ABSTRACT
BACKGROUND: Type 2 diabetes and pre-diabetes are an increasing pandemic globally and often remain undiagnosed long after onset in low-income settings. The objective of this study is to assess the determinants and prevalence of undiagnosed diabetes and pre-diabetes among adults in Bangladesh. METHODS: In an exploratory study, we performed oral glucose tolerance test on 1243 adults ≥20 years of age from urban Mirpur, Dhaka (n = 518) and rural Matlab, Chandpur (n = 725) who had never been diagnosed with diabetes or pre-diabetes. We collected data on socioeconomic, demographic, past medical history, physical activity, and measured weight, height, waist and hip circumferences, and blood pressure. Risk factors associated with undiagnosed diabetes and pre-diabetes were examined using a multiple logistic regression model. RESULTS: Overall prevalence of diabetes and pre-diabetes was 6.6 % (95 % CI 5.3, 8.1) and 16.6 % (14.5, 18.7) respectively, with both being significantly higher in urban than rural populations (diabetes 12.2 % vs 2.6 % respectively, p < 0.000; pre-diabetes 21.2 % vs 13.2 %, p < 0.001). After adjustment the variables, urban residence (OR 2.5 [95 % CI 1.02, 5.9]), age group 40-59 y (2.9 [1.7-5.2]), ≥60 y (8.1 [2.8-23.8]), overweight (2.2 [1.3-3.9]), abdominal obesity (3.3 [1.8-6.0]) and high WHR 5.6 (2.7-11.9) were all significant predictors of diabetes. Significant predictors of pre-diabetes included age group 40-59 (1.6 [1.1-2.2]), female sex (1.5 [1.0-2.2]), abdominal obesity (1.7 [1.2-2.4]) and high WHR (1.6 [1.2-2.3]). CONCLUSION: Both overweight and abdominal obesity contribute to the hidden public health threat of undiagnosed diabetes and pre-diabetes. Awareness raising and screening of high risk groups combined with a tailored approach are essential for halting the epidemic of diabetes and pre-diabetes in Bangladesh.
ABSTRACT
OBJECTIVE: This paper reviews existing NCD programs in Bangladesh and identifies key priorities for the country to help address the NCD burden. METHODS: To identify existing chronic disease programs in Bangladesh, country experts were interviewed and literature searches were conducted in PubMed and Ovid Medline (January 1970 to June 2009) for potentially relevant studies focused on tobacco-related illnesses, diabetes or cardiovascular disease. Programs not being implemented at the time of the study were excluded. Programs underway at the time of the study were included. RESULTS: Bangladesh has a total of 11 NCD programs at varying levels of development. Roughly half of the programs involved diabetes; three addressed the reduction of primary risk factors and about half provided infrastructure (e.g., hospitals or clinics) for NCD services or health professional training. The programs were roughly divided between the government and nongovernment organizations (NGOs). CONCLUSIONS: The Bangladeshi government and non-government organizations have taken several steps to implement appropriate NCD programs, but there are many areas where efforts could be enhanced or strengthened. Key among them is improved monitoring and evaluation of NCD programs and the development of nationally representative NCD surveillance data which includes prevalence and associated risk factors.
