Natl. J. Physiol. Pharm. Pharmacol., (2025), Vol. 15(2): 119–123

Original Research

10.5455/NJPPP.2025.v15.i2.1

Prevalence of diabetes mellitus (type II) and its association with liver function parameters: a cross-sectional study among Police Staff in Surendranagar District

Shyam Shah¹, Nikita G. Solanki², Jaykumar H. Nimavat²,* , Jaini Pandya³, Shaili Pandya⁴, Kishor Sochaliya²

¹Department of Medicine, C.U. Shah Medical College, Surendranagar, Gujarat, India, 363001

²Department of Community Medicine, C.U. Shah Medical College, Surendranagar, Gujarat, India, 363001

³C.U. Shah Medical College, Surendranagar, Gujarat, India, 363001

⁴Indus university, Ahmedabad Gujarat, India, 363001

*Corresponding Author: Dr Jay Nimavat, Department of Community Medicine, C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India, 363001. Email: drnimavat [at] gmail.com

Submitted: 20/11/2024 Accepted: 01/01/2025 Published: 28/02/2025

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ABSTRACT

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia. This persistent high blood sugar is the leading cause of diabetic complications (NPNCD, MOHFW). Police work is recognized as inherently stressful due to long and unpredictable working hours, exposure to traumatic situations, interactions with anti-social elements, and strict disciplinary practices.

Aim: To estimate the prevalence of DM and its association with liver function parameters among police personnel in Surendranagar District, Gujarat.

Method: A cross-sectional study was carried out among 1478 police personnel of the Surendranagar district during the period of June to October 2024. Medical records of police personnel, such as HbA1c, cholesterol levels, liver enzymes, age, and gender, were analyzed using appropriate descriptive and inferential statistical tests. Diagnosis of DM, IFG was based on HbA1c estimation as per World Health Organization (WHO) criteria. Permission from the Institutional Ethics Committee was obtained before starting the study. The data were anonymized to protect participant confidentiality.

Results: Out of 1478 police personnel, 82.21% had normal HbA1c levels, while 11.37% were prediabetic, and 6.43% were diabetic, indicating that nearly 18% were at risk or diagnosed with diabetes. Dyslipidemia was prevalent, with abnormal HDL levels in 88.04% and LDL levels in 63.87% of participants. A weak but significant positive correlation was found between HbA1c and cholesterol, serum triglycerides, LDL cholesterol, and liver enzymes like SGPT. Cholesterol, LDL/HDL ratios, and serum triglycerides were significantly higher in participants with prediabetes and diabetes. Post hoc analysis confirmed higher cholesterol, triglyceride, and liver enzyme levels in participants with diabetes than in healthy individuals.

Conclusion: Although most police personnel maintained normal HbA1c levels, nearly 18% were either prediabetic or diabetic, highlighting a significant at-risk population. Dyslipidemia, particularly abnormal HDL and LDL cholesterol levels, was prevalent among participants. Furthermore, individuals with prediabetes and diabetes exhibited significantly higher cholesterol, LDL/HDL ratios, and liver enzyme levels than those with normal HbA1c levels. These results emphasize the need for targeted interventions to monitor and manage both diabetes and liver function in police personnel.

Keywords: Prevalence, Diabetes mellitus (type II), Liver function parameters, Police personnel.

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INTRODUCTION

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Persistent high blood glucose is the leading cause of diabetic complications, contributing to longterm damage and failure of various organs, including the eyes, kidneys, nerves, heart, and blood vessels (NPNCD, MOHFW).

According to the World Health Organization (WHO), noncommunicable diseases (NCDs) were responsible for 74% of global deaths in 2019, with diabetes contributing to 1.6 million deaths, making it the 8^th leading cause of death worldwide (The top 10 causes of death). By 2035, it is projected that nearly 592 million people will succumb to diabetes (Tao et al., 2015). Type 2 diabetes, which accounts for 90% of all diabetes cases, was once seen as a disease prevalent in affluent “Western” countries. However, it has now become a global health issue, leading to significant disability and death, increasingly affecting younger populations (International Diabetes Federation, 2021). According to data from the International Diabetes Federation (IDF), the prevalence of Diabetes Mellitus in Adults in India was estimated to be 8.3% in 2024 (India, 2023).

The liver plays a crucial role in the development and progression of Diabetes Mellitus (DM). Liver enzymes such as ALT (Alanine Aminotransferase), AST (Aspartate Aminotransferase), ALP (Alkaline Phosphatase), and GGT (Gamma-Glutamyl Transferase) are commonly included in liver function tests. ALT and AST are important markers of hepatocellular function, whereas GGT provides insight into biliary tract function (Hanley et al., 2004). Various studies have reported liver disease as a major cause of mortality in patients with T2DM (Jin et al., 2005; Clouston and Powell, 2004).

In addition to liver involvement, recent research has focused on the prevalence of diabetes among different occupational groups, with growing interest in the influence of occupational factors. Police work, in particular, is recognized as inherently stressful due to long and unpredictable working hours, exposure to traumatic situations, interactions with antisocial elements, and strict disciplinary practices (Selokar et al., 2011). This occupational stress can adversely affect blood glucose regulation, complicating the management of hyperglycemia and its associated complications (American Diabetes Association). Therefore, this study was undertaken to estimate the prevalence of DM and its association with liver function parameters among police personnel in Surendranagar District, Gujarat.

Objectives

1. To estimate the prevalence of diabetes mellitus (type II) among police personnel.

2. To estimate liver function parameters.

3. To associate liver function parameters with diabetes mellitus (type II).

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MATERIALS AND METHODS

A cross-sectional study was carried out among all police personnel of Surendranagar district during the period of June to October 2024. This study utilized secondary data from the Multispeciality Medical Consultation Camp conducted by the district police Department in association with C. U. Shah Medical College and Hospital, Surendranagar. The dataset contains information on 1508 police personnel, including demographic data, clinical diagnoses, and laboratory test results, including liver function parameters and HbA1c levels. The data were collected between 22/6/2024 and 23/6/2024.

The inclusion criteria were individuals with complete records of HbA1c levels. Participants with missing or incomplete key variables were excluded, resulting in a final sample size of 1478 participants.

The primary outcome variable was HbA1c, which was categorized into normal (<5.7%), prediabetic (5.7%–6.4%), and diabetic (≥6.5%) (ICMR). Independent variables included cholesterol levels, liver enzymes, and demographic characteristics such as age and gender. Total cholesterol >200 mg/dL, LDL cholesterol >100 mg/dL, HDL cholesterol ≤60 mg/ dL, triglycerides >150 mg/dL, VLDL cholesterol >30 mg/dL, LDH/HDL ratio >5, cholesterol/HDL ratio >5, SGOT >40, and SGPT >56 were considered abnormal (Cholesterol and south Asians).

Data cleaning involved removing records with missing values and checking for enzyme level outliers. Age was grouped into four categories (18–30, 31–45, 46–60, and above 60). Descriptive statistics (frequency, percentage, means, and standard deviations) were used to summarize participant characteristics, whereas ANOVA and Tukey’s honestly significant difference tests were used to compare liver function parameters between the normal, prediabetic, and diabetic groups. Pearson’s correlation analysis was used to assess the relationship between HbA1c and liver function parameters.

Data analysis was performed using SPSS version 26, with a significance level set at p < 0.05. Ethical approval was granted by the Institutional Ethics Committee of C.U. Shah Medical College. The data were anonymized to protect participant confidentiality.

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RESULTS

A total of 1478 police staff members participated in the study, with male participants being the predominant group (75.44%). The mean age of the participants was 37.75 ± 10.51 with most participants (52.30%) were between 31 and 45 years old, followed by 27.13% in the 15-30 age group. The remaining participants were aged 46–60 years (17.46%) and above 60 years (3.11%) (Table 1).

Table 1. Sociodemographic characteristics of the study participants (n=1478).

Fig. 1. Prevalence of diabetes mellitus among police personnel based on HbA1c reports (n=1478).

Among the 1,478 police personnel, 82.21% (1,215 participants) had normal HbA1c levels, indicating no signs of diabetes. However, 11.37% (168 participants) were classified as having prediabetes, and 6.43% (95 participants) were diagnosed with diabetes. These data reveal that, while a significant portion of the police staff maintained normal blood glucose levels, nearly 18% were at risk or already diagnosed with diabetes (Figure 1).

Out of 1478 participants, 786 underwent lipid function tests. The distribution of liver function parameters showed that nearly two-thirds (61.58%, 62,81%, and 62.21%) of participants had normal cholesterol levels, serum triglycerides level, and VLDL cholesterol levels. Most participants (88.04%) had abnormal HDL-C and 63.87% had abnormal LDL-C. The LDL/HDL ratio was normal for 98.09% of participants, and 88.93% had a normal cholesterol/ HDL ratio. The liver enzymes SGPT and SGOT were largely normal (97.46% and 96.44%, respectively). Overall, dyslipidemia was prevalent, especially in HDL and LDL levels (Table 2).

The correlation analysis showed that HbA1c had a weak positive correlation with cholesterol (r=0.104, p=0.004), serum triglycerides (r=0.304, p < 0.001), LDL cholesterol (r=0.092, p=0.010), and the LDL/ HDL ratio (r=0.129, p < 0.001). Additionally, the cholesterol/HDL ratio (r=0.155, p < 0.001) and SGPT (ALT) (r=0.095, p=0.007) were positively correlated with HbA1C. HDL cholesterol showed a weak negative correlation, but it was not statistically significant. SGOT (AST) had no significant correlation with HbA1C (Table 3).

Table 2. Distribution of participants according to liver function parameters (n=786).

Table 4 presents the association of liver function parameters across three groups: normal, prediabetes, and diabetes. Cholesterol levels were significantly higher in the prediabetes (203.39 ± 49.90) and diabetes (202.23 ± 55.53) groups than in the normal group (189.62 ± 43.84, p=0.00). The cholesterol/HDL ratio and LDL/HDL ratio were elevated in individuals with prediabetes and diabetes compared with the normal group (p < 0.00). The serum triglyceride levels were significantly higher in the diabetes group than in the non-diabetic group (249.18 ± 163.11, p=0.00). No significant differences were observed for serum high-density lipoprotein cholesterol levels across the groups (p=0.26), whereas serum low-density lipoprotein cholesterol, SGOT (AST), SGPT (ALT), and very low-density lipoprotein cholesterol levels showed higher values in the diabetes group (p < 0.05).

Table 3. Correlation between HbA1C and liver function parameters (n=786).

Table 4. Association between liver function parameters and diabetes status among police staff (n=786).

Post hoc analysis using Tukey’s honestly significant difference test revealed significant differences across groups for several liver function parameters. Cholesterol levels were significantly lower in normal participants compared to prediabetic participants (mean difference=-13.77, p=0.028). Both the cholesterol/ HDL and LDL/HDL ratios were higher in prediabetic and diabetic. Serum triglycerides were notably higher in diabetics compared to normal participants (mean difference=-106.29, p < 0.001). SGOT (AST) levels were significantly higher in those with prediabetes, while SGPT (ALT) and VLDL cholesterol levels were significantly elevated in those with diabetes (p < 0.05).

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DISCUSSION

A cross-sectional study was conducted to estimate the prevalence of type 2 diabetes mellitus (T2DM) and its association with liver function among police personnel in Surendranagar District. Police work involves irregular duty hours and high levels of stress, which can increase the risk of metabolic disorders like diabetes. The liver, which is key to glucose metabolism, is affected in T2DM due to insulin resistance, leading to altered liver function. Understanding this association among police personnel is important for addressing the impact of occupational stress on their metabolic and liver health, highlighting the need for preventive healthcare measures among police personnel. This study is probably the first of its kind conducted in Surendranagar District to estimate the prevalence of type 2 diabetes mellitus (T2DM) and its association with liver function among police personnel, focusing on a specific occupational group.

The prevalence of diabetes among police staff in our study was 6.43%, with an additional 11.37% classified as prediabetic, meaning nearly 18% of participants were either at risk of developing or already diagnosed with diabetes. This is slightly lower than the 15% prevalence reported by Kumar et al. (2013). Their sample included a larger proportion of older individuals, with 34.9% aged 50 years or more, compared to our study where most participants (52.30%) were between 31 and 45 years. These age differences likely contributed to the lower diabetes prevalence observed in our study. Similarly, Kumar et al. (2008), in their study of Kolkata policemen, reported a diabetes prevalence of 11.5%, which aligns more closely with the combined prevalence of diabetes and prediabetes in our cohort. This suggests that early intervention strategies are crucial, especially for those in the prediabetic stage, to prevent progression to full-blown diabetes.

In our study, there was a high prevalence of abnormal HDL cholesterol (88.04%) and LDL cholesterol (63.87%), indicating widespread dyslipidemia. In contrast, only 13.08% of the participants in another study had abnormal LDH cholesterol (Chilay et al., 2023). Very few participants had abnormal SGPT and SGOT. Similar findings were also found in a study by Chilay et al. (2023).

We found a significant correlation between HbA1c and liver function parameters, except for SGOT. A study by Jha et al. (2021) also produced similar results.

In a study by Teshome et al. (2019), liver function parameters were significantly associated with diabetes, particularly in cholesterol, serum triglycerides, LDL cholesterol, HDL cholesterol, SGPT (ALT), and SGOT (AST) levels. In our study, HDL-C had no significant association with diabetes, but all other liver function parameters were significantly associated with diabetes.

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CONCLUSION

The majority of police personnel had normal HbA1c levels, and nearly 18% were either prediabetic or diabetic, highlighting an emerging concern for metabolic health in police workers. Given the physically demanding and stressful nature of police work, which may contribute to lifestyle-related health risks, the prevalence of prediabetes and diabetes warrants attention. Additionally, dyslipidemia was highly prevalent, particularly in individuals with abnormal HDL and LDL cholesterol levels. The association between elevated HbA1c levels and altered liver function parameters, such as cholesterol, triglyceride, and liver enzyme levels, underscores the need for regular monitoring of metabolic and liver health in police staff to prevent further complications.

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ACKNOWLEDGMENTS

We are grateful to Dr Girish Pandya, superintendent of police, Surendranagar District, for his kind help and support.

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CONFLICT OF INTEREST

This study focuses on the prevalence of Type II diabetes mellitus and its association with liver function parameters among police staff. The authors declare no conflict of interest regarding the publication of this research. The study was conducted independently and without any financial, institutional, or personal influences that could bias the findings.

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FUNDING

None declared.

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