Factors associated to type 2 diabetes among employees of a public hospital in Belo Horizonte, Brazil
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ORIGINAL Received: 02/21/2019
Accepted: 09/02/2019
ARTICLE Funding: none
Factors associated to type 2 diabetes
among employees of a public hospital
in Belo Horizonte, Brazil
Fatores associados ao diabetes mellitus tipo 2 entre
trabalhadores de uma empresa pública de Belo Horizonte
Marcelo Cássio Mendes Lúcio1 , Janice Sepúlveda Reis1 ,
Alexandra Dias Moreira2 , Tatiane Géa Horta Murta1 , Pedro Wesley Rosário1
ABSTRACT | Background: Occupational aspects have been described as additional risk factors for type 2 diabetes mellitus (DM2).
Workers whose job interferes with healthy eating and physical activity might be more susceptible to disease. Objective: To investi-
gate sociodemographic, clinical, occupational and lifestyle factors associated with DM2 among employees of a public hospital in Belo
Horizonte, Minas Gerais, Brazil. Methodology: Cross-sectional study with 443 employees of a public hospital in Belo Horizonte.
We administered a sociodemographic and occupational questionnaire and the Finnish Diabetes Risk Score (FINDRISC) and collected
biochemical data. We performed multivariate logistic regression analysis to investigate factors associated with diabetes. The significance
level was set to 5%. Results: 6.3% of the participants had a diagnosis of DM2 and 13% were found to be at high or very high risk to
develop disease within 10 years. Participants aged above 54, with abnormal waist circumference, who took antihypertensive drugs or
had family history of diabetes exhibited higher odds of developing disease. Conclusion: Older age, abdominal obesity, hypertension
and family history of diabetes were associated with diagnosis of DM2.
Keywords | diabetes mellitus, type 2; risk factors; occupational health; epidemiology.
RESUMO | Introdução: Características ocupacionais têm sido apontadas como fatores de risco adicionais para o desenvolvimento do
diabetes mellitus tipo 2 (DM2). Trabalhadores cujas rotinas de trabalho dificultam a adoção de hábitos saudáveis relacionados à alimen-
tação e atividade física podem estar mais vulneráveis a desenvolver esse agravo. Objetivo: Estimar os fatores sociodemográficos, clínicos,
ocupacionais e de hábitos de vida associados ao DM2 entre trabalhadores de uma empresa pública de Belo Horizonte. Metodologia:
Trata-se de um estudo transversal com 443 trabalhadores de uma empresa hospitalar pública de Belo Horizonte (MG). Foram aplicados
questionários envolvendo características sociodemográficas, ocupacionais, juntamente com o Finnish Diabetes Risk Score (FINDRISC)
e coletados dados bioquímicos. Para análise dos fatores associados ao diabetes, utilizou-se a regressão logística multivariada, conside-
rando nível de significância de 5%. Resultados: Entre os trabalhadores, 6,3% tinham diagnóstico de diabetes tipo 2 e 13% encontra-
vam-se na faixa de risco alto/muito alto de desenvolver a doença nos próximos 10 anos. Observou-se que as pessoas com idade acima
de 54 anos, circunferência da cintura alterada, que usavam medicamentos para hipertensão arterial e que tinham história de diabetes
na família apresentaram maior chance de desenvolver a doença em comparação a pessoas com menos de 45 anos, cintura normal, que
não usavam medicamento para hipertensão e sem história familiar. Conclusão: A idade avançada, a obesidade abdominal, a hiper-
tensão arterial e a história familiar foram fatores associados ao diagnóstico de diabetes mellitus tipo 2.
Palavras-chave | diabetes mellitus tipo 2; fatores de risco; saúde ocupacional; epidemiologia.
Holy House of Mercy of Belo Horizonte, Learning and Research Institute of Belo Horizonte – Belo Horizonte (MG), Brazil.
1
2
Mother-Child Care and Public Health Department, Nursing School, Universidade Federal de Minas Gerais – Belo Horizonte (MG), Brazil.
DOI: 10.5327/Z1679443520190395
Rev Bras Med Trab. 2019;17(3):292-9
292Factors associated to type 2 diabetes among workers
INTRODUCTION Health care workers deserve special attention within
this context, inasmuch as they are frequently work night
Diabetes mellitus (DM) is associated with countless shifts, have long working hours and more than one job,
acute and chronic complications which have considerably which factors hinder their attempts at adopting a healthy
negative impact on the quality of life of patients and their lifestyle. Stress and anxiety further contribute to increase
families1. The prevalence of DM was 7.6% among adults in risk among this population of workers6,7.
Brazil at the end of the 1980s and increased to about 9% By comparison to other conditions with a well-estab-
in 2016 in the country as a whole and to 10% in São Paulo lished relationship to work, that of DM2 might be less
and Belo Horizonte1,2. evident within the scope of chronic degenerative disorders,
Most cases of DM correspond to two etiopathogenic even though it is not less relevant for some occupational
categories known as type 1 (DM1) and 2 (DM2). The latter groups. Nevertheless, few studies analyzed the association
accounts for 90 to 95% of DM cases worldwide1. Different between occupational characteristics and risk of DM2, and
from DM1, DM2 is preventable. While countless factors even less specifically addressed this relationship among
were found to be associated with this condition, the most health care workers8,9.
significant ones derive from lifestyle changes which took As a function of the aforementioned considerations,
place in the past decades, including increase of dietary the aim of the present study was to investigate sociodemo-
fats and rapidly absorbed carbohydrates, as well as in the graphic, clinical, occupational and lifestyle factors related
consumption of sugary drinks. When associated with phys- with DM2 among employees of a public hospital in Belo
ical inactivity these factors increase the risk of overweight, Horizonte, Minas Gerais, Brazil.
obesity and DM23.
The pathophysiology of DM2 involves complex
interactions between genetic predisposition and envi- METHODOLOGY
ronmental risk factors. As is known, there is a close rela-
tionship between obesity/overweight and risk of DM2. The present cross-sectional study was conducted from
Also the distribution of the body fat influences the risk May through October 2016 in a public hospital in Belo
of disease, being abdominal obesity the variety asso- Horizonte that provides medical, pharmaceutical, dental
ciated with the highest risk. Other known risk factors and social care under an ad hoc social security regime.
include sedentary lifestyle, hypertension, dyslipidemia, The hospital employees were invited to participate in
history of gestational diabetes and age. The prevalence the study on the occasion of periodic medical examina-
of disease also varies as a function of ethnicity. Genetic tions at the Occupational Health and Safety Department
predisposition is considerable, whence the relevance of (OHSD). Those who met the inclusion and exclusion
the family history1. criteria were considered eligible. We excluded workers
Several additional risk factors were investigated in with DM diagnosed before age 25, having been hospi-
recent years including occupational aspects. Thus, for talized or receiving insulin since the time of diagnosis,
instance, workers whose job routine hinders them from pregnant women and interns (since they are not subjected
adopting healthy eating habits and performing physical to periodic examinations, therefore the necessary labo-
activity might be more susceptible to disease. This is ratory data were lacking).
the case of workers with long working hours, who work For sample size calculation we considered a 2-point differ-
night shifts, have several jobs, inadequate meal and rest ence on the Finnish Diabetes Risk Score — FINDRISC — for
times and are frequently exposed to considerable stress a similar population of workers, significance level of 5% and
and anxiety. Recent studies evidenced that circadian statistical power of 90%. As a result 212 participants were
rhythm disorders and occupational stress are associated needed at least.
with higher risk of DM2 independently from traditional The sample was characterized based on a ques-
risk factors such as body weight, diet, physical activity tionnaire, anthropometric measurements and labora-
and family history4,5. tory tests. The data were entered on ad hoc form that
Rev Bras Med Trab. 2019;17(3):292-9
293Lúcio MCM, et al.
included the following variables: self-reported DM by dividing the body weight (in kg) by height (in meters)
diagnosis (yes/no), sex (female/male), marital status squared. We considered obesity as BMI≥30 kg/m2 and
(with/without partner), job at the hospital, second job, overweight as BMI≥25 kg/m2. WC was measured with
weekly working hours (up to 30, 31–50, >50), night non-elastic tape measure at the umbilical level as per inter-
shift (yes/no), smoking (yes/no) and routine laboratory national recommendations14.
tests defined as mandatory for all employees — except Descriptive analysis included calculation of mean, stan-
for interns — in the Occupational Health Medical dard deviation, median and quartile for continuous vari-
Control Program (fasting glycemia, high-density lipo- ables and absolute and relative frequencies for categorical
protein — HDL, triglycerides). variables. Groups were compared by means of the Mann-
Occupations were divided in two categories, namely, Whitney and Kruskal-Wallis tests. Associations were inves-
health care workers and all others, according to the Brazilian tigated with the χ2 and Fisher’s exact tests.
Classification of Occupations10. We performed multivariate logistic regression anal-
We also administered FINDRISC, to wit, a ques- ysis to investigate factors associated with of DM2.
tionnaire validated by the Department of Public Health, We first considered all the variables with pFactors associated to type 2 diabetes among workers
On univariate analysis of risk factors, we found statisti- the average score on FINDRISC was 10. FINDRISC
cally significant association between risk of DM2 and age, was administered in studies conducted in Finland and
BMI, WC, use of antihypertensive medication, high blood Portugal, and the average score was 9.1 and 9.3, respec-
sugar and family history of DM. Neither in this case there tively12,16. In the latter, 12.8% of the participants were rated
was association between risk of DM2 and occupational as with high/very high risk of disease. Among studies in
variables (Table 2). Brazil in which FINDRISC was administered, the rates
Table 3 describes the results of logistic regression of participants categorized as with high/very high risk
analysis with significance level p102 cm and Our findings indicate that also the prevalence of DM and
women with WC >88 cm exhibited 4.10 times higher associated risk factors is increasing among the analyzed
odds of developing DM than the men with WCLúcio MCM, et al.
Table 1. Participants’ risk profile for type 2 diabetes mellitus, Belo Horizonte, Brazil 2016 (n=414).
Risk of type 2 diabetes
Variables Low Slightly elevated Moderate High/very high p-valuea
n % n % n % n %
Smoking
Yes 6 13.9 19 44.2 11 25.6 7 16.3
0.279
No 103 27.8 139 37.5 82 22.1 47 12.7
Sex
Male 25 28.1 35 39.3 22 24.7 7 7.9
0.430
Female 84 25.6 123 37.8 71 21.8 47 14.5
Other jobs
Yes 31 28.2 40 36.4 26 23.6 13 11.8
0.899
No 78 25.6 118 38.8 67 22.0 41 13.5
Weekly working hours
Up to 30 hours 14 25.9 19 35.2 14 25.9 7 12.9
30–50 hours 74 29.5 95 37.8 50 19.9 32 12.7 0.520
>30 hours 21 19.3 44 40.4 29 26.6 15 13.8
Night shift
Yes 14 15.9 40 45.5 22 25.0 12 13.6
0.089
No 95 29.1 118 36.2 71 21.8 42 12.8
Age
64 years old 0 0.0 2 25.0 3 37.5 3 37.5
Waist circumference
Normal 77 61.6 45 36.0 2 1.6 1 0.8
Increased 26 19.9 60 45.8 36 27.5 9 6.9Factors associated to type 2 diabetes among workers
Table 2. Participants’ type 2 diabetes mellitus diagnosis profile, Belo Horizonte, Brazil 2016 (n=443).
Type 2 diabetes
Variables Yes No p-valuea
n % n %
Smoking
Yes 5 10.4 43 89.6
0.211
No 23 5.8 372 94.2
Sex
Male 6 6.3 89 93.7
0.998
Female 22 6.3 326 93.7
Marital status
With partner 18 7.4 224 92.5
0.289
Without partner 10 4.9 191 95.0
Second job
Yes 10 8.3 110 91.6
0.289
No 18 5.6 305 94.4
Weekly working hours
Up to 30 hours 5 8.5 54 91.5
31–50 hours 14 5.3 251 94.7 0.534
>50 hours 9 7.6 110 92.4
Night shift
Yes 4 4.3 89 95.7
0.368
No 24 6.9 326 93.1
Age
64 years old 2 20.0 8 80.0
Body mass index
30 kg/m2 12 14.1 73 85.8
Waist circumference
Normal 3 2.3 125 97.6
Increased 2 1.5 131 98.5Lúcio MCM, et al.
Table 3. Multivariate logistic regression analysis of variables asso- methodological differences hinder possible comparisons
ciated with diagnosis of DM2, Belo Horizonte, Brazil 2016 (n=443). with our results.
OR SE p 95%CI Some limitations might have impaired association anal-
Age ysis between occupational aspects and risk of DM2 in the
present study. For having a cross-sectional design and being
54 years old 4.61 3.33 0.035 1.12 19.00 teristics on risk of DM2 might have been impaired. We call
the attention to the need for prospective studies to investi-
Waist circumference
gate causal relationships between the variables of interest.
Normal 1 Among our results, we emphasize the significant associ-
Increased 0.49 0.46 0.445 0.08 3.08 ation found between working night shifts and dietary habits.
In their study with night workers from a Guarulhos metallurgical
Abnormal 4.10 2.65 0.029 1.16 14.53
industry in 2011, Lopes and Simony20 found that most partic-
Antihypertensive drugs ipants exhibited overweight or obesity and reported consider-
No 1 able intake of fat, fried food, sweets and sugar and low intake of
Yes 2.53 1.14 0.041 1.04 6.14 vegetables, fruit, milk and dairy products. In addition, a large
part of their sample stated they were aware of differences in
Family history of diabetes
their diet when off work and during vacation. Similarly, 57% of
No 1 the participants in our study who worked night shifts exhibited
Yesa 0.94 0.80 0.940 0.18 5.02 overweight versus 20.5% of those who did not. This difference,
however, was not statistically significant (p=0.082).
Yesb 3.27 1.64 0.018 1.22 8.74
The scientific evidence for the effect of lifestyle changes,
a
Yes, grandparent/uncle/aunt/cousin; yes, parent/sibling/child; 95%CI:
b
95% confidence interval; OR: odds ratio; SE: standard error.
especially physical activity and healthy eating, for prevention
of DM2 has grown in recent years, is consistent and fully
justifies actions in this regard1. Health care services should
relationship between score on FINDRISC and diagnosis be prepared to act as effectively as possible in the preven-
of DM2 (p102 cm (men)/>88 cm
inal obesity, abnormal waist-hip ratio, sedentary lifestyle, (women), with history of treatment for hypertension or of
smoking and HDLFactors associated to type 2 diabetes among workers
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to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725-31. 590 – Santa Efigênia – CEP: 30150-240 – Belo Horizonte (MG), Brazil – E-mail:
https://doi.org/10.2337/diacare.26.3.725 geahorta@yahoo.com.br
© 2019 Associação Nacional de Medicina do Trabalho
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