Simple risk score to detect rural Asian Indian (Bangladeshi) adults at high risk for type 2 diabetes.

AIMS/INTRODUCTION: To develop and evaluate a simple, non-invasive, diabetes risk score for detecting individuals at high risk for type 2 diabetes in rural Bangladesh. MATERIALS AND METHODS: Data from 2,293 randomly selected individuals aged ≥20 years from a cross-sectional study in a rural community of Bangladesh (2009 Chandra Rural Study) was used for model development. The validity of the model was assessed in another rural cross-sectional study (2009 Thakurgaon Rural Study). The logistic regression model used included age, sex, body mass index, waist-to-hip ratio and hypertension status to predict individuals who were at high risk for type 2 diabetes. RESULTS: On applying the developed model to both cohorts, the area under the receiver operating characteristic curve was 0.70 (95% confidence interval 0.68-0.72) for the Chandra cohort and 0.71 (95% confidence interval 0.68-0.74) for the Thakurgaon cohort. The risk score of >9 was shown to have the optimal cut-point to detect diabetes. This score had a sensitivity of 62.4 and 75.7%, and specificity of 67.4 and 61.6% in the two cohorts, respectively. This risk score was shown to have improved sensitivity and specificity to detect type 2 diabetes cases compared with the Thai, Indian, Omani, UK, Dutch, Portuguese and Pakistani diabetes risk scores. CONCLUSIONS: This simple, non-invasive risk score can be used to detect individuals at high risk for type 2 diabetes in rural Bangladesh. Subjects with a score of 9 or above (out of 15) should undergo an oral glucose tolerance test for definitive diagnosis of diabetes.

Obesity and associated type 2 diabetes and hypertension in factory workers of Bangladesh.

BACKGROUND: Recent data suggest that the prevalence of obesity and its associate cardiometabolic risks are increasing in Bangladesh. Published data of obesity in Bangladeshi industry workers is scarce. The purpose of this study was to assess the prevalence of general and central obesity in Bangladeshi factory workers and their associations with diabetes and hypertension. METHODS: A total of 791 male factory workers aged ≥ 20 years in capital Dhaka city of Bangladesh were investigated in a population-based cross-sectional survey. According to the International Association for the Study of Obesity and the International Obesity Task Force guidelines for Asian population, general obesity was defined as body mass index (BMI) ≥ 25 kg/m(2), central obesity was defined as a waist circumference (WC) of ≥ 90 cm and waist hip ratio (WHR) of ≥ 0.90. Pearson's correlation coefficient and logistic regression analysis were used to observe the association between anthropometric indices (BMI, WC and WHR) and cardiometabolic risk indicators (FBG, 2 hBG, SBP and DBP). RESULTS: The prevalence of overweight (BMI 23-24.9 kg/m(2)) and general obesity (BMI ≥ 25 kg/m(2)) in this study population was 29.8 and 43.5% respectively. Central obesity defined by WC and WHR was 35.3 and 78.3% respectively. Both general and central obesity were found to be significantly associated with diabetes and hypertension in separate logistic regression analyses. CONCLUSION: The prevalence of general and central obesity in Bangladeshi factory workers was high, and it was associated with diabetes and hypertension.

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants.

BACKGROUND: Obesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population. METHODS: 2293 subjects aged ≥ 20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined. RESULTS: The age standardized prevalence of overweight (BMI 23-24.9 kg/m(2)) and obesity (BMI ≥ 25 kg/m(2)) were 17.7 (95% confidence interval (CI): 16.1, 19.2%) and 26.2% (95% CI: 24.4, 27.9%), respectively. The age standardized prevalence of central obesity based on WC (M ≥ 90 & F ≥ 80 cm) and WHR (M ≥ 0.90 & F ≥ 0.80) were 39.8% (95% CI: 37.9, 41.7%) and 71.6% (95% CI: 69.8, 73.4%) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity. CONCLUSIONS: In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity.

Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and International Diabetes Federation definitions.

AIMS/INTRODUCTION: To compare the prevalence of metabolic syndrome (MS) using the modified National Cholesterol Education Program Adult Treatment Plan III (NCEP) and the International Diabetes Federation (IDF) definitions and, using both definitions, determine and compare the association of MS, prediabetes, type 2 diabetes, hypertension (HTN) and cardiovascular disease risk (CVD). MATERIALS AND METHODS: A total of 2,293 randomly selected participants (aged ≥20 years) in a rural community in Bangladesh were investigated in a population-based cross-sectional study. Sociodemographic and anthropometric characteristics, blood pressure, blood glucose, and lipid profiles were studied. Age-adjusted data for MS and cardiometabolic risk factors were assessed, and their relationships were examined. RESULTS: The age-adjusted prevalence of MS was 30.7% (males 30.5%; females 30.5%) using the NCEP definition, and 24.5% (males 19.2%, females 27.5%) using the IDF definition. The prevalence of MS using the NCEP definition was also higher in study participants with prediabetes, type 2 diabetes, HTN and CVD risk. The agreement rate between both definitions was 92% (k = 0.80). The NCEP definition had a stronger association with type 2 diabetes and HTN (odds ratio 12.4 vs 5.2; odds ratio 7.0 vs 4.7, respectively) than the IDF definition. However, the odds ratios for prediabetes and CVD risk were not significantly different. CONCLUSIONS: The prevalence of MS was higher using the NCEP definition, and was more strongly associated with prediabetes, type 2 diabetes, HTN and CVD in this Bangladeshi population.

Association of general and central obesity with diabetes and prediabetes in rural Bangladeshi population.

BACKGROUND AND AIMS: Recent data shown that both general and central obesity indices are significantly associated with diabetes (T2DM) and prediabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]). Data regarding association of obesity with T2DM and prediabetes in rural Bangladeshi population is scarce. This study aims to observe the association of general and central obesity with diabetes (T2DM) and prediabetes in rural Bangladeshi population. MATERIALS AND METHODS: A total of 2293 rural Bangladeshi adults aged ≥20 years were randomly selected in a population-based, cross-sectional survey which was conducted in 2009. The association of general (defined by body mass index [BMI]) and central obesity (defined by waist circumference [WC] and waist hip ratio [WHR]) with T2DM and prediabetes was assessed by using receiver operating characteristic curve analysis and logistic regression. RESULTS: Subjects with T2DM, IGT and IFG had a higher rate of general and central obesity than normal subjects. WHR was more closely associated with T2DM than WC and BMI. However, all three obesity indices were significantly associated with IGT and IFG. CONCLUSIONS: In rural Bangladeshi population, both general and central obesity showed good association with T2DM and prediabetes.

Anthropometric indices of obesity and type 2 diabetes in Bangladeshi population: Chandra Rural Diabetes Study (CRDS).

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.

South Asian women with diabetes: Psychosocial challenges and management: Consensus statement.

Diabetes is the ninth leading cause of death in women globally. In South Asians mortality in women with diabetes stands second highest. There is a marked gender discrimination which is faced by women across South Asia esp in access to services and support for diabetes, resulting in high rates of morbidity and mortality in women with diabetes. The most important risk factor identified for the diabetes epidemic is obesity along with genetic susceptibility. Lack of health care, social and cultural disparity, discrimination at work, disparity in marriage, restricted medical facilities are prevalent. Diabetes and depression are common in women. Increasing age, low level of education, low socioeconomic conditions, difficulties posed in finding partners, frequent divorce and family history of psychiatric illness are significant risk factors for diabetes and depression. Such patients usually have poor metabolic control, higher complication rates, increased healthcare costs, lost productivity, lower quality of life as well as increased risk of death. Preconception counseling should be incorporated in the routine diabetes clinic visit for all women of childbearing potential. Women with diabetes should have information and access to contraception. Proper family planning counseling and psychological support can help stop practices such as female foeticide and multiple pregnancies. Psychological support to patients and their families are needed to break the barrier. There is emerging evidence that women with diabetes are more prone to untoward outcomes as compared to men. Central obesity, metabolic syndrome and the polycystic ovary syndrome show ethnic specific differences in South Asian women. Optimal sexuality is an integral part of holistic health. Shortage of trained female health care professionals, lack of privacy in over-crowded health care facilities, a social taboo attached to such matters, and lack of confidence in patients contribute to the neglect of sexual issues in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended.

Prevalence of type 2 diabetes and impaired glucose regulation with associated cardiometabolic risk factors and depression in an urbanizing rural community in bangladesh: a population-based cross-sectional study.

BACKGROUND: To determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression. METHODS: A total of 2,293 subjects aged ≥20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed. RESULTS: The prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and ß-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male. CONCLUSION: Rising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population.

Social and economic consequences of diabetes in women from low-income countries: a case study from Bangladesh.

Diabetes poses a serious threat to low-income countries such as Bangladesh. It is one of the leading causes of premature morbidity and mortality, and requires life-long healthcare services. Women with diabetes are affected in all stages of their lives. Uniquely, diabetes affects the health of mothers and their unborn children. Poverty, ignorance, and gender discrimination adversely affect women with diabetes. However, the Diabetic Association of Bangladesh has played an increasingly effective role in providing comprehensive socio-medicare and life-long follow-up of diabetic women, free of charge. This is reflected by the increasing attendance of women with diabetes, especially from rural areas.

Type 2 diabetes and impaired fasting blood glucose in rural Bangladesh: a population-based study.

BACKGROUND: Diabetes is a fast expanding global health problem but more so in the developing countries. Therefore, it is of particular interest to study the epidemiological transition of the state and to identify the risk factors in order to recognize the extent of the problem. METHODS: A random sample of 5000 rural individuals (age >/=20 years) were included in a cross-sectional study. Fasting capillary blood glucose levels were measured from 4757 individuals. Height, weight, waist, hips including blood pressure and demographic information was collected. RESULTS: The study population was lean [mean body mass index (BMI) 19.4] with a low prevalence of type 2 diabetes but relatively high impaired fasting glucose. No relationship between type 2 diabetes and BMI in men, but an overall relationship was observed for women (P = 0.04) (data not shown). Age, sex, and waist/hip ratio appeared to be important risk factors for the occurrence of type 2 diabetes in this population. CONCLUSIONS: Low prevalence of type 2 diabetes and relative high impaired fasting blood glucose was observed. The factors associated with the occurrence of diabetes in this population appeared to differ than its known relations with BMI. This may indicate that the risk factors for type 2 diabetes are likely to differ in different population. Our results are likely to be in line with the Indian data suggesting that a revised guideline for anthropometric measures in the South Asian population is called for, in order to classify people at risk.

Sulphonylureas in the management of type 2 diabetes during the fasting month of Ramadan.

Although a majority of Muslim patients with type 2 diabetes fast during the month of Ramadan, there are no accepted guidelines for its management during this period. The few studies on this subject suggest that there are important alterations in energy intake and physical activity, and that most patients change their pattern of drug intake. This is associated with a greater risk of hypoglycaemia and ketoacidosis. The usual pattern of eating during Ramadan, and its influence on the normal diurnal variation of blood sugar with a regular non-fasting diabetic diet, suggests that anti-diabetic agents for use during this period need to be selected according to their pharmacokinetic and tablet formulation characteristics. The sulphonylureas are first line drugs in type 2 diabetes and used by a majority of patients. A comparison of the pharmacokinetics, efficacy, and safety characteristics of these agents suggests that a long-acting once daily formulation of gliclazide such as gliclazide modified release, taken in the evening, may be the sulphonylurea of choice during Ramadan.

Diabetes and impaired fasting glycemia in the tribes of Khagrachari hill tracts of Bangladesh.

OBJECTIVE: To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a tribal population of Bangladesh. RESEARCH DESIGN AND METHODS: A cluster sampling of 1,287 tribal subjects of age > or =20 years was investigated. They live in a hilly area of Khagrachari in the far northeast of Bangladesh. Fasting plasma glucose, blood pressure, height, weight, waist girth, and hip girth were measured. Lipid fractions were also estimated. We used the 1997 American Diabetes Association diagnostic criteria. RESULTS: The crude prevalence of type 2 diabetes was 6.6% and IFG was 8.5%. The age-standardized (20-70 years) prevalence of type 2 diabetes (95% CI) was 6.4% (4.96-7.87) and of IFG was 8.4% (6.48-10.37). Both tribesmen and women had equal risk for diabetes and IFG. Compared with the lower-income group, the participants with higher income had a significantly higher prevalence of type 2 diabetes (18.8 vs. 3.1%, P < 0.001) and IFG (17.2 vs. 4.3%, P < 0.001). Using logistic regression, we found that increased age, high-income group, and increased central obesity were the important risk factors of diabetes. CONCLUSIONS: The prevalence of diabetes in the tribal population was higher than that of the nontribal population of Bangladesh. Older age, higher central obesity, and higher income were proven significant risk factors of diabetes. High prevalence of diabetes among these tribes indicates that the prevalence of diabetes and its complications will continue to increase. Evidently, health professionals and planners should initiate diabetes care in these tribal communities.

Diabetes and impaired fasting glycemia in a rural population of Bangladesh.

OBJECTIVE: To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a rural population of Bangladesh. RESEARCH DESIGN AND METHODS: A cluster sampling of 4,923 subjects >/=20 years old in a rural community were investigated. Fasting plasma glucose, blood pressure, height, weight, and girth of waist and hip were measured. BMI and waist-to-hip ratio (WHR) were calculated. Total cholesterol, triglycerides, and HDL cholesterol were also estimated. We used the 1997 American Diabetes Association diagnostic criteria. RESULTS: The crude prevalence of type 2 diabetes was 4.3% and IFG was 12.4%. The age-standardized prevalence of type 2 diabetes (95% CI) was 3.8% (3.12-4.49) and IFG was 13.0% (11.76-14.16). The subjects with higher family income had significantly higher prevalence of type 2 diabetes (5.9 vs. 3.5%, P < 0.001) and IFG (15.6 vs. 10.8%, P < 0.001) than those with lower income. Employing logistic regression in different models, we found that wealthy class, family history of diabetes, reduced physical exercise, and increased age, BMI, and WHR were the important predictors of diabetes. Total cholesterol, triglycerides, and HDL cholesterol showed no association with diabetes and IFG. CONCLUSIONS: The prevalence of diabetes and IFG in the rural population was found to be on the increase compared with the previous reports of Bangladesh and other Asian studies. Older age, higher obesity, higher income, family history of diabetes, and reduced physical activity were proved significant risk factors for diabetes and IFG, whereas plasma lipids showed no association with diabetes and IFG. Further study may address whether diabetes is causally associated with insulin deficiency or insulin resistance.