Rising prevalence of diabetes and prediabetes among Bangladeshi factory workers

To determine the prevalence of type 2 diabetes (T2DM) and prediabetes - impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and associated risk determinants in Bangladeshi factory w orkers. A total of 791 male factory w orkers aged ≥20 years in the capital Dhaka city of Bangladesh w ere investigated. Anthropometric details, blood pressure and metabolic parameters w ere studied. We used the 2006 WHO diagnostic criteria for the diagnosis of T2DM and prediabetes. The age - standardized prev alence of T2DM, IFG and IGT w ere 15.4, 17.7, and 25.8%, respectively. The prevalence of IFG and IGT increased w ith age. Among the study population, 38.9% had family history of diabetes (F/H DM), 27.9% hypertension (HTN), general obesity defined by body mas s index (BMI) was 43.7% and central obesity defined by w aist circumference (WC) and w aist -hip ratio (WHR) w ere 35.3% and 78.3%, respectively. Poor agreement w as observed betw een fasting and 2 hr blood glucose. Employing logistic regression, it w as found that increased age, F/H DM, higher BMI and WHR, and HTN w ere independent risk indicators for T2DM. Increased age and higher BMI w ere also independent risk indicators for prediabetes. The prevalence of T2DM and prediabetes w ere found relatively high in these factory w orkers. Obesity and HTN w ere also observed high in this study population

Hospital-based prevalence of chronic kidney disease among the newly registered patients with diabetes

Chronic kidney disease (CKD) is proved to be a major public health issue worldwide and an important contributor to the overall non-communicable disease burden. It increases risk of mortality, end-stage renal disease and accelerated cardiovascular disease (CVD). Diabetes is the biggest contributor to CKD and end stage renal disease (ESRD). In Bangladesh, very few data on CKD is available. This study aimed to estimate the prevalence of CKD among the newly registered diabetic patients at BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders), a referral center for diabetes in Bangladesh. Methods: The study included all diabetic patients aged 18 - 80 years and were registered in the year 2012. Socio-demographic (age, sex, residence, income, literacy), clinical (obesity, blood pressure) and biochemical (blood glucose, lipids, eGFR) information were collected from the BIRDEM registry. CKD was defined according to the K/ DOQI guidelines. Results: A total of 1317 type 2 diabetic patients of age 18 to 80 years were studied. Of them, men and women were 54.7% and 45.3%, respectively. The overall prevalence of CKD (eGFR ≤60 (ml/min/m2)) was 13.9%. The prevalence was significantly higher in women than men (21.3 v. 7.8%, p50y), higher sBP (≥140mmHg) and taking oral hypoglycemic agent (OHA) were significant. Conclusions: Thus, the study concludes that the prevalence of CKD among the newly registered diabetic patients is quite high in Bangladesh. The female diabetic patients with older age and with higher SBP bear the brunt of CKD. Considering high prevalence of CKD with severe lifelong complications it is of utmost importance for early detection and intervention at the primary health care (PHC) level

Increasing Diabetes Healthcare Capacity in Bangladesh through a Distance Learning Project

The purpose of this study was to evaluate the impact of the Distance Learning Program (DLP) on provider capacity to provide comprehensive diabetes care and improvement on patient outcomes in Bangladesh. Study was conducted among 1974 DLP trained physicians, 1876 Non-DLP physicians and 2617 diabetic patients. In addition, quality of patient care and clinical outcomes before and after the implementation of DLP were also studied. Historical documents including patient case records from registered patient guidebooks and biochemical profiles from laboratory database were documented and analyzed. DLP physicians had more knowledge in each clinical practice guideline of diabetes care than Non-DLP physicians (odds ratio [OR] range: 2.2 to 11.7). DLP-trained physicians performed more diabetes-related examinations including blood pressure (OR=3.0), waist and hip circumference (OR= 2.6), BMI (OR= 2.6), foot (OR= 2.2), eye (OR= 2.0) and investigated blood glucose (OR= 2.2), hemoglobin A1c (A1C) (OR= 2.1), lipids (OR=1.9), creatinine (OR=1.9), micro albumin (OR=1.8) and ECG (OR=1.6) more than non-DLP physicians. DLP physicians felt more confident to give advice on key areas of diabetes care including diet (OR=2.9), physical activity (OR=3.0), smoking cessation (OR=2.5), foot care (OR=2.9) and complications related to diabetes (OR=2.8) than non-DLP doctors. Significant improvement of patients care including dietary advice (91 to 96%), frequency of clinic visits (3 to 3.6 time), foot care referral (3 to 8%), measurement of blood pressure (73.1 to 89.2%) and blood glucose (58 to 75%) were observed from pre to post DLP period. Average values of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) significantly decreased in post DLP period. Patient satisfaction also improved between pre to post DLP period. DLP is feasible and acceptable to physicians in Bangladesh. It has made highly positive impact on patients care. We recommend that other resource-poor settings should consider the adoption of a DLP

Risk of coronary heart disease in type 2 diabetes: a follow-up study of Bangladeshi population

The aim of this study was to determine the potential risk factors of CHD in Type 2 diabetic patients. We studied 2887 diabetic patients from the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) registry record books for the period from 1984 to 1997. We included socio- demographic information (age, sex, residence and education), anthropometry (height, weight) and blood pressure. Body mass index (BMI) and mean arterial blood pressure (MABP) were calculated. Also, the time from the diagnosis of type 2 diabetes mellitus (T2DM) to the occurrence of CHD was recorded. We used the logistic regression model and examined the potential risk factors. We have studied 2887 Type 2 diabetic patients. Among them male and female participants were 67.3% and 32.7% respectively. Their mean (SD) age was 52.69 (12.41) years, BMI was 22.92 (3.80) and MABP was 97.26 (11.53). The mean (SD) of 2-hBG was 12.39 (3.37) mmol/l. The subject with advanced age (1.7 vs. 5.7%; χ2=11.12, p= 0.001), increasing BMI (p=0.000) and MABP (p=0.000), and urban (p=0.000) participant had significantly higher prevalence of CHD than compared with the lower (age ≤ 40, BMI ≤ 21.46, MABP ≤ 93.33 ) groups and rural counterpart. The logistic regression analysis also showed that urban subjects, literate population, and increased age, BMI and MABP were the important risk factors of CHD with diabetes. We conclude that older age, obesity and high blood pressure were significant risk factors of CHD with diabetes. Compared with rural subjects, the urban subjects showed significantly greater risk for CHD. We couldn′t find any correlation with the increasing 2-hBG as a significant risk factor of CHD