Kaniz Fatema

Prevalence of Diabetes Mellitus and its Associated Risk Indicators in a Rural Bangladeshi Population

Background: Substantial racial heterogeneity in diabetes leads to the necessity of conducting epidemiological studies in different communities. Such studies are still inadequate in Bangladeshi population, particularly in truly respective rural areas. The objectives of the study were to estimate the prevalence of diabetes and to identify its associated risk indicators in a rural population of Bangladesh. Methods: This population based cross-sectional study was conducted in remote rural areas of Northern Bangladesh, which included a total of 836 participants aged at or above 25 years through screening in camp settings. Diabetes was diagnosed by WHO criteria after a 2-sample OGTT. BMI, waist-hip ratio, blood pressure, lipid profile and serum creatinine were also estimated. Results: The prevalence of diabetes was found to be 7.2% (95% CI 5.4-9.0) and that of impaired glucose regulation (including both impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)) was 6.5% (95% CI 4.8-8.2). The prevalence of diabetes and impaired glucose regulation differed between males and females, but, both increased with age in males as well as females. A good correlation was observed between fasting blood glucose and 2hr after glucose (Kappa value 0.86) among the study participants. After adjusting for potential confounders BMI and WHR were found as significant independent risk indicators for the occurrence of diabetes in this population.

Prevalence and Associated Risk Indicators of Retinopathy in a Rural Bangladeshi Population with and without Diabetes

Abstract Purpose: To determine the prevalence of retinopathy among people with normal and abnormal glucose metabolism in a remote rural community of Bangladesh, and to identify the associated risk indicators for developing retinopathy in this population. Methods: A population-based cross-sectional study was conducted through screening in camp settings, which included a total of 836 participants (468 male and 368 female) aged 30 years or over. Retinopathy was determined by fundus photography. Anthropometric measures (body mass index and waist-to-hip ratio), oral glucose tolerance, glycosylated hemoglobin (HbA1c), blood pressure, lipid profile, serum creatinine and urine albumin creatinine ratio (UACR) were measured. Logistic regression analysis was used with adjustment for potential confounders. Results: The overall prevalence of retinopathy was 5.4% (95% confidence interval, CI, 3.9–6.9). The prevalence rates of retinopathy among diabetic, impaired glucose regulation and non-diabetic subjects were 21.6%, 13% and 3.5%, respectively. Adjusted odds ratios for retinopathy were 2.53 (95% CI 1.52–5.41) for abnormal glucose metabolism and 1.98 (95% CI 1.17–5.63), 1.74 (95% CI 1.09–3.02) and 1.63 (95% CI 1.08–3.12) for hypertension, HbA1c and UACR, respectively. Additionally, age, body mass index, triglyceride and total cholesterol were also found to be significant independent risk indicators for the occurrence of retinopathy in this population. Conclusion: A high prevalence of retinopathy was observed in this rural Bangladeshi population. In addition to blood glucose control for diabetes, screening for hypertension, obesity, hyperlipidemia and proteinuria as well as adequate treatment of these risk indicators may prevent retinopathy in rural Bangladeshi populations.

Clinical and biochemical characterization of high risk and not high risk for cardiovascular disease adults in a population from peripheral region of Bangladesh

BackgroundA group of 63708 Bangladeshi adults from a rural area were screened in 2011–12 for cardiovascular diseases (CVD) risk using a questionnaire based tool developed as part of the ‘WHO CVD-RISK Management Package for low-and medium resource setting’. In the current study participants who were found to be high risk and a sample of the not high risk participants from the screening were further characterized clinically and biochemically to explore the burden and determinants of CVD risk factors in a remote rural Bangladeshi population.MethodsThe high risk participants comprised all 1170 subjects who screened positive in 2011–12 and the not high risk group comprised 563 randomly sampled participants from the 62538 who screened negative. Socio-demographic, behavioral, anthropometric, clinical and biochemical data (glucose and lipids) were collected by standardized procedures. Body Mass Index (BMI) was classified following Asian BMI criteria. Data was analyzed using univariable and multivariable methods.ResultsOn univariable analysis in high risk and not high risk participants respectively, age in years (Mu2009±u2009SD) was 50u2009±u200911 for both groups, ratio of male: female was 40:60 and 66:44, current smoking 28.5xa0% and 50.6xa0%; smokeless tobacco use 37.1xa0% and 34.8xa0%; overweight and obesity measured by body mass index (BMI) was 39.1xa0% and 20.5xa0%; high waist circumference (WC) 36.1xa0% and 11.9xa0%; high waist to hip ratio (WHR) 53.8xa0% and 26.3xa0%; and with high waist to height ratio (WHtR) 56.4xa0% and 28.4xa0%, existence of hypertension (HTN) was 15.8xa0% and 3.6xa0%, pre-HTN 43.8xa0% and 12.1xa0%, diabetes (DM) 14.0xa0% and 10.5xa0%, pre-DM 16.9xa0% and 12.1xa0% and dyslipidaemia 85.8xa0% and 89.5xa0%. In multivariable logistic regression analysis female sex, BMI, WC, WHR and WHtR, HTN and dyslipidaemia remain significantly more common among high risk participants (pu2009<u20090.05 and pu2009<u20090.001).ConclusionsThe prevalence of clinical and biochemical risk factors of CVDs are quite high even in this rural population and this may be related to the socioeconomic and cultural transition in Bangladeshi society. Surprisingly more of the high risk group was female and there were fewer smokers. Obesity and hypertension were more frequent in high risk participants.

Serum glucose and insulin response to mango and papaya in type 2 diabetic subjects

Abstract To rank Bangladeshi Mango and Papaya in terms of their Glycemic Index (GI) and Insulinemic Index (II), which are useful measures of glucose and insulin responses to a dietary component, thirteen type 2 diabetic subjects consumed, under a cross-over design, equi-carbohydrate amounts of mango (250 g), papaya (602 g) and white bread (the reference food, 63 g). Blood sample was drawn 5 times between 0h and 3h. Serum C-peptide was measured to evaluate Insulinemic status. Mango and Papaya showed higher serum glucose responses compared to that of bread. The similar glycemic responses of Papaya and Mango were reflected in their GI values. Papaya showed higher insulin response compared to both Mango and Bread ( p

Determinants of overweight and obesity among Bangladeshi diabetic women of reproductive age

BackgroundSeveral reproductive disorders with overweight and obesity are now known to be associated with insulin resistance. The study was aimed to assess the proportion and determinants of overweight and obesity among diabetic women of reproductive age.MethodsThis cross-sectional analytic study was conducted among 888 diabetic women of reproductive age attending the out-patient department (OPD) of the central hospital of the Diabetic Association. Body Mass Index (BMI) was used to assess the general obesity. Waist Circumference (WC), Waist-Hip Ratio (WHR) and Waist-Height Ratio (WHtR) were used to assess central obesity.ResultsThe overall prevalence of overweight was 22% (95% CI 19-24) and that of obesity was 48% (95% CI 45-51). Prevalence of central obesity by waist circumference was 77%, by waist-hip ratio was 99.9% and by waist-height ratio was 89%. Overweight and obesity were higher in the age group of 45-49 years (49%) and 35-44 years (24%) respectively. On Pearson’s correlation analysis, BMI and WC were significantly correlated with age (r =u20090.135, p =u20090.001; r =u20090.162, p =u20090.001) and income (r =u20090.151, p =u20090.001; r =u20090.087, p =u20090.009) respectively. WHR was also correlated with income (r =u20090.094, p =u20090.005). Moreover, WHtR was significantly correlated with age (r =u2009 0.139, p =u20090.001), income (r = 0.069, p = 0.04) and duration of diabetes (r = 0.073, p = 0.03).On binary logistic regression analysis, BMI was significantly associated with age, income and management of diabetes by Oral Hypoglycemic Agent (OHA) (p <u20090.05). WC was significantly associated with age, income and management of diabetes by OHA and insulin (p <u20090.05). Where, WHR was significantly associated only with duration of diabetes (p <u20090.05). WHtR was significantly associated with age (p <u20090.05), management of diabetes by OHA (p <u20090.05) and insulin (p <u20090.05) in this analysis.ConclusionsA high prevalence of both overweight and obesity exists in diabetic women of reproductive age in Bangladesh and it seems to be associated with increasing age, income, duration of diabetes, and use of oral hypoglycemic agents.

Knowledge attitude and practice regarding diabetes mellitus among Nondiabetic and diabetic study participants in Bangladesh

BackgroundIncreased awareness amongst large population groups is a major determinant for the prevention of diabetes and its complications as well as related metabolic disorders. Knowledge and attitude are the principal markers of awareness that need to be studied in various population groups in specific racial and cultural contexts. The present study was undertaken to explore knowledge, attitude and practice (KAP) regarding -diabetes mellitus (DM) among nondiabetic (nonDM) and type 2 diabetes mellitus (T2DM) patients in Bangladesh.MethodsA cross-sectional study was conducted among 18,697 adults (aged 18xa0years and above; 7796 male and 10,901 female; 6780 nonDM and 11,917 T2DM) selected purposively from the OPD of 19 healthcare centres in and around Dhaka and in northern parts of Bangladesh. KAP were assessed by a pre-structured, interviewer-administered questionnaire and categorised using predefined scores of poor (meanxa0+xa01 SD). Univariate and bivariate statistical analysis were done as appropriate. Multivariate linear regression was done to examine the association between diabetes related KAP and other covariates.ResultsThe mean (±SD) age (years) of all the study participants was 46xa0±xa014, mean BMI 24.4xa0±xa04.1 and mean waist-hip ratio (WHR) was 0.93xa0±xa00.07. The proportion of poor, average and good knowledge scores among T2DM subjects were 17%, 68% and 15% respectively. The corresponding values for attitude score were 23%, 67% and 10% respectively. The KAP regarding diabetes was found to be better among people who were living with diabetes compared to their counterparts. DM males showed better knowledge and practice regarding diabetes, compared to nonDM counterparts (Mxa0±xa0SD; 44.18xa0±xa016.13 vs 40.88xa0±xa015.62, pxa0=xa0<0.001; 66.00xa0±xa029.68 vs 64.21xa0±xa031.79, pxa0<xa00.001, respectively). Females showed better attitude score compared to males. Overall KAP were found to be significantly higher (pxa0<xa00.001) in middle aged (31–50xa0years) participants in each group. Participants from urban residents, higher educational background and upper socio-economic class demonstrated significantly greater score in terms of KAP in both nonDM and T2DM groups (pxa0<xa00.001). On linear regression analysis, knowledge scores correlated strongly with education, income, residence, diabetic state, BMI and attitude.ConclusionsThe overall level of knowledge and practice concerning diabetes among Bangladeshi population is average, but the overall level of attitude is good both in nonDM and T2DM subjects. To prevent diabetes and its complications there is an urgent need for coordinated educational campaigns with a prioritized focus on poorer, rural and less educated groups.

Cardiovascular risk assessment among rural population: findings from a cohort study in a peripheral region of Bangladesh☆

OBJECTIVESnThe incidences of non-communicable diseases including cardiovascular diseases (CVDs) is increasing in Bangladesh. The reasons for this increasing trend need to be explored. The aim of this study is to assess the risk of CVDs among a peripheral rural Bangladeshi population and to explore the sociodemographic, anthropometric and clinical variables associated with increased risk.nnnSTUDY DESIGNnCohort study.nnnMETHODSnFrom a cohort of 190,471 individuals of all ages, originally included in a diabetic eye disease program initiated in 2008-2009, a purposive sub-cohort of 66,710 individuals, aged 31-74 years was recruited. During 2011-2012 these participants were assessed for CVDs using the WHOs risk assessment tool designed for primary care settings in low resource societies. Participant characteristics associated with higher risk were explored using univariable and multivariable regression analysis.nnnRESULTSnOut of all (95.5% participation rate) participants 1170 (1.84%) were found to be at high risk for CVD. The prevalence of hypertension (HTN), pre-HTN, obesity, underweight and self-reported DM were 8.9%, 15.2%, 9.6%, 7.8% and 0.5% respectively, among the study population. In multivariable regression analysis female sex, older age, temporary housing structure (i.e., tin shed), extremes of BMI (both underweight and obese) and central obesity were associated with higher risk for CVDs.nnnCONCLUSIONSnThe prevalence of CVD risk factors and high CVD risk individuals in this cohort was found to be lower than previous studies. It may be the effects of urbanization are yet to reach this relatively traditional rural population. This study adds to the literature on use of the WHO risk assessment tool.

Prevalence of risk factors for cardiovascular diseases in Bangladesh: A systematic review and meta-analysis

Background Given the rising incidence of cardiovascular diseases (CVDs) in Bangladesh, an improved understanding of the epidemiology of CVD risk factors is needed. Therefore, we reviewed published studies on CVD modifiable risk factors e.g., Type 2 Diabetes Mellitus (T2DM), hypertension (HTN), dyslipidemia and smoking as well as studies on CVDs and conducted a meta-analysis of risk factors and disease prevalence. Methods We searched the GLOBAL HEALTH, MEDLINE, EMBASE ‘BanglaJol’ databases for all studies in English on CVDs and its associated modifiable risk factors. Random effects meta-analysis methods were used to estimate pooled prevalence. Results There were 74 eligible studies (outcome: T2DM = 32, HTN = 24, dyslipidaemia = 8 and smoking = 25; CVDs = 10). Due to high between study heterogeneity (p<0.001, I2> 95%) in the prevalence of CVD risk factors, we presented median and interquartile range (IQR) instead of the pooled estimates as the summary measures. Median (IQR) prevalence of T2DM, HTN, dyslipidemia and smoking were 5.9% (1.97%-8.25%); 15.1% (10.52%-17.60%); 34.35% (10.66%-48.50%) and 40.56% (0.80%-55.95%), respectively. The prevalence of T2DM and dyslipidemia were significantly higher in urban compared to rural populations (13.5 vs 6%, p<0.001; 41.5 vs 30%, p = 0.007, respectively). Conclusions The prevalence of risk factors for CVDs is high in Bangladesh, more so in urban areas. Ageing of the population may be a factor but urbanization seems to have an influence, possibly related to changes in dietary and physical activity patterns. Further research, in particular longitudinal studies, is needed to explore the complex interaction of these factors and to inform policies and programs for the prevention and management of CVDs in Bangladesh.

Short-term predictive ability of selected cardiovascular risk prediction models in a rural Bangladeshi population: A case-cohort study

BackgroundPrediction of absolute risk of cardiovascular diseases (CVDs) has important clinical and public health significance, but the predictive ability of the available tools has not yet been tested in the rural Bangladeshi population. The present study was undertaken to test the hypothesis that both laboratory-based (Framingham equation and WHO/ISH laboratory-based charts) and non-laboratory-based tools may be used to predict CVDs on a short-term basis.MethodsData from a case-cohort study (52989 cohort and 439 sub-cohort participants), conducted on a rural Bangladeshi population, were analysed using modified Cox PH model with a maximum follow-up of 2.5xa0years. The outcome variable, coronary heart diseases (CHDs), was assessed in 2014 using electrocardiography, and it was used as a surrogate marker for CVDs in Bangladesh. The predictive power of the models was assessed by calculating C-statistics and generating ROC curves with other measures of diagnostic tests.ResultsAll the models showed high negative prediction values (NPVs, 84xa0% to 92xa0%) and these did not differ between models or gender. The sensitivity of the models substantially changed based on the risk prediction thresholds (between 5–30xa0%); however, the NPVs and PPVs were relatively stable at various threshold levels. Hypertension and dyslipidaemia were significantly associated with CHD outcome in males and ABSI (a body shape index) in females. All models showed similar C-statistics (0.611–0.685, in both genders). Overall, the non-laboratory-based model showed better performance (0.685) in women but equal performance in men.ConclusionsExisting CVD risk prediction tools may identify future CHD cases with fairly good confidence on a short-term basis. The non-laboratory-based tool, using ABSI as a predictor, may provide better predictive accuracy among women.

Prevalence and determinants of metabolic syndrome among newly diagnosed type 2 diabetic subjects according to different criteria.

BACKGROUND AND AIMnMetabolic syndrome (MS) is becoming a serious global public health problem. The prevalence of MS differs in different population by using different definitions. Present study aimed to find out the prevalence and determinants of MS among newly diagnosed type 2 diabetes (NDT2D) according to different criteria.nnnSUBJECTS AND METHODSnThis cross-sectional analytic study was conducted among 281 subjects selected purposively from the OPD of BIRDEM. Information on lifestyle factors and disease history were collected using a semi-structured questionnaire by face to face interview. The three definitions of MS used in this study are from the International Diabetes Federation (IDF), a modified version of the ATP III criteria for Asian populations (modified ATP III) and World Health Organization (WHO) criteria. Adjusted odds ratio and confidence limit were generated through logistic regression.nnnRESULTSnThe overall prevalence of metabolic syndrome among the study subjects according to modified ATPIII, WHO and IDF criteria were 79% (95% CI: 74.2-83.8), 81% (95% CI: 76.4-85.6) and 68% (95% CI: 62.6-73.5) respectively. The prevalence of metabolic syndrome among female were higher compared to males in all the criterias. Female gender (OR=5.93), family history of diabetes (OR=1.92), overweight (OR=6.2), and obesity (OR=5.13) were found as important confounders associated with metabolic syndrome.nnnCONCLUSIONnThe prevalence of the metabolic syndrome among NDT2D is considerably higher in our population which may indicate considerable risk of cardiovascular diseases in future. Female gender, family history of diabetes, overweight and obesity are important confounders of MS in this population.