Interaction of Body Mass Index and Place of Residence as a Modifier of Diabetes Risk among Indonesian Adults

Diabetes mellitus (DM) is a public health emergency. Prior studies have examined the independent effect of body mass index (BMI) and urban and rural environments on the risk of diabetes. However, the interaction of BMI and residence settings on the risk of diabetes has not received much attention. This study sought to examine the interaction between BMI and place of residence on diabetes. This was a cross-sectional study using the 5th wave of the Indonesian Family Life Survey among individuals aged 15 and over. A total of 7,579 participants were selected for HbA1c testing. Sex, age, BMI, diabetes (HbA1c), childhood hunger, fried food consumption, physical activity, and place of residence were analyzed using a multiple logistic regression. This interaction analysis used normal-weight people who live in rural areas as the comparator. We found that obese individuals residing in urban areas are four times more likely to develop diabetes (OR= 4.92; 95% CI=3.27 to 7.40; p<0.001). Meanwhile, obese individuals living in rural settings face a greater risk of diabetes (OR= 6.60; 95% CI= 3.89 to 11.21; p<0.001). This study concludes that obesity has a strong impact on people with diabetes who live in both rural and urban settings. Enhancing obesity management programs and improving accessibility to a supportive physical environment are essential strategies to prevent diabetes in rural area.