Prevalence of diabetes and impaired fasting glucose in urban population of Bangladesh.

We investigated the prevalence of type 2 diabetes (T2DM) and impaired fasting glycemia (IFG) and their risk factors in the urban population of Bangladesh. The study was carried out in Dhaka City Corporation with a population of 99,12,908 in 20,89,336 households distributed in 95 wards. Using a multistage cluster sampling, we investigated 5265 eligible participants of 20 age years and above for height, weight, waist-girth, hip-girth, blood pressure and fasting blood glucose. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. We used WHO diagnostic criteria of 1999. The overall prevalence of T2DM was 11.2% and IFG was 5.9%. The age-standardized prevalence of T2DM (95% CI) was 10.5% (9.37-11.13) and IFG was 5.2% (4.51-5.84). Compared with the slum dwellers, the non-slum dwellers had significantly higher prevalence of both T2DM (7.4 vs. 13.4%, p<0.001) and IFG (4.1 vs. 7.4%, p<0.001). Logistic regression analysis showed that family history of diabetes, higher family income, sedentary lifestyle and higher quartiles of age, BMI and WHR were significantly related to diabetes. The prevalence of diabetes in the urban population has increased alarmingly in recent years. Older age, obesity, higher income, family history of diabetes and reduced physical activity were proved to be the significant risk factors for diabetes and IFG.

Oyster mushroom reduced blood glucose and cholesterol in diabetic subjects.

It has been postulated that mushroom has beneficial effect of lowering blood glucose and cholesterol in diabetic subjects. The literature so far searched and found that there was no published data in this regard. This study was undertaken to assess the effect of reducing blood glucose, cholesterol and triglycerides in diabetic patients. Additionally, this study addressed whether there was any hepatic and renal toxicity of mushroom. This clinical investigation was conducted in BIRDEM hospital from July 2005 to January 2006. Eighty-nine subjects were recruited. Baseline investigations included height, weight, blood pressure (SBP, DBP), plasma glucose for fasting (FPG) and 2-h after-breakfast (2hPG), total cholesterol (T-chol), triglycerides (TG) and high-density lipoprotein (HDL-c). Twenty- four days' study constitutes 7-days mushroom, 7-days no mushroom and then 7-days mushroom. Investigations were done at the start and each after every 7-days. Thirty subjects (M / F = 17 / 13) followed to ensure full compliance with the designed protocol for 24 days. The mean (SD) age of the participants was 46.3 (10) years. Mushroom significantly reduced systolic and diastolic blood pressure (SBP, p<0.01; DBP, p<0.05). It also lowered both plasma glucose significantly (FPG & 2-hPG, p<0.001). Mushroom also lowered total cholesterol and TG significantly; whereas, there was no significant change in weight and HDL-c. When mushroom was withdrawn, there were significant increases of DBP, FPG, 2hPG, T-cholesterol and TG, whereas, no significant change was observed in weight, SBP and HDL-c. Restarting mushroom there was again significant reduction of blood glucose, TG and cholesterol. We conclude that mushroom significantly reduced blood glucose, blood pressure, TG and cholesterol of diabetic subjects without any deleterious effect on liver and kidney. The effect of mushroom may be investigated in a large sample for a longer duration to evaluate its efficacy and toxicity.

Fasting cut-offs in determining the prevalence of diabetes and intermediate glucose abnormality in a non-obese population.

The study was undertaken to compare the effect of ADA and WHO criteria for screening of diabetes mellitus (DM) and intermediate glucose abnormality (Impaired fasting glucose/Impaired glucose tolerance-IFG/IGT) and to explore an acceptable fasting cut-off in a population-based study. Ten suburb villages with a population of 11,895 were selected purposively. Of the total 6235 eligible (> or = 20y) subjects, 4144 volunteered. We took height, weight, hip- and waist-girth, blood pressure and fasting blood glucose (FBG). All participants were classified into Group-1 (Gr-1: n=453) and Group-2 (Gr-2: n=3691), based on FBG above and below 5.4 mmol/l, respectively. All from Gr-1 and 610 randomized subjects from Gr-2 were investigated for oral glucose tolerance test (OGTT), HbA1c and lipids. The mean (SD) of age, body mass index (BMI) and FBG of all participants was 37.6 (15.2) y, 19.4 (2.9), and 4.7 (0.9) mmol/l, respectively. The prevalence of diabetes and IFG/IGT using American Diabetes Association (ADA) criteria were compared with WHO criteria separately in Gr-1 and Gr-2. For group-1, ADA criteria could diagnose 5.9% as diabetes and 2.1% as IFG, whereas, WHO criteria diagnosed 11.5% diabetes and 19% IGT. Likewise, in Gr-2, ADA detected much less than WHO criteria (DM: 0.3 vs. 2.3%; IFG/IGT 1.0 vs. 14.6%). We compared fasting and 2 hours post-load glucose (2-hBG) values according to percentiles. We found that 11.1 of 2-hBG corresponded with a fasting value that lies between 90 to 95th percentile, equivalent to 5.1-5.7 mmol/l. Using receiver operating characteristics (ROC) curve, we determined the cut-offs 4.6 - 5.4 mmol/l for IFG and > or = 5.5 for diabetes. Taking age and BMI into account the kappa agreements were better between the estimated cut-offs and the given 2-hBG values. The ADA cut-offs were found ineffective for screening. We proposed the modified fasting cut-offs for screening IFG and diabetes among the non-obese population.

Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia.

Body mass index (BMI, kg/m.sq) and waist-to-hip ratio (WHR) are widely used as obesity indices for diabetes and cardiovascular risks. Lower adult height was related to diabetes and stroke. Waist-girth was proved important for visceral obesity. Incorporating waist-girth and height as waist-to-height ratio (WHtR), we reported earlier--"Waist-to-height ratio is an important predictor of hypertension and diabetes". We readdressed this index in a larger sample with two-sample OGTT and lipid profiles. In a cluster sampling of 16,818 rural inhabitants, considering age > or = 20 y, 5713 subjects were found eligible. Of them, 4923 (M/F=2321/2602) volunteered for height, weight, blood pressure, waist-girth and hip-girth. Fasting venous blood (5 ml) was drawn for plasma glucose, total cholesterol (T-chol), Triglycerides (TG) and high-density lipoprotien (HDL-c). Overall, 1565 participants were undertaken for OGTT. The mean (SD) values of BMI, WHR and WHtR for subjects with diabetes and hypertension were significantly higher in either sex. The level significance was highest for WHtR. The prevalence of diabetes and hypertension increased significantly with higher quintiles of BMI, WHR and WHtR (chi sq values were largest in WHtR for both events). Partial correlation coefficients, controlling for age and sex, showed that BMI, WHR and WHtR significantly correlated with systolic and diastolic BP, FBG, T-chol and TG. In the entire correlation matrix, the 'r' values were the highest for WHtR. Taking diabetes and hypertension as dependent variables, logistic regression also showed the highest odds ratio in higher WHtR than BMI and WHR. We conclude that WHtR was proved again a valuable obesity index for predicting diabetes, hypertension and lipidemia.

Prevalence of hypertension in Bangladesh: effect of socioeconomic risk factor on difference between rural and urban community.

Several studies reported that migrant Bangladeshis had greater risk for hypertension, diabetes and coronary heart disease compared with the Europeans and other migrant South Asians. So far, there has been no such study among the native population. This paper reports the hypertension prevalence and related risks among native Bangladeshis. A total of 2,361 subjects over 20 years of age were investigated. Overall prevalence rates of systolic and diastolic hypertension in the study population were 14.4 and 9.1 percent respectively. The prevalence of systolic hypertension was significantly higher in rural than in urban participants (P < 0.001). Compared with the poor the rich class had significantly higher prevalence of both systolic (P = 0.002) and diastolic (P = 0.041) hypertension. With increase of age, body mass index (BMI) and blood glucose level were significantly related to hypertension (P < 0.0001); whereas the trend for increasing waist-to-hip ratio (WHR), adjusting for social class, was not significant. Regression analysis showed that age, BMI, rural area and rich class were the strong predictors for hypertension. This study explored that hypertension prevalence in the native Bangladeshis is almost comparable to that of other Asian populations and South Asian migrants.

Genetic background of diabetic and nondiabetic sibs in young Bangladeshis.

The prevalence of diabetes mellitus in the young is higher in Bangladesh like other Asian developing nations. Albeit, undernutrition has been shown to be associated with diabetes in the young, not all such individuals are diabetic. Diabetes Mellitus is a multigenic disease. In IDDM, DR3/4 heterozygotes were shown to have a greatly increased risk of developing the disease, suggesting the concept of genetic factor(s) being involved in the development of diabetes. Therefore, this study was undertaken to determine the distribution of HLA class II alleles (DRB) and to identify the HLA associated risk for developing diabetes mellitus in the young Bangladeshis. A total of fifty individuals were investigated. Half of them (n=25) were diabetic patients, registered in BIRDEM and half the participants were their non-diabetic sibs. A genomic DNA PCR and Enzyme Linked Probe Hybridization Assay (ELPHA, Bio-test, Germany) was used to determine HLA class II alleles (DRB1, DRB 3, 4, 5) by in vitro amplification of DRB gene. Among all the sero-equivalent antigens found in the study subjects, the prevalence of DR15 (DR2) was overrepresented, both in the diabetic subjects and in their non-diabetic sibs. Moreover, compared with the non-diabetic group the diabetic patients showed higher frequency of DR15 alleles (39 and 25%) though the difference was not significant (chisq. 1.7, p>0.05). Next to DR15, DR4 was the most prevalent HLA-DRB gene found in the study population. Interestingly, the frequency of DR4 was higher in the diabetic than in the non-diabetic group (20 vs. 14%). The study showed that the DR15 and DR4 were the most prevalent in the study population. Moreover, DR7 though not very significant, was higher in non-diabetic compared to their diabetic sibs. Comparison between the diabetic and non-diabetic sibs could have been interesting and significant but we could not confirm our findings, possibly, due to small sample size. A study in a larger paired sample of unrelated population is also needed to substantiate our findings, and also to prove the susceptibility or resistant haplotype in the young diabetic subjects.