Effects of Physical Activity, Obesity and Smoking Habits on the Risk

of Type 2 Diabetes Mellitus

Fauzie Rahman

, Dian Rosadi

, Mulyadi

, Andini Octaviana Putri

Department Of Health Policy and Management, Lambung Mangkurat University, Banjarmasin, Indonesia

Department of Epidemiology Departement, Lambung Mangkurat University, Banjarmasin, Indonesia

Student in Health Policy Management, Lambung Mangkurat University, Banjarmasin, Indonesia

Department Of Maternal and Child Health, Lambung Mangkurat University,Banjarmasin, Indonesia

Keywords: Physical Activity, Obesity, Smoking, Type 2 DM

Abstract: Diabetes mellitus (DM) characterized by the occurrence of hyperglycemia and metabolism disorders

associated with deficiencies of insulin secretion. Based on Health Research (Riskesdas) 2013, the number of

DM cases in Banjar District was the highest in South Kalimantan. This study aims to analyze the correlation

of physical activity, obesity and smoking habits with type 2 DM incidence in the work area of Martapura

Public Health Center. This research is a quantitative research using a case-control design. The population is

people who are treated at Martapura Public Health Center from September until December 2017. The sample,

as many as 150 samples with 75 types 2 DM cases and 75 control subjects were included in this research. The

sample was taken by purposive sampling technique. Data were analyzed by univariate with frequency

distribution table and bivariate analysis by chi-square test. Incidence of Type 2 DM occurs in less physical

activity (64%), obesity (56%) and smoking habits (33,3%). Chi-Square test showed there was correlation

between physical activity (p=0,009;OR=2,523) obesity (p=0,003; OR=2,877) and smoking status (p=0,039;

OR=2,385) with type 2 DM incident. It is advisable to community and health workers from applying a healthy

life behaviour to prevent the incidence of type 2 DM

1 INTRODUCTION

Diabetes mellitus (DM) is a disease characterized by

the occurrence of hyperglycemia and metabolic

disorders that are associated with a lack of insulin

work and secretion [World Health Organization,

2015]. The global prevalence of DM in the

community (aged 20-79 years) in 2014 as many as

387 million people (8.3%) with cases of type 2 DM

were the most common cases (70%) [International

Diabetes Foundation, 2015]. Based on IDF data in

2014, Indonesia ranked fifth of DM patients in the

world, with an estimated 9 million people with a

prevalence of 1.1%. According to the results of the

Basic Health Research (Riskesdas) 2013, the

prevalence of DM in Indonesia was 2.1%. This

prevalence is higher than the prevalence in 2007,

which was 1.1% [Ministry of Health of Republic,

Indonesia, 2013].

Banjar District is one of the districts in South

Kalimantan. Based on the data from Riskesdas (2013)

the number of cases of DM in Banjar District was the

highest in South Kalimantan (3.8%) and above the

national prevalence (2.1%) [4]. Based on data from

the Banjar District Health Office in 2016 the highest

health centre with DM cases was Martapura health

centre, which was 1114 cases with the highest cases

in type 2 DM (566 cases). Monthly morbidity data at

Martapura

Public Health Center, Banjar Regency, showed that

cases of type 2 DM still high in the last three months

as many as 39 cases in October, 43 cases in November

and 34 cases in December 2016.

Sukmaningsih WR (2016) study found

OR=7.737 which means that someone who has low

physical activity has a risk of 8 times more likely to

experience the incidence of type 2 DM. In addition,

there is a relationship between obesity and the

incidence of type 2 diabetes mellitus (p = 0,000) then

there is a significant relationship between obesity and

the incidence of type 2 DM. Smoking habits can also

trigger the occurrence of type 2 DM. Sukmaningsih

WR (2016) states that someone who smokes has a risk

332

Rahman, F., Rosadi, D., Mulyadi, . and Octaviana Putri, A.

Effects of Physical Activity, Obesity and Smoking Habits on the Risk of Type 2 Diabetes Mellitus.

DOI: 10.5220/0010676200002967

In Proceedings of the 4th International Conference of Vocational Higher Education (ICVHE 2019) - Empowering Human Capital Towards Sustainable 4.0 Industry, pages 332-335

ISBN: 978-989-758-530-2; ISSN: 2184-9870

of 2,538 times more likely to experience the incidence

of type 2 DM.

Based on the above problems, a study was

conducted to explain the risk factors for the incidence

of type 2 DM in the work area of Martapura Public

Health Center, Banjar District

2 METHODS

This study used an observational analytic design with

a case-control design that aimed to analyze the

relationship between physical activity, obesity and

smoking habits with the incidence of type 2 DM in

the work area of Martapura Public Health Center. The

study population was all resident who seeks treatment

Martapura Public Health Centres many as 82,194

people in 2016. The number of samples was 150 with

75 cases samples (type 2 DM patients) and 75 control

samples (not type 2 DM patients). Determination of

samples using a purposive sampling technique. The

instrument used in this study was a questionnaire. The

independent variables in this study were physical

activity, obesity, and smoking habits, while the

dependent variable was the incidence of type 2 DM.

Data were extracted from the questionnaire into

Microsoft Excel and to SPSS 21.0 for analysis. Data

were analyzed using univariate frequency distribution

tables and bivariate analysis using the chi-square test.

3 RESULTS

3.1 Univariate Analysis

Based on the results of the study, the frequency

distribution of the research variables can be seen in

Table 1 below:

Table 1: Frequency Distribution of Research Variables.

Variable

Type 2 DM Incident

Case Control

n % n%

Physical

Activit

Less

Goo

64,0

36,0

41,3

58,7

Obesit

Obesity

Not Obesit

56,0

44,0

30,7

69,3

Smokin

Habits

Smoke

25 33,3 13 17,3

Non Smoke

50 66,7 62 82,7

Based on table 1, it is known that the majority

of respondents have a less physical activity that is

equal to 79 people (52.7%) compared to respondents

with good physical activity, which is equal to 71

people (47.3%). Physical activity will cause

metabolic changes that are also influenced by

duration, the weight of exercise and fitness level.

Proper physical activity can provide freshness of the

body, more controlled blood glucose, reduce the need

for drugs or insulin and can prevent type 2 DM

[Sugiyanto Z, 2014].

Based on table 1, it is known that 65 respondents

(43.3%) were obese, and 85 respondents (56.7%)

were not obese. Obesity is a direct factor that can

affect the incidence of type 2 diabetes, obese people

have excessive fat distribution in the body, especially

the abdomen is more likely to develop type 2 diabetes

[Trisnawati et all, 2013].

Table 1 shows that 65 respondents (43.3%) were

smokers and 85 respondents (56.7%) were non-

smokers. The biological habit of smoking can

increase free radicals in the body which causes

damage to endothelial cell function and damage beta

cells in the pancreas. It is known that the hormone

insulin is produced by beta cells in the pancreas, if

there is damage to the pancreas, it will affect the

production of insulin which will inhibit the entry of

glucose into the cell and eventually will increase

glucose levels in the blood and cause the incidence of

type 2 DM [Adiningsih et all, 2014].

3.2 Bivariate Analysis

Bivariate analysis was done to see the correlation of

each independent variable with dependent. The

results of the bivariate analysis can be seen in Table

2 below.

Table 2: Correlation between Independent Variables With

The Incidence Of Type 2 DM.

Varia

ble

Type 2 DM

Incident

val

Case Control

n % n % (95% Cl)

Physi

cal

Activi

Less

Good

64,

36,

41,

58,

0,0

(1,306 –

4,874)

Obesity

Effects of Physical Activity, Obesity and Smoking Habits on the Risk of Type 2 Diabetes Mellitus

333

Varia

ble

Type 2 DM

Incident

val

Case Control

n % n % (95% Cl)

Obesit

Non

Obesit

56,

44,

30,

69,

0,0

(1,473 –

5,623)

Smoking Habits

Smok

33,

17,

0,0

2,385

Non

Smok

66,

82,

(1,108 –

5,134)

Based on table 2, it is known that there is a

relationship between physical activity and the

incidence of type 2 DM (p = 0.009; OR = 2.523).

Respondents with less physical activity were 2.523

times more likely for developing type 2 diabetes

compared to people with good physical activity.

Obesity is also a risk factor for the incidence of type

2 diabetes mellitus. Based on table 2, it is known that

there is a relationship between smoking status and the

incidence of type 2 DM (p=0.039; OR=2.338).

Respondents who were smokers were 2,385 times

more likely to develop type 2 diabetes compared to

non-smokers.

Another factor that has a relationship with the

incidence of type 2 diabetes is the smoking status of

the respondents. The results showed that there was a

relationship between smoking status and the

incidence of type 2 DM (p=0.039; OR=2.338).

Respondents who were smokers were 2,385 times

more likely to develop type 2 diabetes compared to

non-smokers

4 DISCUSSION

Type 2 DM is a hyperglycemic disease due to cell

insensitivity to insulin. Insulin levels may decrease

slightly or be in the normal range. Insulin is still

produced by pancreatic beta cells, then type 2 DM is

considered as non-insulin DM. Based on table 2, it

can be seen that there is a correlation between

physical activity with the incidence of type 2 DM.

Based on observations in the field, type 2 DM patients

rarely carry out regular exercise activities for reasons

of being lazy to exercise, and they feel tired quickly.

This, of course, can lead to a lack of response to

insulin (insulin resistance) so that glucose cannot

enter the cell.

This study is in line with the research of

Sukmaningsih WR (2016), which states that a person

who has low physical activity is eight times more

likely to experience type 2 DM [10].

Fikasari’s (2012) study showed that there was a

relationship between physical activity and the

incidence of type 2 DM (p = 0.045 <0.05). Regular

physical activity can reduce the risk factors for type 2

DM because physical activity can reduce weight and

improve sensitivity to insulin, which can improve

glucose control in the blood [Sukmaningsih, 2016].

The results showed that there was a correlation

between obesity and the incidence of type 2 DM.

Based on the results of the study, DM patient with

obese stated that their weight was high because they

did not maintain their diet and didn’t do a regular

exercise. This makes insulin unable to work optimally

to help body cells absorb glucose because it is

disturbed by complications of obesity, such as high

blood fat levels (cholesterol).

The results of this study are in line with the

research conducted by Jin Ook Chung, Dong Hyeok

Cho, Dong Jin Chung, and Min Young Chung (2012)

which states that there is a significant relationship

between obesity and insulin resistance (p <0.05).

Obesity condition causes excess fat deposits.

Freeform fatty acids can circulate in blood vessels

throughout the body and cause oxidative stress which

we are familiar with lipotoxicity. Lipotoxicity will

interfere with insulin receptor function [Jin OC et all,

2012].

The results of the statistics analysis showed that

there was a correlation between smoking habits with

the incidence of type 2 DM. Based on the facts in the

field, they smoke to eliminate tension and stress

because nicotine releases certain compounds to create

a calm and relaxing effect. Besides that they smoke

because they see the habits of their parents, who are

also smokers. This situation certainly causes insulin

resistance and causes blood sugar levels to increase,

which causes type 2 DM disease.

The results of this study are in accordance with the

research of Trisnawati et al. (2013) which states that

there is an influence of smoking habits on the

incidence of type 2 DM (p=0.002). Someone who

smokes 2.4 times more likely to developing type 2

DM compared to non-smokers. According to

previous research, smoking habits caused impaired

glucose metabolism and increased insulin resistance

which causes an increased risk of developing DM.

This result is in accordance with the Coronary Artery

Risk Development in Young Adults study data, which

ICVHE 2019 - The International Conference of Vocational Higher Education (ICVHE) “Empowering Human Capital Towards Sustainable

4.0 Industry”

334

found that active smoker was associated with the risk

of glucose intolerance.

Based on the theory, cigarettes are the main

product of tobacco-containing TAR, including the

polycyclic aromatic hydrocarbon compound,

containing nicotine CO, HCN, and benzopyrene.

Nicotine can cause a reduction in sensitivity and

increase the occurrence of insulin resistance. In

addition, smoking can reduce HDL cholesterol in the

bloodstream; smoking can also make blood quickly

freeze, which increases the likelihood of arterial

blockage. Nicotine can increase blood glucose levels

which can cause insulin resistance. Nicotine

significantly affects the stress hormone cortisol. This

cortisol hormone causes the body to be resistant to

insulin

5 CONCLUSION

There was a correlation between physical activity,

obesity, and smoking habit with type 2 DM incident

in the work area of Martapura Public Health Center.

It is advisable to community and health workers from

applying a healthy life behaviour to prevent the

incidence of type 2 DM

ACKNOWLEDGEMENTS

I am highly thankful to Martapura Subdistrict,

Martapura Public Health Center, all research

respondents and all the people who have helped this

research

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