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Padjadjaran of Nursing Journal

Original

Vol. 13 No. 2 (2025): Jurnal Keperawatan Padjadjaran

Factors associated with type 2 diabetes mellitus in older adults living in Coastal Areas: Implications for community nursing practice

DOI
https://doi.org/10.24198/jkp.v13i2.2767
Submitted
March 15, 2025
Published
2025-08-30

Abstract

Background: Indonesia’s growing older adult population is experiencing a rising burden of type 2 diabetes mellitus (T2DM). Coastal populations face unique risks, including limited health service access, dependence on fisheries-based livelihoods, and dietary patterns high in salt and low in fresh produce. These factors may heighten vulnerability to T2DM, yet remain underexplored.

Purpose: This study aimed to examine determinants of T2DM among older adults living in a coastal community.

Methods: A cross-sectional study was conducted with 86 older adults selected using purposive sampling between October 30 and December 14, 2024. Data were collected using demographic questionnaires, the Mini Nutritional Assessment (MNA), the Geriatric Depression Scale (GDS), and the Physical Activity Scale for the Elderly (PASE). Chi-square tests assessed associations between independent variables and T2DM, and variables with p < 0.25 were entered into multivariable logistic regression to identify significant predictors.

Results: Comorbidity (p < 0.001), nutritional status (p = 0.001), physical activity (p < 0.001), and depression (p < 0.001) were significantly associated with T2DM. In multivariable analysis, lower physical activity emerged as the strongest predictor (OR = 4.13, 95% CI: 1.18–14.48; Wald = 4.92; p = 0.027). Comorbidity (OR = 3.61), depression (OR = 3.64), and nutritional status (OR = 3.28) also remained significant independent factors.

Conclusions: T2DM among older adults in coastal areas was more likely in those with comorbidities, depressive symptoms, altered nutritional status, and especially low physical activity. These findings highlight the need for community-based nursing interventions emphasizing physical activity promotion, nutritional counseling, and depression screening to mitigate T2DM risk in vulnerable coastal populations

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References

  1. Alharithy, M. K., Alobaylan, M. M., Alsugair, Z. O., & Alswat, K. A. (2018). Impact of family history of diabetes on diabetes control and complications. Endocrine Practice, 24(9), 773-779. https://doi.org/https://doi.org/10.4158/EP-2018-0071
  2. American Diabetes Association (ADA). (2013). Diagnosis and Classification of Diabetes Mellitus. Diagnosis and Classification of Diabetes Mellitus
  3. Audaya, I. R., Febriana, D., Yanti, S. V., & Hadi, N. (2022). Measurement of nutritional status in elderly with hypertension. Idea Nursing Journal, 13(1), 54-64.
  4. Azadbakht, M., Taheri Tanjani, P., Fadayevatan, R., Froughan, M., & Zanjari, N. (2020). The prevalence and predictors of diabetes distress in elderly with type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 163, 108133. https://doi.org/https://doi.org/10.1016/j.diabres.2020.108133
  5. Central Statistics Agency (BPS). (2021). 2021 Elderly Population Statistics. https://www.bps.go.id/id/publication/2021/12/21/c3fd9f27372f6ddcf7462006/statistik-penduduk-lanjut-usia-2021.html
  6. Central Statistics Agency (BPS). (2023). Elderly population statistics 2023. https://www.bps.go.id/id/publication/2023/12/29/5d308763ac29278dd5860fad/statistik-penduduk-lanjut-usia-2023.html
  7. Central Statistics Agency (BPS) of South Buton Regency. (2024). South Buton Regency in Figures 2024. https://buselkab.bps.go.id/id/publication/2024/02/28/d3deea151ec4d9d2f7781fc5/kabupaten-buton-selatan-dalam-angka-2024.html
  8. Central Statistics Agency of Southeast Sulawesi Province. (2022). Statistics of the Elderly Population of Southeast Sulawesi Province 2022. https://sultra.bps.go.id/id/publication/2023/11/24/b6ea2ca510db17be44808d3c/statistik-penduduk-lanjut-usia--provinsi-sulawesi-tenggara-2022.html
  9. Bellary, S., Kyrou, I., Brown, J. E., & Bailey, C. J. (2021). Type 2 diabetes mellitus in older adults: Clinical considerations and management. Nature Reviews Endocrinology, 17(9), 534-548. https://doi.org/10.1038/s41574-021-00512-2
  10. Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Compr Physiol, 2(2), 1143-1211. https://doi.org/10.1002/cphy.c110025
  11. Brown, R. B. (2020). Diabetes, diabetic complications, and phosphate toxicity: A scoping review. Current diabetes reviews, 16(7), 674-689. https://doi.org/10.2174/1573399815666191104113236
  12. Cerdas Pérez, S. (2023). Menopause and diabetes. Climacteric, 26(3), 216-221. https://doi.org/10.1080/13697137.2023.2184252
  13. Chentli, F., Azzoug, S., & Mahgoun, S. (2015). Diabetes mellitus in elderly. Indian Journal of Endocrinology and Metabolism, 19(6), 744-752. https://doi.org/10.4103/2230-8210.167553
  14. Das, U., & Kar, N. (2023). Prevalence and risk factor of diabetes among the elderly people in West Bengal: Evidence-based LASI 1st wave. BMC Endocrine Disorders, 23(1), 170. https://doi.org/10.1186/s12902-023-01421-3
  15. Dattani, S., & Rodés-Guirao, L. (2023). Why do women live longer than men? https://ourworldindata.org/why-do-women-live-longer-than-men
  16. Elnaem, M. H., Bukhori, N. A. S., Tengku Mohd. Kamil, T. K., Rahayu, S., Ramatillah, D. L., & Elrggal, M. E. (2025). Depression and anxiety in patients with type 2 diabetes in Indonesia and Malaysia: Do age, diabetes duration, foot ulcers, and prescribed medication play a role? Psychology, Health & Medicine, 30(3), 555-571. https://doi.org/10.1080/13548506.2025.2450545
  17. Gao, P., Yang, F., Ma, Q., Ma, B., Jing, W., Liu, J., Guo, M., Li, J., Wang, Z., & Liu, M. (2025). Prevalence and risk factors of type 2 diabetes mellitus among depression inpatients from 2005 to 2018 in Beijing, China. Health Data Science.
  18. Guigoz, Y., Vellas, B. and Garry, P.J. (1994). Mini Nutritional Assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts and Research in Gerontology, 4 (Suppl.2), 15-59
  19. Hao, Z., Huang, X., Liu, X., He, F., & Shao, H. (2022). Association analysis between different diabetic family history and gender with diagnosed age of type 2 diabetes mellitus: A cross-sectional study in Tianjin, China. INQUIRY, 59, 00469580221086364. https://doi.org/10.1177/00469580221086364
  20. Huang, E. S. (2016). Management of diabetes mellitus in older people with comorbidities. BMJ, 353, i2200. https://doi.org/10.1136/bmj.i2200
  21. Institute for Health Metrics and Evaluation (IMHE). (2024). Global life expectancy to increase by nearly 5 years by 2050 despite geopolitical, metabolic, and environmental threats: Reports new global study. Institute for Health Metrics and Evaluation. https://www.healthdata.org/news-events/newsroom/news-releases/global-life-expectancy-increase-nearly-5-years-2050-despite.
  22. Internationa Diabetes Federation. (2021). IDF Diabetes Atlas. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf
  23. Joseph, J. J., & Golden, S. H. (2017). Cortisol dysregulation: The bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci, 1391(1), 20-34. https://doi.org/10.1111/nyas.13217
  24. Junaid, O. A., Ojo, O. A., Adejumo, O. A., Junaid, F. M., Ajiboye, K. J., Ojo, O. E., Akitikori, T. O., Kolawole, A. B., & Ikem, T. R. (2022). Malnutrition in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: A cross-sectional study. Dialogues in Health, 1, 100030. https://doi.org/https://doi.org/10.1016/j.dialog.2022.100030
  25. Kelly, J., Edney, K., Moran, C., Srikanth, V., & Callisaya, M. (2016). Gender differences in physical activity levels of older people with type 2 diabetes mellitus. Journal of Physical Activity and Health, 13(4), 409-415. https://doi.org/10.1123/jpah.2015-0147
  26. Ministry of Health of the Republic of Indonesia. (2023). 2023 Indonesian Health Survey (SKI) in Figures. https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/
  27. Coordinating Ministry for Human Development and Culture of the Republic of Indonesia. (2021). The government strives for health protection for the elderly: The elderly can age healthily. https://www.kemenkopmk.go.id/pemerintah-upayakan-perlindungan-kesehatan-bagi-lansia-agar-lansia-dapat-menua-dengan-sehat
  28. Kikuti-Koyama, K. A., Monteiro, H. L., Ribeiro Lemes, Í., de Morais, L. C., Fernandes, R., Turi-Lynch, B., & Codogno, J. (2019). Impact of type 2 diabetes mellitus and physical activity on medication costs in older adults. The International Journal of Health Planning and Management, 34(4), e1774-e1782. https://doi.org/https://doi.org/10.1002/hpm.2892
  29. Kim, H. J., An, S. Y., Han, S. J., Kim, D. J., Hong, C. H., Kim, Y. H., Shin, D. H., Kim, N. H., Seo, J. A., Ahn, Y. B., Ko, S. H., Cho, Y. W., Park, S. W., Kim, S. K., Kim, K. W., Kim, C. S., & Lee, K. W. (2019). The association of diabetes duration and glycemic control with depression in elderly men with type 2 diabetes mellitus. J Res Med Sci, 24, 17. https://doi.org/10.4103/jrms.JRMS_43_18
  30. Kim, Y. T., Chung, H. J., Park, B. R., Kim, Y. Y., Lee, J. H., Kang, D. R., Kim, J.-Y., Lee, M. Y., & Lee, J. Y. (2020). Risk of cardiovascular disease and chronic kidney disease according to 2017 blood pressure categories in diabetes mellitus. Hypertension, 76(3), 766-775. https://doi.org/10.1161/HYPERTENSIONAHA.120.15320
  31. Malik, F. A., Susanty, S., & Rustam, M. (2024). The relationship between adults, elderly, and smoking history with the incidence of adhesive capsulitis shoulder. JKG (Jurnal Keperawatan Global), 30-39. https://doi.org/10.37341/jkg.v9i1.901
  32. Markle-Reid, M., Ploeg, J., Fraser, K. D., Fisher, K. A., Bartholomew, A., Griffith, L. E., Miklavcic, J., Gafni, A., Thabane, L., & Upshur, R. (2018). Community program improves quality of life and self-management in older adults with diabetes mellitus and comorbidity. Journal of the American Geriatrics Society, 66(2), 263-273. https://doi.org/https://doi.org/10.1111/jgs.15173
  33. Morley, J. E., Abbatecola, A. M., & Woo, J. (2017). Management of comorbidities in older persons with type 2 diabetes. Journal of the American Medical Directors Association, 18(8), 639-645. https://doi.org/10.1016/j.jamda.2017.05.006
  34. Mutambudzi, M., & Javed, Z. (2016). Job strain as a risk factor for incident diabetes mellitus in middle and older age U.S. workers. The Journals of Gerontology: Series B, 71(6), 1089-1096. https://doi.org/10.1093/geronb/gbw091
  35. Oktaviyani, P., Salman, S., Happy Nurmalita Sari, M., Frisilia, M., Munazar, M., Satria, A., & Maretalinia, M. (2022). Prevalence and risk factors of hypertension and diabetes mellitus among Indonesian elderly. Makara Journal of Health Research. https://scholarhub.ui.ac.id/mjhr/vol26/iss1/2
  36. Rachmawati, U., Sahar, J., & Wati, D. N. K. (2019). The association of diabetes literacy with self-management among older people with type 2 diabetes mellitus: A cross-sectional study. BMC nursing, 18, 1-8. https://doi.org/10.1186/s12912-019-0354-y
  37. Rajamanickam, A., Munisankar, S., Dolla, C. K., Thiruvengadam, K., & Babu, S. (2020). Impact of malnutrition on systemic immune and metabolic profiles in type 2 diabetes. BMC Endocrine Disorders, 20(1), 168. https://doi.org/10.1186/s12902-020-00649-7
  38. Rashid, T., Zia, S., Mughal, S., Baloch, A. A., Abdul Rauf, M. U., & Hasan, S. M. (2025). Prevalence of malnutrition and associated factors among the elderly with type 2 diabetes using MNA form. Journal of Nutrition and Metabolism, 2025(1), 2107146. https://doi.org/10.1155/jnme/2107146
  39. Sari, D. K., Wardani, I. M. K., Masyiyah, S., Samah, D. A., Alma, L. R., Katmawanti, S., & Ulfah, N. H. (2021). Correlation of marital status, family income, "grandiose" eating habits and consumption of fried foods with the risk of diabetes in early elderly women (46-55 years). The Indonesian Journal of Public Health, 6(2), 111. https//doi.org/10.17977/um044v6i22021p111-122
  40. Sari, W. C. (2022). The relationship between family history, nutritional status, and physical activity with the incidence of hypertension in the elderly in Batu Belah Village, Air Tiris Community Health Center Work Area in 2022. Pahlawan Tuanku Tambusai University].
  41. Sirirak, T., Sangsupawanich, P., Wongpakaran, N., & Srisintorn, W. (2022). The geriatric depression scale predicts glycemic control in older adult with type 2 diabetes mellitus: A longitudinal study. Healthcare (Basel), 10(10). https://doi.org/10.3390/healthcare10101990
  42. Susanty, S., Chung, M. H., Chiu, H. Y., Chi, M. J., Hu, S. H., Kuo, C. L., & Chuang, Y. H. (2022). Prevalence of loneliness and associated factors among community-dwelling older adults in Indonesia: A cross-sectional study. Int J Environ Res Public Health, 19(8). https://doi.org/10.3390/ijerph19084911
  43. Susanty, S., Mujahid, E., Suyanto, J., Sudayasa, I., & Chuang, Y. (2024). Older adults with predictors factors of depressive symptoms in the community of Indonesia: A cross sectional study. Advances in gerontology= Uspekhi gerontologii, 37(5), 525-531. https://doi.org/doi: 10.34922/AE.2024.37.5.006
  44. Susanty, S., Nadirawati, N., Setiawan, A., Haroen, H., Pebrianti, S., Harun, H., Azissah, D., Suyanto, J., Sarasmita, M. A., Chipojola, R., Khwepeya, M., & Banda, K. J. (2025). Overview of the prevalence of loneliness and associated risk factors among older adults across six continents: A meta-analysis. Archives of Gerontology and Geriatrics, 128, 105627. https://doi.org/https://doi.org/10.1016/j.archger.2024.105627
  45. Susanty, S., Sarasmita, M. A., Sudarma, I. W., Azissah, D., Suyanto, J., Kamil, S., Budiman, B., & Suharjiman, S. (2023). Animated video development COVID-19 prevention and management for anxiety among older adults in Indonesia. Geriatr Nurs, 49, 13-21. https://doi.org/10.1016/j.gerinurse.2022.10.015
  46. Thaenpramun, R., Komolsuradej, N., Buathong, N., & Srikrajang, S. (2024). Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study. British Journal of Nutrition, 131(9), 1497-1505. https://doi.org/10.1017/S0007114524000175
  47. Vellas, B., Guigoz, P., Garry, P., Ondervoeding, T., Bejaarden, P., Zorgverlener, A., Guigoz, Y., Vellas, B., & Garry, P. (2009). Mini Nutritional Assessment (MNA®). Actualiseren van de bestaande BeST–databank & Aanvullen van de bestaande BeST–databank met nieuwe schalen, 28.
  48. Washburn, R. A., Smith, K. W., Jette, A. M., & Janney, C. A. (1993). The physical activity scale for the elderly (PASE): Development and evaluation. Journal of Clinical Epidemiology, 46(2), 153-162. https://doi.org/10.1016/0895-4356(93)90053-4
  49. World Health Organization (WHO). (2024a). Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
  50. World Health Organization (WHO). (2024b). Diabetes. https://www.who.int/health-topics/diabetes#tab=tab_1
  51. World Health Organization (WHO). (2025). Ageing and health in the South-East Asia Region. https://www.who.int/southeastasia/health-topics/ageing
  52. Yang, H., Wu, F., Gui, M., Cheng, Y., & Zhang, L. (2023). The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus. BMC Geriatrics, 23(1), 196. https://doi.org/10.1186/s12877-023-03929-8
  53. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. https://doi.org/https://doi.org/10.1016/0022-3956(82)90033-4