Impaired fasting glucose and impaired glucose tolerance in rural population of Bangladesh.

The prevalence of type 2 diabetes is rapidly rising all over the world at an alarming rate. Over the past 30 years, the increase in prevalence is rising exponentially in South Asian region, data suggest a three fold increase (from 2.0 to 7.0%) in the urbanizing population of Bangladesh within 5 years. However, the prevalence of various degrees of glucose intolerance, i.e., type 2 diabetes, impaired glucose tolerance and impaired fasting glucose considered vital for prevention are still unknown in this population. The objective of the study was to estimate the prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) with their demographic and anthropometric characteristics in a reasonable large sample compare to other studies conducted in Bangladesh. A random sample of 5000 rural population aged > or =20 years was included in this cross sectional study. Fasting blood glucose (FBG) level was measured from 3981 individuals and 2-hr blood glucose (BG) was done on 3954 subjects, excluding known diabetic cases (n= 27). Height, weight, waist and hip circumference including blood pressure and demographic information was also collected. The prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly detected type 2 diabetes (T2DM) were 1.3%, 2.0% and 7.0% respectively. IFG, IGT, IFG+IGT were more prevalent in females than males. Age, body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR) were higher in glucose-intolerant subjects than in normal glucose tolerant (NGT) group. FBG and 2-hr BG values were correlated in NGT and DM subjects. Our data suggest that estimation of FBG value identifies more people with diabetes compared to 2-hr BG estimation. These findings need to be further examined in other settings with urban and rural populations for the justification of FBG for screening of diabetes in Bangladeshi population for development of intervention strategy for the prevention and management of abnormal glucose tolerance. The significance of IFG as a precursor of diabetes and CVD will become evident only from longitudinal studies in different ethnic groups.

Glucose tolerance in a rural population of Bangladesh.

CONTEXT: The prevalence of type 2 diabetes is increasing in the Bangladeshi population. However, there is little information available on the prevalence of glucose intolerance, ie, type 2 diabetes, impaired glucose tolerance, and impaired fasting glucose. AIMS: The main aim of this study is to determine the prevalence of different categories of glucose intolerance and their relationship with different anthropometric and demographic characteristics. SETTINGS AND DESIGN: This cross-sectional study was performed in a rural area of Bangladesh. MATERIALS AND METHODS: A random sample of 5000 persons aged >/= 20 years was included in this study. Fasting blood glucose was measured in 3981 individuals and 2-h post-glucose blood glucose was measured in 3954 subjects after the known cases of diabetes (n = 27) were excluded. Height, weight, waist and hip circumference, and blood pressure were measured. STATISTICAL ANALYSIS: Pearson Chi-squared test and correlation test were used for analysis as appropriate. RESULTS: The prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were 1.3, 2.0, and 7.0%, respectively. IFG, IGT, and IFG + IGT were more prevalent in females. Age showed a significant positive relationship with increasing levels of glucose intolerance. Body mass index, waist circumference, and waist-to-hip ratio were higher in the glucose-intolerant group than in the normal glucose tolerance (NGT) group. There was a positive correlation between FBG and 2-h BG in NGT and DM subjects. CONCLUSION: The FBG value identified more people with glucose intolerance than the 2-h BG. These findings will help developing diabetes preventive strategy in rural populations.

Prevalence of depression and diabetes: a population-based study from rural Bangladesh.

AIMS: To determine the extent of depressive symptoms in a rural community of Bangladesh and its association with newly recognized diabetes. METHODS: Depressive symptoms were assessed in 184 newly diagnosed diabetic subjects and 768 randomly selected individuals without diabetes. The Montogomery and Aasberg Depression Rating Scale (MADRS) was used to assess depressive symptoms. A structured interview was performed to obtain socio-demographic and economic information and anthropometric measures were collected. Fasting plasma glucose was measured by the HemoCue glucose analyser. RESULTS: Twenty-nine percent of male and 30.5% of female participants with diabetes and 6.0% of male and 14.6% of female subjects without diabetes had depressive symptoms rating > or = 20 on the MADRS. An association between depressive symptoms and diabetes was found (P < 0.01). After controlling for potential confounding factors including age, gender, fasting plasma glucose > 7.0 mmol/l and waist-hip ratio, the association of depression with diabetes remained significant. CONCLUSIONS: An unexpectedly high level of unrecognized depressive symptoms was found in the general rural population of Bangladesh. These are among the first data to suggest that depressive symptoms in this culture are common, especially in women. Depression is particularly common in those with diabetes. Psychiatric intervention may be necessary in addition to lifestyle changes to prevent the exponential increase in the occurrence of Type 2 diabetes. In addition, a common approach including psychiatric treatment in diabetes care may be necessary to achieve improved glycaemic control in this population.

Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh.

AIMS: To describe differences in prevalence of Type 2 diabetes mellitus with its associated risk factors between rural and urban populations in Bangladesh. Diagnostic criteria [fasting blood glucose (FBG) and oral glucose tolerance tests (OGTT)] were compared and reviewed for both populations. METHODS: A total of 1555 subjects from urban and 4757 from rural communities (age > or = 20 years) with similar cultural and ethnic backgrounds were randomly selected in a cross-sectional survey. FBG values were determined from all and 2-h post-glucose capillary blood samples were determined after a 75-g oral glucose load for a selected number (urban 476, rural 1046). RESULTS: A higher prevalence of diabetes was found in urban (8.1%) compared with rural populations (2.3%). Age, sex and waist-to-hip ratio for men were significant risk factors for both urban and rural subjects following fasting and 2-h post-glucose values adjusted for a number of confounding variables. Poor agreement was observed between FBG and OGTT for both urban (kappa 0.41) and rural (kappa 0.40) areas. CONCLUSIONS: A higher prevalence of diabetes mellitus (DM) in the urban population was observed compared with rural subjects despite similar body mass indexes (BMI). Differences in obesity, waist/hip ratio or hypertension failed to explain the increasing occurrence of T2DM in the urban population.

Dietary calcium intake in premenopausal Bangladeshi women: do socio-economic or physiological factors play a role?

OBJECTIVE: Evaluation of data on dietary calcium intake in premenopausal women of two socio-economic groups in Bangladesh. DESIGN: A cross sectional study. Three days dietary records were used to estimate habitual calcium intake. SETTING: Two regions of Bangladesh. The Dhaka city area and the Betagair Union in the sub-district Nandail, Mymensingh. SUBJECTS: A total of 191 subjects of two groups (low socio-economic group=group L, n=101 and high socio-economic group=group H, n=90) of Bangladeshi women aged 16-40 y. About 87% of the subjects were housewives and the rest 13% were distributed in other different professions. Each group consisted of three sub-groups (non-pregnant non-lactating=1, pregnant=2 and lactating=3). RESULTS: : The influence of socio-economic status on dietary intake of calcium (P<0.001) was observed in this study. The dietary intake of calcium was influenced by physiological status (PS) in high income group only (P<0.005). The mean dietary calcium intake was significantly higher (P&<0.005) in all sub-groups of this group compared with the corresponding sub-groups in low income group. Although in group H, 47% of subjects failed to meet even the lowest level (400-500 mg/day) of WHO recommended dietary allowances (RDA) of calcium for adult women. No subject in group L was found to meet the RDA level. Moreover, 63% of the women in group L had calcium intake lower than 200 mg/day. These figure could be more critical in both groups if we consider the recent USA-RDAs of calcium for adult women (1000 mg/day). The observed sources of dietary calcium were different in the two groups. CONCLUSIONS: The results of the study suggested that low calcium intake could reduce the bone accretion rates and increase the risk of osteoporosis in the subjects of the present study. Calcium rich food may be recommended for women in both groups.