A Community-based Picture of Type 2 Diabetes Mellitus in Vietnam

Okara Improved Blood Glucose Level in Vietnamese with Type 2 Diabetes Mellitus

Diabetes mellitus (DM) has been increasing rapidly in Vietnam. We hypothesized that the main reason may be low fiber intake. Regarding sources, fiber comes mainly from vegetables. However, vegetables popular in Vietnam have low fiber (<2 g fiber/100 g vegetable), so it is difficult to supply sufficient fiber only from vegetables. Therefore, in this study we tried to increase fiber intake a day by using 60 g of Okara foods, containing about 6 g of fiber per day, and assess the effects on the blood glucose levels of DM patients. We contacted 300 type 2 DM outpatients at a hospital and selected 60 of them. We formed 30 pairs matched by gender, age, BMI and years with DM and divided them randomly into an intervention group and a control group. The intervention group consumed about 6 g of fiber from Okara per day for 2 wk. At the baseline and final periods, anthropometric measurements, blood withdrawal and a 3-d weighing method nutrition survey were conducted. Dietary fiber intake increased from 6.9 to 12.6 g (p<0.01) in the intervention group, but there was no change in the control group. Fasting blood glucose and fructosamine in the intervention group dropped from 6.3 to 5.4 mmol/L (p<0.05) and from 319 to 301 μmol/L (p<0.05), respectively but they remained unchanged in the control group. Vietnamese people consumed about 60 g of Okara per day from various menus and increased fiber intake to 6 g/d in 2 wk, which improved blood glucose in DM patients.

Diabetes in Vietnam

BACKGROUND

The prevalence for diabetes, prediabetes, and gestational diabetes in Vietnam are low relative to other parts of the world, but they are increasing at alarming rates. These changes have occurred in the setting of economic and cultural transitions.

OBJECTIVES

The aim of this study was to provide relevant information depicting the diabetes burden in Vietnam.

METHODS

Literature was reviewed using PubMed and local Vietnamese sources, including papers published in the Vietnamese language.

FINDINGS

In 2012, the prevalence of diabetes was 5.4% and prediabetes 13.7%. In 2005, the prevalence of obesity was 1.7%. There is a dual burden of over- and undernutrition observed in Vietnam. Diabetes is associated with an increased waist-to-hip ratio despite normal body mass index. Nutritional transitions occurred with increased protein, fat, and fast foods, and with decreased fresh fruits and vegetables. Tobacco use is very high in Vietnam with 66% of adult men currently smoking. Challenges include endocrinology training, health care coverage, patient education, and lack of coordination among government and specialist agencies.

CONCLUSION

Diabetes is a growing problem in Vietnam and is associated with obesity, changes in dietary patterns, and other cultural transitions. More research is needed to better understand this health care problem and to devise targeted interventions.

Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Vietnam: A Systematic Review

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.

Diabetes care and service access among elderly Vietnamese with type 2 diabetes

BACKGROUND

Vietnamese patients are disproportionately represented in type 2 diabetes mellitus statistics and also incur high rates of diabetes complications. This situation is compounded by limited access to health care. The aim of this project was to gain a deeper understanding of the difficulties Vietnamese patients experience when accessing services and managing their type 2 diabetes mellitus, and to identify factors that are important in promoting health service use.

METHODS

Three focus groups with 15 Vietnamese participants with type 2 diabetes mellitus, 60 to >70 years of age, were conducted in Vietnamese. Open-ended questions were used and focussed on experiences of living with diabetes and access to healthcare services in the Inner Northwest Melbourne region. Audio recordings were transcribed and then translated into English. Data were analysed using a thematic analysis framework.

RESULTS

Findings indicate four main themes, which together provide some insight into the experiences of living with diabetes and accessing ongoing care and support, for elderly Vietnamese with type 2 diabetes. Themes included: (1) the value of being healthy; (2) controlling diabetes; (3) staying healthy; and (4) improving services and information access.

CONCLUSIONS

Participants in this study were encouraged to adhere to diabetes self-management principles, based largely on a fear of medical complications. Important aspects of healthcare access were identified as; being treated with respect, having their questions answered and having access to interpreters and information in Vietnamese. Attention to these details is likely to lead to improved access to healthcare services and ultimately to improve glycemic control and overall health status for this community.

Association of the common FTO-rs9939609 polymorphism with type 2 diabetes, independent of obesity-related traits in a Vietnamese population

Type 2 diabetes (T2D) is a complex disorder resulting from both genetic and environmental factors in its pathogenesis. A case-control study was designed with subjects recruited from a general population to investigate whether the association between T2D and the common T>A polymorphism (rs9939609) in fat mass and obesity associated (FTO) gene is mediated by obesity-related measurements, considering the contribution of socio-economic status and lifestyle factors. The significant association between the FTO rs9939609 polymorphism and T2D was first observed in the model unadjusted (OR per A allele=1.61, 95% CI=1.06-2.44, P=0.024). It remained consistently replicated in the final model after adjustments for sex, age, systolic blood pressure, socio-economic status, lifestyle factors, and obesity-related measurements (body mass index, waist-hip ratio, body fat percentage, and body adiposity index), showing an increased T2D risk with an additive effect of the alleles (ORs per A allele=1.80-1.92, 95% CI=1.09-3.19, P<0.05). The FTO-rs9939609 polymorphism, systolic blood pressure, and waist-hip ratio were the most significant independent predictors for T2D, in which the power of the adjusted prediction model was 0.769. In conclusion, the study suggested that the FTO-rs9939609 polymorphism was significantly associated with the increased risk of T2D, independent of obesity-related measurements in a Vietnamese population.

Characteristics of metabolic syndrome and its clinical components among diabetic Vietnamese patients: A survry at two institutions in Ho Chi Minh City

SUMMARY

OBJECTIVE

The purpose of this study was to estimate the prevalence of metabolic syndrome among Vietnamese diabetic patients and to investigate their characteristics.

METHODS

This cross-sectional study was conducted among 652 outpatients who were recruited from one public general hospital (People Hospital 115) and one private clinic (Medic Center) in Ho Chi Minh City, Vietnam. We obtained informed consent from participants, collected clinical information from medical files, and conducted patient interviews. We evaluated the collected information descriptively and diagnosed metabolic syndrome according to the International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome.

RESULTS

A total of 517 eligible patients (175 men and 342 women) were analyzed. Mean age was 54.6 years for men and 60.7 years for women. Metabolic syndrome was observed in 39.4% of men and 70.5% of women. Central obesity was more prevalent among women (72.5%) compared to men (39.4%). Participants with metabolic syndrome were less likely to endorse a sense of general well-being, and women with metabolic syndrome were likely to have less diabetes-related distress.

CONCLUSIONS

this study revealed a high prevalence of metabolic syndrome in diabetic Vietnamese patients, especially among women, and revealed central obesity as a key feature. A prospective study should be conducted in this population in order to assess impacts of metabolic syndrome on disease outcome.

Effect of Vietnamese common diet on postprandial blood glucose level in adult females

To elucidate the effect of a typical Vietnamese diet including a high content of white rice on postprandial blood glucose levels, the present study was designed. Thirty healthy female subjects with a similar body mass index, 10 each in their twenties, forties and sixties, were recruited. Four meals with a similar protein energy percentage (13-15%) but different energy ratios of fat and carbohydrate (FC ratio) and vegetable contents were provided by cross-over design. Meal A was designed according to the commonly consumed diet in Vietnam. The FC ratio was 14:71 and 84 g of carbohydrate was from rice. Meal B contained carbohydrate in a lower ratio than meal A by fat replacement and its FC ratio was 30:57. Meal C was similar to meal A except lacking vegetables. The energy of meal A, B and C was about 2.1 MJ. Meal D was designed to match the amount of carbohydrate and fat within A and B, respectively. The FC ratio of meal D was 26:61 and the energy was about 2.4 MJ. Fasting blood glucose was measured before consumption of a test meal. Postprandial blood glucose was measured every 30 min for 2 h. Areas under the curve (AUC) were calculated to compare the glycemic response among the four test meals. There was no significant difference in AUC among the four test meals in the subjects in their twenties. In the subjects in their forties, the AUC of meal A tended to be lower than that of meal C (p = 0.07). In the subjects in their sixties, the AUC of meal A was significantly higher than that of meal B (p < 0.001). Glycemic responses showed a significant relationship with age (r = 0.26, p < 0.01); however, there was no association between glycemic responses and BMI (p = 0.20). Dietary fat ratios were inversely associated with glycemic responses (r = -0.28, p < 0.01). In conclusion, the diet with about 70% energy from carbohydrate which is commonly consumed by Vietnamese may increase glycemic response, especially in elderly people and dietary vegetables may be beneficial to prevent such an increase in glycemic response.