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Clinical characteristics and complications of patients with type 2 diabetes attending an urban hospital in Bangladesh
Abstract and Figures
Aims: To investigate the clinical features of patients with type 2 diabetes on oral medication and determine the complications and risk factors in these patients.
Methods: A cross-sectional was conducted among 515 patients with type 2 diabetes at the outpatient clinics of Bangladesh Institute of Health Science (BIHS) hospital from September to December 2013. We collected data on socio-economic characteristics, clinical status, risk factors, complications, anthropometric measurements and blood tests. Univariate and multivariate logistic regression was performed to identify risk factors associated with diabetes complications.
Results: The mean(±SD) age of the participants was 50.0(±10.1) years and 15.3% were less than 40 years. The mean HbA1c was 8.3(±2.1). Only 28.7% of the participants achieved targets for HbA1c. The overall prevalence of hypertension, obesity and dyslipidemia was 57.5%, 62.6% and 72.7% respectively. Eye problems were the most common complication (68.9%) followed by chronic kidney diseases (21.3%) and cardiovascular diseases (11.8%). There were significant associations between the complications and age, duration of diabetes and duration of hypertension. In the multivariate analysis adjusting for other confounding variables, only systolic blood pressure was found to be significantly associated with complications [OR 0.809, 95% CI 0.666-0.981, (p-value 0.031)].
Conclusion: Results of the study confirms that even under best clinical settings a great majority Bangladeshi adults with type 2 diabetes have uncontrolled diabetes and a high prevalence of risk factors that might contribute to early development of complications. Early screening of high risk groups and proper management of diabetes is recommended to avoid early complications.
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... By 2045, diabetes is expected to afflict 693 million individuals globally, making it one of the illnesses with the greatest rate of growth (Cole & Florez, 2020). Devastating microvascular consequences (diabetic retinopathy, diabetic kidney disease, and neuropathy) and macrovascular complications (cardiovascular disease) raise the risk of death, cause blindness or kidney failure, and generally lower the quality of life for people with diabetes (Cole & Florez, 2020;Islam et al., 2015). Most of the patients with diabetes mellitus have a challenge in self-care which poses a greater risk for complications (da Rocha et al., 2020;Shetty et al., 2021). ...
... There is however a weak positive correlation between specific complication and duration of diabetes mellitus (r=0.070). similar findings have been documented by other authors (Faselis et al., 2020;Islam et al., 2015) Whether the respondents buy drugs, affordability of drugs, availability of drugs, payment for lab test, affordability of tests, availability of RBS, dedicated room for diabetic patients, assigned staff for diabetic patients and whether patient is called or not for clinic appointment did not significantly influence the development of chronic complications (p>0.05). ...
Background: Diabetes can have a good prognosis when medical assistance is provided in good time in about 60% of patients across the globe. In Kenya diabetes has been associated with a poor prognosis that is very rapid from the day of diagnosis of a diabetic patient that has led to increased mortality and deformities within short duration of illness. Objectives: The main was to determine the factors associated with chronic complications of diabetes mellitus. Methods: The study was a cross sectional study design. Sample size was determined by Yamane Taro formular in which 50 participants were selected using simple random sampling. Data in the current study was collected using structured questionnaire. Results: There is no significant variation in the ages of the patients who have chronic complications of diabetes mellitus at JOOTRH during the study period. (F=1.302, p=0.258, df=1). This would suggest that chronic diabetes complications occur across all age's patients with diabetes mellitus. Duration of diabetes mellitus was a significant determinant of chronic complications in both type 1 and type 2 diabetes mellitus (p=0.047). Sex, employment status, education level, religion and marital status were not associated with chronic complications among diabetic patients either in type1 or type 2. There was no significant variation in specific chronic complications of diabetes mellitus (F=0.251, df=1, p=0.618). There was no statistically significant relationship (p=0.626) between specific complications and duration of diabetes mellitus. There is however a weak positive correlation between specific complication and duration of diabetes mellitus (r=0.070). Whether the respondents buy drugs, affordability of drugs, availability of drugs, payment for lab test, affordability of tests, availability of RBS, dedicated room for diabetic patients, assigned staff for diabetic patients and whether patient is called or not for clinic appointment did not significantly influence the development of chronic complications (p>0.05). Conclusion: Age is the only sociodemographic factor that significantly determine the development of diabetes mellitus chronic complications. Duration of diabetes mellitus is associated with more diabetes complications. Institutional factors did not determine development of diabetes mellitus complications. Duration of diabetes mellitus greatly determine the development of diabetes mellitus complications.
... In a study the overall prevalence of hypertension, obesity, dyslipidemia, and chronic kidney diseases were found 57.5%, 62.6%, 72.7%, & 21.3% respectively, for SBP mean ± SD was 131.56± 17.60, for DBP mean ± SD was 79.38 ± 10.10. [26]. ...
... In a study the overall prevalence of hypertension, obesity, dyslipidemia, and chronic kidney diseases were found 57.5%, 62.6%, 72.7%, & 21.3% respectively, for SBP mean ± SD was 131.56± 17.60, for DBP mean ± SD was 79.38 ± 10.10. [26]. ...
People's lifestyles are changing a lot with time. Busy working life, indifference to ideal living, addiction to yummy junk food and lack of physical activity are causing many health hazards. Due to changes in lifestyle and dietary habits, the prevalence of several diseases has increased, among which diabetes can be identified as one of them. Diabetes is a chronic disease that affects people of all ages. There are several forms of diabetes. Type 2 is the most common. The number of people in Bangladesh who have type-2 diabetes has increased dramatically making it one of the country's major health problems. The rising prevalence of diabetes in Bangladesh is associated with overweight, age, family history of diabetic, physical activity, eating habit of high carbs food etc. So, we collected 320 individuals affected or take medication or checks themselves in any Diabetic Center in Gopalganj district for treatment or any suggestions. The aim of the study is to explain the status of diabetes affected peoples on average result and to find out any certain factor which relates to the disease. The variables included the age of the patient, job category, exercise time, meal plan and some other important factor that is considered to be related to diabetes. The dependent variable was chosen as the blood glucose level of the respondents. We used chi-square test and logistic regression to find any significant relation that can be described. Logistic regression analysis identified some important factors that significantly affect the blood glucose level of the respondents, namely average sleep time, rice for breakfast, diet, red meat, smoking and age.
People's lifestyles are changing a lot with time. Busy working life, indifference to ideal living, addiction to yummy junk food and lack of physical activity are causing many health hazards. Due to changes in lifestyle and dietary habits, the prevalence of several diseases has increased, among which diabetes can be identified as one of them. Diabetes is a chronic disease that affects people of all ages. There are several forms of diabetes. Type 2 is the most common. The number of people in Bangladesh who have type-2 diabetes has increased dramatically making it one of the country's major health problems. The rising prevalence of diabetes in Bangladesh is associated with overweight, age, family history of diabetic, physical activity, eating habit of high carbs food etc. So, we collected 320 individuals affected or take medication or checks themselves in any Diabetic Center in Gopalganj district for treatment or any suggestions. The aim of the study is to explain the status of diabetes affected peoples on average result and to find out any certain factor which relates to the disease. The variables included the age of the patient, job category, exercise time, meal plan and some other important factor that is considered to be related to diabetes. The dependent variable was chosen as the blood glucose level of the respondents. We used chi-square test and logistic regression to find any significant relation that can be described. Logistic regression analysis identified some important factors that significantly affect the blood glucose level of the respondents, namely average sleep time, rice for breakfast, diet, red meat, smoking and age. Keywords: Food habits, Diabetes, blood glucose level, Chi-square test, Logistic regression.
Abstract: Jobs in the banking sector are perceived challenging and stressful;
therefore, the likelihood of hypertension among the bank employees is high.
However, no previous study investigated the prevalence and associated factors of
hypertension among the bank employees in Bangladesh. Therefore, in this study, we
estimated prevalence and risk factors of hypertension among a sample of bank
employees in Dhaka city, Bangladesh. A cross-sectional design was employed to
collect data from the 180 bank employees selected conveniently. Multiple logistic
regression was conducted to observe the factors associated with hypertension.
Prevalence of hypertension and pre-hypertension among the respondents were
24.44% and 32.22%, respectively. Furthermore, more than half of those found with
hypertension were previously undiagnosed. We found that bank employees’ sex,
family size, monthly salary, parental hypertension, parental diabetes, parental renal
disease, and daily meat consumption were the factors significantly associated with
hypertension. Our findings indicated that hypertension prevalence among the
respondents was higher than that of national prevalence. Awareness build-up and
healthy lifestyle is recommended to prevent hypertension associated morbidity and
mortality in the future. Further studies could be carried out to identify the causal
mechanisms of hypertension and appropriate interventions to address the issue.
Jobs in the banking sector are perceived challenging and stressful; therefore, the likelihood of hypertension among the bank employees is high. However, no previous study investigated the prevalence and associated factors of hypertension among the bank employees in Bangladesh. Therefore, in this study, we estimated prevalence and risk factors of hypertension among a sample of bank employees in Dhaka city, Bangladesh. A cross-sectional design was employed to collect data from the 180 bank employees selected conveniently. Multiple logistic regression was conducted to observe the factors associated with hypertension. Prevalence of hypertension and pre-hypertension among the respondents were 24.44% and 32.22%, respectively. Furthermore, more than half of those found with hypertension were previously undiagnosed. We found that bank employees’ sex, family size, monthly salary, parental hypertension, parental diabetes, parental renal disease, and daily meat consumption were the factors significantly associated with hypertension. Our findings indicated that hypertension prevalence among the respondents was higher than that of national prevalence. Awareness build-up and healthy lifestyle is recommended to prevent hypertension associated morbidity and mortality in the future. Further studies could be carried out to identify the causal mechanisms of hypertension and appropriate interventions to address the issue.
Aim: The objective of the study was to determine the clinical factors associated with
knowledge and self-care practice among adults living with type 2 diabetes mellitus.
Design: Descriptive cross-sectional design.
Methods: A convenience sample of 330 participants was recruited over 3-months
in 2018 and data were collected using a structured instrument.
Results: Participants on insulin treatment modality had four times higher odds
of knowledge on diabetes (B = 4.17, p = 0.023) while those on combined therapy
(both oral hypoglycaemic agent and insulin) had 7.26 times higher odds of knowledge (B = 7.26, p < 0.001). Participants without medically confirmed diabetic complications had 3.66 higher odds of knowledge of diabetes (B = 3.66, p = 0.002). Participants on insulin treatment modality had a 1.4-fold higher odds of self-care
practice (B = 1.4, p = 0.028). It was revealed that participants with hypertension and diabetic foot had lower odds of self-care practice (B = −1.13, p = 0.021).
Conclusion: In particular, participants who were on insulin and combined therapy
(tablet and insulin) had higher knowledge and better self-care practice. Self-care
was significantly influenced among those with, than those without diabetic foot and hypertension as complications.
Background: Diabetes distress is a condition distinct from depression that is related to diabetes outcomes.This study intends to identify the predicting risk factors of diabetes distress in Bangladeshi type 2 diabetes mellitus patients. Methods: A cross sectional study was conducted from January to June, 2012 in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. Data were collected through interview and reviewing documents. Results: Among 165 respondents, the proportion of diabetes distress was 48.5% (n=80) which include 22.4% (n=37) high distress and 26.1% (n=43) moderate distress. Glycemic status measured by HbA 1c was the best predictor of diabetes distress [Adjusted odds ratio (AOR) 1.56; 95% Confidence Interval (CI) 1.16 to 2.10]. Insulin users were five times more likely to develop distress [Adjusted odds ratio (AOR) 5.05; 95% Confidence Interval (CI) 1.20 to 21.19] than users of oral anti-diabetic agents. Other predictors of diabetes distress were duration of DM [Adjusted odds ratio (AOR) 1.27; 95% Confidence Interval (CI) 1.06 to 1.52], Diabetic complications [Adjusted odds ratio (AOR) 3.92; 95% Confidence Interval (CI) 1.09 to 14.19], Average monthly family income [Adjusted odds ratio (AOR) 1.00; 95% Confidence Interval (CI) 1.00 to 1.00]. Conclusion: HbA 1c , treatment modalities, duration of DM, diabetic complications and average monthly family income appeared to be significant predicting factors of diabetes distress among the type 2 diabetes mellitus patients. This should be taken into consideration for effective management of patient.
In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health status in populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality worldwide with and a serious public health threat to developing countries. Recognizing the importance and urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was to understand the current situation of different NCD public health programs and the current trends in NCD research and policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy participants representing scientists, physicians, academics and students from several institutes in Germany
and abroad. Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the participants to learn about evidence-based practices and policies for prevention and management of major NCDs and to debate the way forward.
Background. Mobile phone technologies including SMS (short message service) have been used to improve the delivery of health services in many countries. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. The aim of this study therefore is to measure the impact of a mobile phone SMS service on treatment success of newly diagnosed type 2 diabetes in an urban area of Bangladesh.
Methods. This is a single-centred randomized controlled intervention trial (prospective) comparing standard-of-care with standard-of-care plus a mobile phone-based SMS intervention for 6 months. A total of 216 participants with newly diagnosed type 2 diabetes will be recruited. Data will be collected at the outpatient department of Bangladesh Institute of Health Science (BIHS) hospital at baseline and after 6 months. The primary outcome measure will be change in HbA1c between baseline and 6 months. The secondary outcome measures are self-reported medication adherence, clinic attendance, self-reported adoption of healthy behaviours, diabetes knowledge, quality of life and cost effectiveness of the SMS intervention. The inclusion criteria will be as follows: diagnosed as patients with type 2 diabetes by the BIHS physician, using oral medication therapy, living in Dhaka city, registered with the BIHS hospital, using a mobile phone, willing to return for follow up after 6 months and providing written informed consent. Participants will be allocated to control and intervention arms after recruitment using a randomization software. Data will be collected on Socio-demographic and economic information, mobile phone use and habits, knowledge of prevention, management and complications of diabetes, self-perceived quality of life assessment, self-reported diseases, medical history, family history of diseases, medication history, medication adherence, health seeking behaviour, tobacco use, physical activity, diet, mental health status, life events and disability, anthropometric measurements of weight, height, blood pressure and blood tests for HbA1c.
Discussion. Mobile phone SMS services have the potential to communicate with diabetes patients and to build awareness about the disease, improve self-management and avoid complications also in resource-limited setting. If this intervention proves to be efficient and cost-effective in the current trial, large-scale implementation could be undertaken. Trial Registration: DRKS00005188
To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors.
Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities.
The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence.
Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.
A territory-wide diabetes management program (Risk Assessment Management Program - RAMP) was recently established, providing comprehensive management for all diabetics, helping to delineate current level of control and complications prevalence among primary care diabetic patients in Hong Kong.
This cross-sectional study captured anonymous clinical data from RAMP patients. Data obtained include sociodemographic details, type of diabetes, illness duration, family history, drug usage, coexisting illnesses, diabetic complications and other clinical parameters.
Data from 15,856 type 2 diabetic patients were analyzed. 57.1% were above 60 years old, with mean disease duration of 7.3 years. Hypertension was the commonest coexisting chronic illness (57.6%). 30.2% and 61.8% have their systolic and diastolic pressure controlled to below 130 mmHg and 80 mmHg respectively. Over half (51.5%) had an HbA1c level of less than 7.0%. 88.4% did not achieve target lipid level. 15% were on diet control alone . Only 22.2% were on statins. In patients with microalbuminuria and macroalbuminuria, 40.7% and 54.5% were on angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) respectively. 12.9%, 38.8% and 2.4% had diabetic retinopathy, nephropathy and neuropathy respectively. Overall, 37.9%, 7.3% and 0.4% had single, two and three concurrent microvascular complications respectively.
The level of diabetic control is comparable with other developed countries. We demonstrated a high prevalence of microvascular complications among Chinese primary care patients despite achieving adequate HbA1c levels, highlighting the importance of managing all aspects of diabetes including weight, lipid and blood pressure. Efforts to improve holistic management must be tailored according to the needs of our population, with the challenges that the majority have low educational background and in the older age group.
Background
Obesity is a risk factor for type 2 diabetes (DM); however, no study has specially assessed the anthropometric indices as predictors of diabetes in rural Bangladeshi population.
Objective
To identify markers for diabetes through body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and waist height ratio (WHtR) and identify the optimal cut-off values suitable for Bangladeshi adult population.
Methods
A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey. Age adjusted data for anthropometric indices and diabetes risk were assessed and their relationships were examined.
Results
Age adjusted prevalence of DM in men and women were 9.5% and 7.0%, respectively. Both men and women with DM had a higher rate of general obesity (defined by BMI) and central obesity (defined by WC, WHR and WHtR) than non-diabetic subjects. In both men and women the most sensitive indice was WHR for predicting DM. The appropriate cut-offs values for WHR to predict DM in men and women were 0.93 and 0.87, respectively. WC of 82 cm for both sexes was appropriate to predict DM. Those of BMI and WHtR were 21.2 kg/m2, 21.8 kg/m2 and 0.53, 0.54 in men and women, respectively.
Conclusions
Compared with BMI, measures of central obesity, WHR, WC, WHtR showed a better association with the risk of DM for both sexes in rural Bangladeshi population. Follow-up studies are needed for validifying these cut-offs values.
Background: Diabetes distress is a condition distinct from depression that is related to diabetes outcomes. This study intends to identify the predicting risk factors of diabetes distress in Bangladeshi type 2 diabetes mellitus patients.
Methods: A cross sectional study was conducted from January to June, 2012 in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. Data were collected through interview and reviewing documents.
Results: Among 165 respondents, the proportion of diabetes distress was 48.5% (n=80) which include 22.4% (n=37) high distress and 26.1% (n=43) moderate distress. Glycemic status measured by HbA1c was the best predictor of diabetes distress [Adjusted odds ratio (AOR) 1.56; 95% Confidence Interval (CI) 1.16 to 2.10]. Insulin users were five times more likely to develop distress [Adjusted odds ratio (AOR) 5.05; 95% Confidence Interval (CI) 1.20 to 21.19] than users of oral anti-diabetic agents. Other predictors of diabetes distress were duration of DM [Adjusted odds ratio (AOR) 1.27; 95% Confidence Interval (CI) 1.06 to 1.52], Diabetic complications [Adjusted odds ratio (AOR) 3.92; 95% Confidence Interval (CI) 1.09 to 14.19], Average monthly family income [Adjusted odds ratio (AOR) 1.00; 95% Confidence Interval (CI) 1.00 to 1.00].
Conclusion: HbA1c, treatment modalities, duration of DM, diabetic complications and average monthly family income appeared to be significant predicting factors of diabetes distress among the type 2 diabetes mellitus patients. This should be taken into consideration for effective management of patient.
Keywords: Diabetes distress, Type 2 diabetes mellitus, Predictors, Glycaemic status, Treatment modalities of DM
