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.

Orlistat as an adjunct therapy in type 2 obese diabetic patients treated with sulphonylurea: a Bangladesh experience.

Co-existence of obesity and type 2 DM exacerbates metabolic and other remediable health consequences further. Various pharmacological therapies have been adopted when changing of lifestyle fail to achieve target glycaemic control. Our objective is to find out whether Orlistat can reduce both weight and need for oral hypoglycaemic agent (OHA) and improves glycaemic status,lipid disorders, blood pressure in Bangladesh type 2 DM with obesity. In this center, open-label, randomized, controlled pilot trial 36 type 2 patients with obesity were enrolled. All patients aged 40-65 years had BMI >25 kg/m2 taking sulfonylureas and hypocalorie diet. Twenty one randomly cases were treated with orlistat 120 mg three times daily for 6 months and 15 without orlistat as control. Body weight, waist circumferances, fasting blood sugar, HbAlc,serum lipids, blood pressure and dose of drugs were monitored at 0,12, 24 weeks. After 6 months, orlistat group showed non-significant weight loss than control group (3.95% vs 1.42% from base lines), but showed significant reduction of waist circumference (6 % vs 0.63 %, p<0.01 vs p>0.05 from base line). Orlistat group had significant improvement in glycaemic status (HbA1c changes: 22.37% vs 13.38%, p<0.001 vs p>0.05 and FBS changes: 21.76% vs 22.95%, p<0.01vs p<0.05). Lipid profile had reduced significantly from base lines (Chol: 19.31% vs 9.12%,p<0.001vs >0.05; LDL Chol: 24.99% vs 19.09%, p<0.001 vs p<0.01; Triglyceride: 34.48% vs 12.61%, p<0.001 vs p>0.05). Diastolic pressure had improved significantly in orlistat group (6.73% vs 3.70%, p<0.01 vs >0.05). Reduction of OHA doses were found in both groups. Thus orlistat can be used as an adjuvant therapy with other OHA in managing glycaemic control, lipid profiles and blood pressure.

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.

Hypertension in the rural population of Bangladesh--a preliminary survey.

A total of 5,026 persons constituting 75% of the total population of a village of Bangladesh were screened for elevated blood pressure. Three hundred thirty seven (6.7%) showed diastolic blood pressure of 90 mm Hg or above. Those with diastolic blood pressure of 95 or above constituted 2% of the population. 74% of the hypertensives were asymptomatic while 86.3% of the cases were undetected and therefore remained untreated. Our findings indicate the need for early detection and control of elevated blood pressure to prevent complications. It is recommended that a large scale community survey programme may be undertaken for detection and early treatment of hypertension which helps prevention of total complications.