Type 2 diabetes mellitus (T2DM) is the most common and clinically significant metabolic disease, which has become a global pandemic and a major health burden worldwide. There were 382 million patients with T2DM worldwide in 2013, and it is estimated that this number will increase to over 590 million patients by 2035 [1]. In Indonesia, the prevalence of diabetes mellitus is also rapidly increasing. This is evident from the Indonesian Basic Health Research (Riskesdas) data for the years 2007, 2013, and 2018, which were 5.7%, 14.8%, and 21.8%, respectively [2]. The increase in the prevalence of T2DM in developing countries is estimated to be nearly four times greater than in developed countries, primarily due to the adoption of a "Western lifestyle" by developing nations [1].

Type 2 diabetes is known to have various causes, including genetic factors, unhealthy lifestyles (such as physical inactivity and smoking), and dietary factors. Among various dietary factors, dietary fiber has drawn the attention of many researchers in the control of glycemic levels in T2DM patients. While several studies have documented the relationship between dietary fiber intake and T2DM, the results are still controversial. Some have found a protective association between high dietary fiber intake and the risk of T2DM, while many others have found no significant relationship [3].

Approximately 90% of T2DM cases are associated with excess body weight. Various previous studies have indicated that central obesity increases the risk of chronic diseases such as cardiovascular diseases, hypertension, and type 2 diabetes. Fat in the abdominal organs produces fatty acids and other substances that promote the release of proinflammatory compounds into the bloodstream, which impairs insulin metabolism in the liver and insulin sensitivity in surrounding tissues [4].

Individuals with T2DM are recommended by the American Diabetes Association (ADA) to engage in moderate-intensity aerobic exercise at least three times a week and strength training at least two times a week. Research indicates that physical activity can improve glucose control in T2DM. However, these studies have not yet shown consistent results [5].

The primary goal of managing T2DM is glycemic control and quality of life because having diabetes can lead to a decrease in a person's quality of life [6]. Therefore, it is crucial to assess the quality of life of type 2 diabetes patients. These factors then drive researchers to further investigate the relationship between dietary fiber intake, central obesity, and physical activity with blood sugar levels and the quality of life in T2DM patients.

Participant

This study is a descriptive study with a cross-sectional design. The research was conducted from September to November 2021 in the city of Jambi. All adults with diabetes mellitus in the city of Jambi who met the inclusion and exclusion criteria were included in this study.

Data were obtained from questionnaires filled out by the research subjects. The questionnaire consisted of subject characteristics, a 3x24-hour food record (2 regular days, 1 holiday), physical activity, and the quality of life of the research subjects. In addition, anthropometric measurements (waist circumference and waist-to-hip ratio) and blood sugar level examinations were also performed on the research subjects.

Statistics

Univariate analysis is presented in a table of distribution and frequency. Bivariate analysis is presented using the chi-square test to determine whether there is a significant relationship among the variables under investigation.

Informed consent was obtained from the patients, and the research has been approved by the ethics committee of the Faculty of Medicine and Health Sciences at the University of Jambi (No. 1965/UN21.8/PT.01.04/2023).

Out of the 137 prospective research subjects who were willing to participate in this study, 27 individuals did not meet the inclusion and exclusion criteria. Therefore, the analysis was carried out on 110 research subjects. The characteristics of the respondents in this study include age, gender, and education status, as shown in Table 1. Based on the data in Table 5.1, it is observed that the majority of research respondents are aged 56-65 years, with 59 respondents (53.7%) being female and 63 respondents (57.3%).

Table 1: Respondent Characteristics.

According to Table 2, the majority of research respondents have low dietary fiber intake (68.2%), central obesity (60.9%), insufficient physical activity (66.4%), high HbA1c levels (75.4%), and low quality of life (57.3%).

Table 2: Distribution Frequency of dietary fiber intake, central obesity, physical activity, blood sugar levels, and quality of life.

Table 3: Relationship of dietary fiber intake, central obesity, and physical activity with blood sugar levels, and quality of life (n=110)^a.

^aData shown in frequency (percentage)

^bRelationship analysis with chi-square test

In Table 3, it is evident that there is a statistically significant relationship between dietary fiber intake, central obesity, physical activity with blood sugar levels, and quality of life data in research subjects (P value < 0.01).

The consumption of high-fiber foods is associated with a decreased insulin response, which in turn lowers the risk of developing insulin resistance. As per a study carried out by Lee and colleagues in 2018, fasting blood glucose levels demonstrate heightened sensitivity in forecasting the likelihood of developing type 2 diabetes, particularly in individuals aged 40 years or older (Lee et al., 2018). In this research, we found that respondents had a low dietary fiber intake (42.1%). These results are in accordance with the research done by Jin et al.

Over a span of 6 years, it was observed that the rate of new diabetes cases remained higher among individuals with lower physical activity levels, regardless of their BMI. Existing research points to several potential biological mechanisms that explain the protective impact of physical activity on the development of type 2 diabetes (T2DM). Physical activity is believed to enhance insulin sensitivity; physical activity is likely to be most effective in preventing the progression of T2DM during its early stages before insulin therapy becomes necessary. The protective effects of physical activity seem to work synergistically with insulin. When skeletal muscles contract during a sustained physical activity session, they facilitate glucose uptake into the cells by increasing blood flow in the muscles and enhancing glucose transport into muscle cells. Physical activity has also been shown to reduce intra-abdominal fat, a recognized risk factor for insulin resistance. Various studies have demonstrated an inverse relationship between physical activity and the distribution of intra-abdominal fat, resulting in a reduction in overall body fat stores. It's worth noting that lifestyle and environmental factors are reported as the primary culprits behind the significant increase in the incidence of T2DM (Sami et al., 2017).

From this study, data has been obtained regarding dietary fiber intake, central obesity status, physical activity, blood sugar levels, quality of life, and the relationship between dietary fiber intake, central obesity, and physical activity with blood sugar levels and quality of life in Type 2 diabetes mellitus patients. This information can serve as a basis for the nutritional management of overweight and obese patients and can be used as a reference for further research.

Acknowledgment

This research funding source is from the Division of Research and Community Service at Jambi University.

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