M Abu Sayeed

Effect of Socioeconomic Risk Factors on the Difference in Prevalence of Diabetes Between Rural and Urban Populations in Bangladesh

OBJECTIVE To compare the prevalence of diabetes between the poor and rich of rural and urban populations in Bangladesh. RESEARCH DESIGN AND METHODS A total of 1,052 subjects from urban and 1,319 from rural communities (age ≥ 20 years) of different socioeconomic classes were investigated. Capillary blood glucose levels, fasting and 2 h after a 75-g glucose drink (2-h blood glucose [BG]), were measured. Height, weight, waist, hips, and blood pressure were also measured. RESULTS Age-adjusted (30–64 years) prevalence of NIDDM was higher in urban (7.97% with 95% CI 6.17–9.77) than in rural subjects (3.84%, CI 2.61–5.07), whereas impaired glucose tolerance (IGT) prevalence was higher in rural subjects. In either urban or rural areas, the highest prevalence of NIDDM was observed among the rich, and the lowest prevalence was observed among the poor socioeconomic classes. The rural rich had much higher prevalence of IGT than their urban counterpart (16.5 vs. 4.4%, CI 6.8–17.4). Increased age was an important risk factor for IGT and NIDDM in both rural and urban subjects, whereas the risk related to higher BMI and waist-to-hip ratio (WHR) was less significant in rural than urban subjects. Using logistic regression and adjusting for age, sex, and social class, the urban subjects had no excess risk for NIDDM. In contrast, an excess risk for glucose intolerance (2-h BG ≥ 7.8 mmol/l) was observed in the rural subjects. CONCLUSIONS Adjusting for age, sex, and social class, the prevalence of NIDDM among urban subjects did not differ significantly from that among rural subjects. Increased age, higher socioeconomic class, and higher WHR were proven to be independent risk factors for glucose intolerance in either area.

Prevalence of diabetes in a suburban population of Bangladesh

To determine the prevalence of diabetes and hypertension, 6847 subjects of age 15 years or older, were investigated in a suburban population in Bangladesh. Fasting and post-prandial (capillary) blood glucose (2-hPG) was estimated. According to WHO criteria the crude prevalence of impaired glucose tolerance (IGT) was 7.5% and non-insulin-dependent diabetes mellitus (NIDDM) was 4.1%. The age standardized (30-64 years) prevalence of IGT was 7.7% with 95% confidence interval (CI) 6.96-8.44 and NIDDM was 4.5%, CI 3.94-5.12. Compared with the younger subjects the older subjects (< 40 vs. > or = 40 years) showed significant association with IGT (chi2, 65.9; P < 0.001) and NIDDM (chi2, 92.0; P < 0.001). Higher BMI (< or = 22.0 vs. > 22.1) was also significantly associated with IGT (chi2, 16.6; P < 0.001) and NIDDM (chi2, 83.9; P < 0.001). The higher BMI had stronger association with NIDDM than with IGT. Lower height showed significant association only with NIDDM. The logistic regression analyses also showed that increased age, higher BMI and short stature were independent risks for NIDDM. The study showed an increased prevalence of IGT and NIDDM among the suburban population of Bangladesh and the excess risk was observed with increased age, higher BMI and short stature.

Prevalence of diabetes and hypertension in a rural population of Bangladesh.

OBJECTIVE To determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and hypertension in a rural community of Bangladesh. RESEARCH DESIGN AND METHODS A cluster sampling of 1,005 subjects > 15 years of age in the rural community of Dohar was investigated. Capillary blood glucose of fasting and 2 h after 75 g oral glucose (2hBG) were estimated. World Health Organization criteria were used for diagnosis of NIDDM and IGT. Blood pressure, height, and weight were also measured. RESULTS The crude prevalence of NIDDM was 2.1% (men 3.1, women 1.3%) and IGT was 13.3% (men 14.4, women 12.4%). Age-adjusted (30–64 years of age) prevalence was 2.23% (95% confidence interval [CI] 1.01–3.45) for NIDDM and 15.67% (95% CI 12.59–18.75) for IGT. Prevalence of hypertension with systolic blood pressure (sBP) ≥140 mmHg was 10.5% and with diastolic blood pressure (dBP) >90 mmHg was 9.0%. Increased age was the risk factor for NIDDM, IGT, and hypertension; whereas increased BMI showed inconsistent association with them. Relative risk for sBP with higher BMI (<22.0 vs. ≥22.1) was 1.94 with CI 1.55–2.43 and for dBP it was 2.2 with CI 1.40–3.46. Correlation of sBP was significant with age, BMI, and 2hBG. Similar correlation was also observed with dBP. CONCLUSIONS High prevalences of NIDDM, IGT, and hypertension were observed among rural subjects. Increased age was shown to be an important risk factor for all these disorders, whereas BMI-associated risk was significant with NIDDM and hypertension but not with IGT.

Blood pressure and coronary heart disease in NIDDM subjects at diagnosis: prevalence and risks in a Bangladeshi population

Overall obesity and central fat distribution are frequently accompanied by hyperglycemia, hypertension (HTN) and coronary heart disease (CHD) observed in developed nations and in South Asian migrants. This study attempts to estimate the prevalence of CHD and HTN and to assess the related risks among the newly diagnosed diabetics in the developing communities. From a total of 3583 non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) subjects, the authors investigated 693 (M = 295, F = 398) randomly selected non-smokers of age 30-60 years. WHO diagnostic criteria were used for NIDDM and IGT. Systolic and diastolic hypertension (sHTN and dHTN) were defined as systolic blood pressure (SBP) > or = 140 and diastolic (DBP) > or = 90 mmHg. Diagnosis of CHD was based on electrocardiogram either on rest or on stress or both when equivocal. The overall prevalence of CHD in the NIDDM subjects was 18.6%. The prevalence rates of sHTN and dHTN were 23.2 and 13.6%, respectively. CHD and HTN did not differ significantly between male and female and between urban and rural subjects. CHD prevalence was significantly higher in the higher tertiles of age, SBP and DBP (P < 0.001, for all cases). Logistic regression showed that only the increasing age, high waist-to-hip ratio (WHR) and high BP were the independent risks for CHD. For sHTN, the independent risks were increased age and high body mass index (BMI) (kg/m2). Regardless of sex and area, increased prevalence of CHD and HTN were found in the newly diagnosed diabetic subjects. Increased age, central obesity and HTN were the independent risks for CHD while advancing age and overall obesity was related to sHTN.

Diseases of social and mental health: are we concerned?

The rates of social crimes taken as ‘social health indicators’ are commonly used for assessing the magnitude of the diseases of social and mental health (DSMH). The prevalence of social crimes, the indicators of the DSMH, worsened dangerously in recent years. Though both developing and developed countries appear to be affected equally, due to lack of proper documentation, it is difficult to assess the trend of the DSMH in developing countries like Bangladesh. However, the trend of DSMH may be assessed based on some published reports.