Abstract
Background
Few previous studies have investigated the multiple pathways that contribute to diabetes
mellitus (DM) because of the complex, simultaneous interplay of attributing covariates.
Structural equation modelling (SEM) is a robust multivariate approach that measures
both direct and indirect effects of variables by simultaneously utilizing several
regression equations. The current study applied SEM to test a hypothesized model of
the covariates affecting DM among the adult population of the Sultanate of Oman.
Methods
Data from a large nationally representative 2017 WHO STEPwise approach to surveillance
survey were analyzed. Stata 16 software was used to perform SEM and path analysis
of the sociodemographic, behavioral, anthropometric, and metabolic variables affecting
normoglycemia and DM. A priori factor structure was hypothesized with special emphasis
on observing direct and indirect effects, and the correlations that defined them.
Results
Eight paths that directly affected DM status were established based on eight sociodemographic,
metabolic, and behavioral variables (age, sex, educational status, physical activity
level, body mass index, waist-to-hip ratio, systolic blood pressure, and family history
of DM). The remaining variables (marital status, employment status, smoking, high-density
lipoprotein level, total blood cholesterol level, fruit and vegetable intake, and
type of oil used for cooking) showed variable indirect effects.
Conclusions
The results of this study further reinforce the evidence that lifestyle changes are
vital for the prevention and control of DM. Individuals with a family history of DM
and a high waist-to-hip ratio comprise a high-risk group and should be targeted with
screening and lifestyle-intervention programs.
Key Indexing Terms
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Article info
Publication history
Published online: March 11, 2022
Accepted:
March 8,
2022
Received:
October 4,
2020
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
