routine screening shall be implemented to reduce the national burden and further improve the quality of life.