Smoking Habits, Stress, and Physical Activity in relation to Diabetes Mellitus: a nationwide study in Indonesia

Document Type : Original Article


1 Undergraduate Student, Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia

2 Assistant Professor, Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia


Background: Diabetes mellitus remains a primary chronic disease all around the world, including Indonesia. A poor lifestyle that includes smoking habits, stress, and lack of physical activities will increase the incidence of diabetes mellitus.This study aimed to explore the relationship of smoking habits, stress, and physical activity with diabetes mellitus incidence in Indonesia.
Methods: A total of 12,110 respondents from 13 provinces in Indonesia were interviewed and evaluated in a cross-sectional national-based population study in Indonesia. Multivariate binary logistic regression analysis was used to calculate the adjusted odds ratio value with a 95% confidence interval.
Results: Of the 12,110 respondents, 9,154 (75.59%) were ³ 45 years old and 6,704 (55.36%) had low physical activity.  Exposure to cigarette smoke (AOR = 0.73, 95% CI = 0.57-0.94, p < 0.05) and high or vigorous physical activity (AOR = 0.81, 95% CI = 0.67-0.9, p <0.05) were significantly related to diabetes mellitus.
Conclusion:Smoking habits and physical activity were highly associated with diabetes mellitus but stress was not. Therefore, health promotion measures for improvement of life style and prevention of diabetes mellitus are needed and should be organized by primary health care system.


Zhou B, Lu Y, Hajifathalian K, Bentham J, Cesare MD, Danaei G, et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet 2016; 387(10027):1513-30.
International Diabetes Federation. IDF Diabetes Atlas: Seventh Edition. Brussels, Belgium: International Diabetes Federation; 2015.
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017; 128:40-50.
World Health Organization. Global Report on Diabetes. France: WHO; 2016.
Charvat H, Goto A, Goto M, Inoue M, Heianza Y, Arase Y, et al. Impact of population aging on trends in diabetes prevalence: a meta-regression analysis of 160,000 Japanese adults. J Diabetes Investig 2015; 6(5):533-42.
Boles A, Kandimalla R, Reddy PH. Dynamics of diabetes and obesity: epidemiological perspective. Biochim Biophys Acta Mol Basis Dis 2017; 1863(5):1026-36.
Reddy PH. Can diabetes be controlled by lifestyle activities? Curr Res Diabetes Obes J 2017; 1(4): 555568
Pan A, Wang Y, Talaei M, Hu FB. Relation of smoking with total mortality and cardiovascular events among patients with diabetes: a meta-analysis and systematic review. Circulation 2015; 132(19):1795-804.
Wang Y, Qu H, Xiong X, Qiu Y, Liao Y, Chen Y, et al. Plasma asprosin concentrations are increased in individuals with glucose dysregulation and correlated with insulin resistance and first-phase insulin secretion. Mediators Inflamm 2018; 2018:9471583.
Salunkhe VA, Veluthakal R, Kahn SE, Thurmond DC. Novel approaches to restore beta cell function in prediabetes and type 2 diabetes. Diabetologia 2018; 61(9):1895-901.
Akter S, Goto A, Mizoue T. Smoking and the risk of type 2 diabetes in Japan: a systematic review and meta-analysis. J Epidemiol 2017; 27(12):553-61.
Cai X, Chen Y, Yang W, Gao X, Han X, Ji L. The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis. Endocrine 2018; 62(2):299-306.
Hilawe EH, Yatsuya H, Li Y, Uemura M, Wang C, Chiang C, et al. Smoking and diabetes: is the association mediated by adiponectin, leptin, or c-reactive protein? J Epidemiol 2015; 25(2):99-109.
Derek MI, Rottie J, Kallo V. Hubungan tingkat stres dengan kadar gula darah pada pasien diabetes mellitus tipe II di Rumah Sakit Pancaran Kasih GIMM Manado. J Keperawatan 2017; 5(1).
Hackett RA, Steptoe A. Type 2 diabetes mellitus and psychological stress - a modifiable risk factor. Nat Rev Endocrinol 2017; 13(9):547-60.
Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002; 25(12):2335-41.
Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010; 33(12): 2692-6.
Jadhav RA, Hazari A, Monterio A, Kumar S, Maiya AG. Effect of physical activity intervention in prediabetes: a systematic review with meta-analysis. J Phys Act Health 2017; 14(9):745-55.
Grøndahl MF, Bagger JI, Lund A, Faurschou A, Rehfeld JF, Holst JJ, et al. Effects of smoking versus nonsmoking on postprandial glucose metabolism in heavy smokers compared with nonsmokers. Diabetes Care 2018; 41(6):1260-7.
Seifu W, Woldemichael K, Tsehaineh T. Prevalence and risk factors for diabetes mellitus and impaired fasting glucose among adults aged 15-64years in gilgel gibe field research center, southwest Ethiopia, 2013: through a who step wise approach. MOJ Public Health 2015; 2(4):136-43.
Soelistijo SA, Novida H, Rudijanto A, Soewondo P, Suastika K, Manaf A, et al. Konsensus: pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2015. Indonesia: PB. PERKENI; 2015.
Dolongseda FV, Massie G, Bataha Y. Hubungan pola aktivitas fisik dan pola makan dengan kadar gula darah pada pasien diabetes melitus tipe 2 di poli penyakit dalam rumah sakit Pancaran Kasih Gmim Manado. Jurnal Keperawatan UNSRAT 2017; 5(1).
Jonsdottir IH, Rödjer L, Hadzibajramovic E, Börjesson M, Ahlborg G. A prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers. Prev Med 2010; 51(5):373-7.
Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol 2018; 14(2):88-98.
Kohnert KD, Heinke P, Vogt L, Salzsieder E. Utility of different glycemic control metrics for optimizing management of diabetes. World J Diabetes 2015; 6(1):17-29.
White NH, Sun W, Cleary PA, Danis RP, Davis MD, Hainsworth DP, et al. Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus. Arch Ophthalmol 2008; 126(12):1707-15.
Chew EY, Lovato JF, Davis MD, Gerstein HC, Danis RP, Ismail-Beigi F, et al. Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study. Diabetes Care 2016; 39(7):1089-100.
Śliwińska-Mossoń M, Milnerowicz H. The impact of smoking on the development of diabetes and its complications. Diab Vasc Dis Res 2017; 14(4):265-76.
World Health Organization. WHO Diabetes Country Profile. WHO; 2016.
Zanuso S, Jimenez A, Pugliese G, Corigliano G, Balducci S. Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetol 2010; 47(1):15-22.
Mann S, Beedie C, Balducci S, Zanuso S, Allgrove J, Bertiato F, et al. Changes in insulin sensitivity in response to different modalities of exercise: a review of the evidence. Diabetes Metab Res Rev 2014; 30(4):257-68.
Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011; 34(5):1228-37.
Alanazi FK, Alotaibi JS, Paliadelis P, Alqarawi N, Alsharari A, Albagawi B. Knowledge and awareness of diabetes mellitus and its risk factors in Saudi Arabia. Saudi Med J 2018; 39(10):981-9.
Alsous M, Jalil MA, Odeh M, Kurdi RA, Alnan M. Public knowledge, attitudes and practices toward diabetes mellitus: A cross-sectional study from Jordan. PLoS One 2019; 14(3):e0214479.