Shahjada Selim

Frequency and pattern of chronic complications of diabetes and their association with glycemic control among adults with type 2 diabetes in Bangladesh

BACKGROUND The study was conducted in diabetes care centers to explore association of chronic complications of diabetes with glycemic status along with their frequency and pattern among adult patients with type 2 diabetes. METHODS A cross-sectional study was conducted at outpatient departments of eight diabetes care centers in Dhaka. Data were collected by face to face interview by trained research physicians. Disease related information was recorded in the checklist from diabetes guide books of the patients. Chronic complications of diabetes were recorded from the records of expert consultation. RESULTS Records of 5215 patients with type diabetes (59.4% males) were analyzed. Mean age of the male and female subjects was 52.7 and 50.6 years, respectively. Hypertriglyceridemia [OR 1.74, 95% CI (1.18-2.57)], increased LDL [OR 1.27, 95% CI (0.78-2.07)] and decreased HDL [OR 0.81, 95% CI (0.43-1.53)] and diabetic foot ulcers [OR 2.32, 95% CI (1.14-4.01)] were significantly associated with poor glycemic control, whereas hypertriglyceridemia [OR 2.39, 95% CI (1.42-4.03)] diabetic foot ulcer [OR 2.32, 95% CI (1.14-4.01)], hypetension [OR 1.65, 95% CI (1.15-2.43)] and coronary artery diasease [OR 1.23, 95% CI (0.77-2.13) were significantly associated with poor glycemic control according to FPG. CONCLUSION The study finds association of chronic complications of diabetes with glycemic control among type 2 diabetes patients in Bangladesh.

A Novel Mutation in FGF23 Causing Severe Manifestation of Hyperphosphataemic Familial Tumoral Calcinosis

We present a 16-year girl, second issue of a consanguineous couple presented with painless symmetrical bony swellings around hips for 3 years. She lost 25 kg weight due to profound anorexia in the first year of illness and developed secondary amenorrhea. Last 7 months she had repeated generalized tonic clonic seizure due to hypocalcaemia. The bony swellings were located in both gluteal regions and were 30x35 cm2, hard and non tender. Mobility of hip joints were restricted. Except for severe wasting as a part of generalized cachexia other systemic examination was unremarkable. Investigations revealed anaemia (Hb-E trait), low albumin, low corrected calcium (during convulsions) otherwise normal, persistently high phosphate & vitamin-D level, normal iPTH & alkaline phosphatase (ALP), low serum ascorbic acid, normal ESR & CRP. X-ray & CT scan of pelvis showed large calcified mass in periarticular soft tissues. Biopsy confirmed presence of dystrophic calcification. Diagnosis of tumoral calcinosis was based on biochemical parameters, imaging and biopsy findings. A homozygous novel mutation in FGF homology domain: B-21 mutated from G to A at 232 in exon 2. As a result glutamic acid is replaced by lysine. Phosphate restricted diet and phosphate lowering agent improved biochemical paramaters. Surgical excision has been withheld. Contemporary manifestation of hFTC and Hb E trait; two disease of autosomal recessive inheritance in an individual makes it extremely rare. High index of suspicion is needed for early diagnosis and treatment.

Risk of depression among Bangladeshi type 2 diabetic patients

OBJECTIVE The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes in Bangladeshi population. METHODS The study was conducted at the medicine department of Bangabandhu Shiekh Mujib Medical University (BSMMU) during May 2012 to May 2013. Equal number of type 2 diabetes mellitus (T2DM) patients and non-diabetic subjects (patient attendants) were recruited from outpatient department matching for age (±2 years) and gender. Demographic and anthropometric data were collected from all the subjects. Depression was assessed using, Hospital Anxiety and Depression Scale (HADS) questionnaire. A subject with a score above 8 was considered as depressive. Baseline characteristics of diabetic and non-diabetic participants were compared using chi square test. Multivariable logistic regression was performed to assess the association between diabetes and depression adjusting for all plausible confounders in the model. RESULTS 24.8% non-diabetic and 56.2% diabetic subjects were found to have depression. Statistically significant difference was found in income, waist-to-hip ratio between diabetic and non-diabetic subjects (P<0.001). Diabetic patients show 7-fold greater odds of having depression in comparison to their non-diabetic counterpart [OR 7.0, 95% CI (3.4, 14.3)]. Female gender appeared as significant predictor of depression [OR 4.3, 95% CI (2.1, 8.9)]. CONCLUSIONS In Bangladeshi population, people with diabetes are 7 times more likely to have co-existing depression in comparison to non-diabetic subjects. Further studies are required to establish the nature of the relationship between depression and T2DM.

Frequency and pattern of chronic complications of diabetes and their association with glycemic control

BACKGROUND The study was conducted in diabetes care centers to explore association of chronic complications of diabetes with glycemic status along with their frequency and pattern among adult patients with type 2 diabetes. METHODS A cross-sectional study was conducted at outpatient departments of eight diabetes care centers in Dhaka. Data were collected by face to face interview by trained research physicians. Disease related information was recorded in the checklist from diabetes guide books of the patients. Chronic complications of diabetes were recorded from the records of expert consultation. RESULTS Records of 5215 patients with type diabetes (59.4% males) were analyzed. Mean age of the male and female subjects was 52.7 and 50.6 years, respectively. Hypertriglyceridemia [OR 1.74, 95% CI (1.18-2.57)], increased LDL [OR 1.27, 95% CI (0.78-2.07)] and decreased HDL [OR 0.81, 95% CI (0.43-1.53)] and diabetic foot ulcers [OR 2.32, 95% CI (1.14-4.01)] were significantly associated with poor glycemic control, whereas hypertriglyceridemia [OR 2.39, 95% CI (1.42-4.03)] diabetic foot ulcer [OR 2.32, 95% CI (1.14-4.01)], hypetension [OR 1.65, 95% CI (1.15-2.43)] and coronary artery diasease [OR 1.23, 95% CI (0.77-2.13) were significantly associated with poor glycemic control according to FPG. CONCLUSION The study finds association of chronic complications of diabetes with glycemic control among type 2 diabetes patients in Bangladesh.

Stepped-wedge cluster-randomised controlled trial to assess the cardiovascular health effects of a managed aquifer recharge initiative to reduce drinking water salinity in southwest coastal Bangladesh: study design and rationale

Introduction Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh. Methods and analysis The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants’ source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants. Ethics and dissemination The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals. Trial registration number NCT02746003; Pre-results.