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Structural equation model for estimating risk factors in type 2 diabetes mellitus in a Middle Eastern setting: evidence from the STEPS Qatar
  1. Andres Roman-Urrestarazu1,
  2. Faleh Mohamed Hussain Ali2,
  3. Husein Reka2,
  4. Matthew J Renwick1,
  5. Gabriela D Roman3,
  6. Elias Mossialos1
  1. 1LSE Health, London School of Economics and Political Science, London, UK
  2. 2Qatar Supreme Council of Health, Doha, Qatar
  3. 3Institute of Criminology, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Andres Roman-Urrestarazu; a.e.roman-urrestarazu{at}lse.ac.uk

Abstract

Aims Understanding type 2 diabetes mellitus is critical for designing effective diabetes prevention policies in Qatar and the Middle East.

Methods Using the Qatar 2012 WHO STEPwise approach to surveillance survey, a subsample of 1224 Qatari participants aged 18–64 years was selected. Subjects had their fasting blood glucose levels tested, had not been diagnosed with or treated for diabetes, had a fasting time >12 hours and were not pregnant. We applied a hypothesized structural equation model (SEM) to assess sociodemographic, behavioral, anthropometric and metabolic variables affecting persons with type 2 diabetes mellitus.

Results There is a direct effect of triglyceride levels (0.336) and body mass index (BMI) (0.164) on diabetes status. We also found that physical activity levels negatively affect BMI (−0.148) and positively affect high-density lipoprotein (HDL) (0.106); sociodemographic background negatively affects diet (−0.522) and BMI (−0.352); HDL positively affects total cholesterol (0.230) and has a negative effect on BMI (−0.108), triglycerides (−0.128) and waist circumference (−0.104). Diet has a positive effect on triglycerides (0.281) while family history of diabetes negatively affects total cholesterol (−0.104). BMI has a positive effect on waist circumference (0.788) and mediates the effects of physical activity over diabetes status (−0.028). BMI also mediates the effects that sociodemographic factors (−0.058) and physical activity (−0.024) have on diabetes status. BMI and HDL (−0.002) together mediate the effect of physical activity on diabetes status and similarly HDL and tryglycerides (−0.005) also mediate the effect of physical activity on diabetes status. Finally diet and tryglycerides mediate the effects that sociodemographic factors have on diabetes status (−0.049).

Conclusions This study's main finding is that triglyceride levels and BMI are the main variables directly affecting diabetes status in the Qatari population.

  • Lipids and Diabetes
  • Analytic Methods
  • Triglycerides
  • BMI

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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