Discussion
This study identified community based behaviors and assessed the association between T2DM in the
Jordan. Our results revealed that an increased prevalence of T2DM was linked to bad behavior that’s
more prevelant in low income rural area. The findings show significant increases of complication
among patients has past history of; (1) high fat and low fibers diet (2) short sleep duration( SDS) (3)
high level of stress and (4) low monthly income. The results also mention the earlier incidence of T2DM
with that behavior. Our hypothesis states; Is the community based behaviors associated with T2DM
development and complications; Our findings indicate a significant association (Crude: 5.13 CI 2.69–
10.1; Model 1: aOR 5.18 CI 2.76–9.70, Model 2: aOR 5.35 CI 2.36–12.1, Model 3: aOR 5.61 CI 2.29–
13.7).
Interpretation
DM & diet and physical activity
DM & Socioeconomic Status:
DM & educational level
The role of dietary fat in T2DM is still being studied, and the evidence is not entirely conclusive. Some
studies have suggested a positive association between a higher intake of saturated fats, typically
found in animal products and certain tropical oils, and an increased risk of T2DM.[ 1] It is worth noting
that the impact of visible fat intake on T2DM risk should be considered within the context of overall
diet quality. The consumption of visible fat alone may not fully explain the association with T2DM. Diets
high in processed foods, sugary beverages, and unhealthy fats are consistently associated with an
increased risk of T2DM, while diets rich in whole foods, fruits, vegetables, lean proteins, and healthy
fats have been shown to lower the risk.[2]
Strengths and limitations:
There are many factors that affect the management of T2DM, we found that there is a significant
difference between well managed T2DM patients i.e less pharmacological interventions, less
comorbidities and hospitalization in higher educated patients and those who have better socio-
economical status and healthier daily habits [6]. Where as patients with political instability or
rural areas having less manageable T2DM and unhealthy behaviors [9] or having inappropriate eating
habits [10]. Dietary habits and the amount of fatty content, salt or carbohydrate non-ketogenic foods
showed worsening in the management of T2DM [1,2]. Chronic stress, depression and traumatic
experiences are found to increase the propensity of getting T2DM. [3,4] lower income and bad socio-
economical status exposed people to DM [5]. Sleep habits, sleep disorders or excessive sleepiness
directly affected T2DM [7].
This study may be limited by non-avoidable confounders like anti-Hyperglycemic drugs and their side
effects throughout the period of study, and not specifying the differences between exercises and their
impact on alleviating the condition[8] in addition to the sample size which could be enlarged and the
fact that we are medical students with limited time and resources, no funding no acquired a research
experience or even assistance .
Implications for future policy, or practice.
Our results show the need to implicate public health strategies to reduce the burden of T2DM, First, the
healthcare system showed educate the patients about the association between community based
behaviors and T2DM development and complications. Second , there is a need to address multifaced
interventions to general population that change the behavior and the outlook on daily behaviors and
lifestyles. Third, the next health educational program would focus more on the association between
community based behaviors and T2DM development and complications; this will raise the level of
awareness among people to change their behaviors.
These findings are consistent with previous studies reported that T2DM is more frequently diagnosed in
men.30 Regarding the risk factors of diabetes,
the case group had a higher proportion of family history of diabetes (36.7%) and elevated blood
pressure (77%)
(Table 3). A family history of diabetes and hypertension has long been recognized as a potent risk
factor for the
development of T2DM.31,32 In terms of alcohol consumption, the case group participants reported a
lower percentage of
alcohol drinking which might be the result of the active promotion of education related to health risk
factors among
diabetes patients.
1. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in
diet and lifestyle and long-term weight gain in women and men. N Engl
J Med. 2011;364(25):2392–2404. doi:10.1056/NEJMoa1014296
2. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and
management of type 2 diabetes: dietary components and nutritional
strategies. Lancet.2014;383(9933):1999–2007. doi:10.1016/s0140-
6736(14)60613-9
Majoodi
1. Kalandarova M, Ahmad I, Aung TNN, Moolphate S, Shirayama Y, Okamoto
M, Aung MN, Yuasa M. Association Between Dietary Habits and Type 2
Diabetes Mellitus in Thai Adults: A Case-Control Study. Diabetes Metab Syndr
Obes. 2024 Mar 6;17:1143-1155. doi: 10.2147/DMSO.S445015. PMID:
38465346; PMCID: PMC10924810.
2. Heidarzadeh-Esfahani N, Darbandi M, Khamoushi F, Najafi F, Soleimani D,
Moradi M, Shakiba E, Pasdar Y. Association of plant-based dietary patterns
with the risk of type 2 diabetes mellitus using cross-sectional results from
RaNCD cohort. Sci Rep. 2024 Feb 15;14(1):3814. doi: 10.1038/s41598-024-
52946-z. PMID: 38360842; PMCID: PMC10869829.
3. Saya A, Proietti L, Lisi G, Ribolsi M, Uccioli L, Niolu C, Siracusano A.
Traumatic experiences and type 2 diabetes mellitus. Riv Psichiatr. 2020 Nov-
Dec;55(6):349-354. doi: 10.1708/3503.34893. PMID: 33349728.
4. Golden SH. A review of the evidence for a neuroendocrine link between
stress, depression and diabetes mellitus. Curr Diabetes Rev. 2007
Nov;3(4):252-9. doi: 10.2174/157339907782330021. PMID: 18220683.
5. Suwannaphant K, Laohasiriwong W, Puttanapong N, Saengsuwan J, Phajan
T. Association between Socioeconomic Status and Diabetes Mellitus: The
National Socioeconomics Survey, 2010 and 2012. J Clin Diagn Res. 2017
Jul;11(7):LC18-LC22. doi: 10.7860/JCDR/2017/28221.10286. Epub 2017 Jul 1.
PMID: 28892937; PMCID: PMC5583803.
6. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker
EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in
the incidence of type 2 diabetes with lifestyle intervention or metformin. N
Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512. PMID:
11832527; PMCID: PMC1370926.
7. Muraki I, Wada H, Tanigawa T. Sleep apnea and type 2 diabetes. J Diabetes
Investig. 2018 Sep;9(5):991-997. doi: 10.1111/jdi.12823. Epub 2018 Apr 14.
PMID: 29453905; PMCID: PMC6123041.
8. Grace A, Chan E, Giallauria F, Graham PL, Smart NA. Clinical outcomes
and glycaemic responses to different aerobic exercise training intensities in
type II diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol.
2017 Mar 14;16(1):37. doi: 10.1186/s12933-017-0518-6. PMID: 28292300;
PMCID: PMC5351065.
9. Ueno S, Aung MN, Yuasa M, Ishtiaq A, Khin ET, Latt TS, Moolphate S, Sato
S, Tanigawa T. Association between Dietary Habits and Type 2 Diabetes
Mellitus in Yangon, Myanmar: A Case-Control Study. Int J Environ Res Public
Health. 2021 Oct 21;18(21):11056. doi: 10.3390/ijerph182111056. PMID:
34769575; PMCID: PMC8582904.
10 Mannucci E, Tesi F, Ricca V, Pierazzuoli E, Barciulli E, Moretti S, Di
Bernardo M, Travaglini R, Carrara S, Zucchi T, Placidi GF, Rotella CM. Eating
behavior in obese patients with and without type 2 diabetes mellitus. Int J
Obes Relat Metab Disord. 2002 Jun;26(6):848-53. doi: 10.1038/[Link].0801976.
PMID: 12037656.